1976 DISEASES OF BONES 



Climatology.- — The disease is most commonly met with in West 

 Africa, but has been reported from East Africa, Malaya, Sumatra, 

 South China, and the West Indies. It usually affects native races, 

 but has been reported in one European. Usually it begins in the first 

 two decades of life. 



etiology. — This is unknown, though the association with yaws 

 gave rise to the suspicion that this was the setiological factor. 

 Cantlie's European, however, had not suffered frcm yaws, and 

 monkeys do not suffer spontaneously from yaws. 



Occasionally in yaws patients a bilateral or unilateral swelling 

 of the nose is present (pseudo-goundou of Brumpt), but it quickly 

 disappears along with the other symptoms of yaws under treatment 

 with potassium iodide or salvarsan, which 

 has no effect on true goundou. 



Other theories have been that it was a 

 racial trait, or that it was due to a larva of 

 a fly, but these are certainly not correct. 

 As far as we know, it is never congenital. 

 Braddon thinks that it is a disease sui 

 generis, and in our opinion is probably 

 right. 



Pathology. — Whatever the cause may be, 

 there seems no reasonable doubt that the 

 infection begins in the nose; for although 

 we were unable to find any abnormality in 

 the nose of the cases we have seen, still, 

 there was always a history of some obstruc- 

 tion, pain in the nose, and often of a 

 bloody discharge. Moreover, Friedrichsen 

 describes a swollen condition of nasal 

 Fig. 791. -Goundou in a ^^ucosa with almost polypoid excrescences. 

 Native of the Gold 1-eger has noted microscopically a pro- 

 CoAST. liferation of embryonal cellular elements 



derived from the bone-marrow infil- 

 trating the bone-tissues. This is followed later by a true process 

 of cicatrization or osteosclerosis. If this is correct, it is quite easy 

 to understand that the vessels passing from the nose through the 

 sutura notha, in the nasal process of the superior maxilla, can carry 

 that infection to the periosteum, which, being irritated, proceeds 

 to an excessive formation of bone in the area of that suture. This 

 results in the formation of a ony swelling, composed on the out- 

 side of a thin shell of compact bone, underneath which is spongy, 

 bonj^ substance continuous with that of the bone from which it 

 is arising. The sutura notha is, of course, found in all human skulls, 

 and is not pecuHar to the negro race. 



The bony growths are attached to the nasal bone, the nasal 

 process of the superior maxilla, and at times to the maxilla itself. 

 The periosteum strips off readily, but usually shows no signs of 

 recent inflammation. 



