412 DISEASES OF UNCERTAIN .ETIOLOGY 



SYMPTOMATOLOGY. 



Gradual onset, pain in the nose, bloody discharge lasting six to 

 eight months. As this disappears a swelling appears and increases 

 in size. 



The vision may be interfered \vith. 

 ' The deformity is sometimes hideous in the extreme. 



There mav be polvpoid-like excrescences protruding from the nasal 

 mucous membrane. 



The growth ma}- stop at any time. 



TREATMENT. 



Surgical removal is easy and effective. 

 Other treatment is symptomatic. 



BIG HEEL. 



This is a condition seen on the Gold Coast and Formosa. 



The aetiology is obscure. 



The attacks come in the wet season with sudden onset and fever. 



There is great tenderness over the os calcis so as to prevent walking 

 or sleeping. 



In three to seven days tlie bone enlarges and increases progressively 

 for two weeks or so, during which time the pain becomes less and the 

 fever disappears. 



After a month the bone ceases to grow and remains like this for 

 one or two months, when the patient is able to M'alk with some degree 

 of comfort. 



The growth then gradually diminishes, but never wholly disappears. 



It usually affects both sides. 



The ankle-joint is never affected, and the tarsal bones but seldom. 



The bone should be trephined or gouged down to afford relief. 



AINHUM ( = to saw or to cut). 

 DEFINITION. 



A chronic dystrophy of the fifth (rarel}- other) toes in native races, 

 characterized by the formation of a furrow at the digito-plantar fold, 

 which extends and deepens until the toe is severed. 



It is seen in man}' parts of the Tropics. 



PATHOLOGY. 



There is irritation of the cutaneous epithelium causing an internal 

 proliferation, extending to the cutis, injuring the vasomotor nerves, 

 causing spasm of the vessels, endarteritis obliterans, fibrosis of the 

 cutis and rarefying osteitis which separates tlie digit. 



