The following cases will be described: (1) slightly developed cases; (2) moderately developed cases; (3) an advanced case; and (4) an asymmetrical case.
Slightly Developed Cases.—Case I.—The patient, a boy of about seventeen years of age, said that about seven years ago he noticed two small lumps on the nose which began after yaws in which there was a sore in the nose. They increased slightly in size, but soon ceased to grow and have been in their present condition for some years. He never felt any discomfort or pain in them. The two lumps had their long axis directed downwards and outwards, the measurements being half an inch by a quarter of an inch. They were attached to the nasal bones just above the cartilages and the nasal process of the superior maxilla, and were firm, smooth, bony tumors. The skin over them was quite normal and they did not in any way project into the nasal cavity or affect the line of vision, being too small for the latter purpose. There was very little deformity and no treatment was necessary. In this case the lumps soon ceased to grow.
Case II.—A small Grunshi girl from Kumassi, about seven years of age, who had had yaws some time previously, felt pain in the nose a few months ago and noticed a small swelling on each side of the nose, and this gradually increased in size till it reached its present condition. Her mother was most anxious to have it removed on account of the deformity. On inspection there was found to be an oval swelling on each side of the nose, attached to the nasal bones and the nasal process of the superior maxilla. The long axis of the swelling was directed downwardsand outwards—an inch in length and half an inch in breadth. The nasal cartilages were not affected and the interior of the nose was normal. The orbital cavity, the mouth, and the nasal ducts were quite unaffected. The skin over the swelling was normal and freely movable. The patient felt no pain in the tumor and she had never had any headache. The growths were removed by operation. It was very difficult to obtain definite history as to the time when this patient had had yaws and as to the time when the growth appeared, but as far as I could make out the yaws were well developed when the swelling was first noticed.
Moderately Developed Cases.—Case III.—A young man, a Ga native, who had had yaws about seven years ago, felt pain in the nose and got a person to look into it, who said that there were yaw spots on the mucosa, and later a small swelling on each side of that organ was noticed. These small swellings grew slowly to their present size, and the patient said that they were still increasing. He complained of frontal headache and of slight pain in the swellings in wet weather. On inspection two symmetrically placed swellings were seen on each side of the nose, looking somewhat like small eggs. They were oval in shape, with the long axis directed downwards and outwards. The left measured two inches by two inches and the right three inches by two and a half inches. A profile view showed that they were slightly concave on the side towards the orbit. They did not affect the orbital or nasal cavities, nor did they project into the mouth or affect the nasal ducts or the cartilages of the nose. They were attached to the nasal bones, the nasal process of the superior maxilla, and to the superior maxilla itself. They were smooth, but on the left side the tumor rose to a central ridge. The skin over the swellings was quite normal and was freely movable. In order to see clearly, the patient often had to bend his head somewhat. The growths were removed by operation.
Case IV.—The patient was an Akwapim woman, aged about twenty years. This case was similar to Case III., but the swellings, which had started when the patient (who had suffered from yaws) was seven years of age, were rather more rounded. She would not consent to operation.
An Advanced Case.—Case V.—A man, a native of Appolonia,about forty years of age, stated that the swellings began with pain in the nose after yaws, when he was about six years old. They grew steadily and slowly till eight years ago, when they stopped, and they have not increased in size since then. On inspection there were two oval swellings situated on each side of the nose, the left measuring two and a half inches by one inch and the right three-quarters of an inch by half an inch. They projected upwards over the orbit, the long axis in each case being directed downwards and outwards. They did not project into the mouth, the nose, or the orbit, and the nasal duct was free. They were attached to the nasal bones, the nasal process of the superior maxilla, and to the maxilla itself. The skin over the tumor was normal and it was freely movable. The patient complained of headache and found that the swellings interfered with his vision considerably, particularly on the left side. He refused to submit to operation.
An Asymmetrical Case.—Case VI.—An Ashanti boy, aged six years, from Donkeo Inquanta, had yaws, and while suffering therefrom, just a year previous to his consulting me, the swelling appeared on one side of the nose, and had been growing ever since. There was no sign of any lump on the other side. He was advised to go to Kumassi for operation.