28 c ) 
AN UNUSUAL CASE OF GOUNDOU 
BV 
Dr. R. W. ORPEN, 
MEDICAL OFFICRR, W.A.M.S.. SIERRA I.KONK 
(Received for publication 17 June, 19087 
WTiilst at Kanre Lahun, on the Liberian frontier, I chanced to 
see a case of Goundou which presented some unusual and interesting 
characters. 
The patient was a Mendi man, about 22 years of age. He stated 
that about five years ago the usual tumours began to grow, their 
appearance being preceded by a severe attack of yaws and constant 
severe headache. He said he had never had syphilis. About a year 
later, a third tumour began to develop on the left side of the face in 
the malar region. This third tumour is slowly increasing in size, 
whilst the others (nasal) have not increased to any appreciable extent 
during the past two years. It is only within the last few months that 
a discharge has been noticed from the right nostril, and no discharge 
has ever been observed from the left. Constant severe headache has 
been present, preventing him from working and causing loss of sleep. 
When he sloops down the pain is greatly increased. 
Ou examination the patient is seen to be of poor physique. 
Face. On each side of the nose, springing from the nasal 
processes of the superior maxillae, a tumour is seen. They are 
symmetrical, sessile, and of bony hardness. Somewhat oval in shape, 
the long axis being downwards and outwards, they are smooth with 
normal skin freely moveable over them. They are dull on 
percussion. There is a foul discharge coming from the right 
nostril. The passage of tears through the nasal ducts is not 
interfered with. The tumours practically fill the nostrils, and the 
patient is unable to breathe through the nose. The sense of smell is 
totally lost ; he is unable to distinguish the odours of tobacco, 
ammonia, and peppermint. 
On the left side of the face a third tumour is seen in the malar 
region close to, but separate from, the previously described ones. In 
size and shape it is about that of half a hen’s egg, but it is not 
entirely smooth and regular, as on its upper and outer aspect a 
protuberance can be felt. The long axis of the tumour is upwards 
and outwards, and the outer canthus of the eye is dragged with it. It 
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