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 downwards and 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.