Henpuye starts in a native of West Africa during or soon after an attack
of yaws in which there is a history of the nasal mucous membrane being
attacked as a small bony swelling symmetrically placed on either side of
the nose. This swelling, which is generally oval with the long axis
directed downwards and outwards, is attached to the nasal bones, the
nasal process of the superior maxilla, and also to the superior maxilla
in the more advanced cases. It is produced by the deposition of new bone
under the periosteum on the external aspect of these bones and grows
slowly in all directions. It in no way affects the mouth or the orbital
or nasal cavities in any case which I have seen, and the nasal ducts are
quite unaffected. Rarely the growth is asymmetrical, being situated only
on one side of the nose. Pain in the nose and the presence of a sore in
that organ are the symptoms complained of at the commencement of the
disease; later headache is sometimes felt, and pain in the swelling
during wet weather. As the growth becomes larger it seriously interferes
with the sight by growing up in front of the eyes and even hiding them,
but I have never seen it cause destruction of the eyeball. In many cases
the patient has to bend his head downwards in order to be able to see
over the tops of the swellings. The skin over the tumor is normal and is
freely movable. The course of the disease is that the swellings may
cease to grow at any period of their existence or may continue to grow
for years—that is to say, they may remain quite small or may grow to be
large lumps, in the latter case giving rise to the deformity and the
interference with the sight, but I am unacquainted with any case in
which they break down or ulcerate. Finally, the disease is much more
common, in my experience, in men than in women.