does not invade the orbital cavity. The tumour is of bony hardness, 
is not painful on being handled, is dull on percussion, and the skin 
over it is normal and freely moveable. Pain is frequently felt 
radiating to the tempero-maxillary articulation. There is no sign of 
oedema or ‘ egg-shell ’ crackling. This tumour has developed more 
rapidly than the usual tumours. 
Examination of the mouth shows nothing abnormal, the patient 
possessing a perfect set of teeth with none missing. His palate is 
normal, though somewhat low, and both sides are symmetrical His 
chest is flat; his breasts are unduly developed, and the nipples are 
large and prominent. His heart and lungs are normal The 
abdominal organs are also normal. Plis legs are remarkable for the 
great forward curving of the tibiae, without any thickness of their 
anterior borders, which are quite ‘ sword-like ’ in sharpness. From 
time to time sharp shooting pain is experienced in the legs. The 
reflexes are normal. Scars of old yaws can be seen on his chest and 
arms. 
Treatment. Potassium iodide in increasing doses, bromides, 
phenacetin, &c., were all apparently useless. 
The chief reason for venturing to bring forward this case is the 
presence of the third tumour. I have been unable to find that such 
has been described before associated with goundou. The associated 
curvature of the tibiae has been noted already by others, but it is not 
referred to in most text books dealing wdth tropical disease, and the 
same observation largely holds in reference to the continued patency 
of the nasal (lachrymal) ducts. The definite history of yaws preceding 
the appearance of the tumours is also of interest, and the fact that 
nasal discharge was not frequent till after the onset of growth of the 
tumours. 
To what the origin of the third tumour is due I am doubtful It 
is in a position which would lead one to suspect the cause m^ht lie 
in the Antrum of Highmore, but there is neither apparent thinning of 
bone, discharge from the left nostril, missing or decayed teeth, nor 
depression of the left palate. I could get no evidence to support the 
theory that the nasal passages had been invaded by larvae. 
Goundou has been already reported from Sierra Leone, but I 
believe the disease may be said to be rare in this part of West Africa- 
I regret the patient refused to allow me to operate for the removal 
of any of the tumours. 
