Lamprey gave further details, illustrated with drawings, on the same subject. He had seen three such cases on the West Coast of Africa, all of them Fantis; one came from the Wassau territory, one from the Gamin territory, the third was a visitor to Cape Coast Castle. Renner also reports and illustrates a case from the Sierra Leone River.
Maclaud calls attention to what is manifestly the same affection, which, according to him, occurs in a considerable proportion— one or two per hundred —of the inhabitants of certain villages on the Ivory Coast. The natives call it goundou, and, also, anakhre. Maclaud says it is confined to the riverine districts of the Lower Camoe; according to the information he received, if found elsewhere it is only in individuals who had previously resided in this district. Lamprey's and Renner's observations prove that goundou has a considerably wider distribution.
Symptoms.— According to Maclaud, the disease usually commences soon after childhood, although adults also may be attacked. The earliest symptoms are severe arid more or less persistent headache which, after a time, is associated with a sanguino-purulent discharge from the nostrils, and the formation of symmetrical swellings the size of a small bean at the side of the nose. (Fig. 222.) Apparently the swelling affects the nasal process of the superior maxilla. The cartilages are not involved. Although Maclaud does not refer to this point, it may be assumed that the nasal ducts remain patent. After continuing for six or eight months, the headache and discharge subside. Not so the swellings; these persist and continue slowly and steadily to increase until in time they may attain the size of an orange, or even of an ostrich's egg. As they grow, the tumours, encroaching on the eyes, may interfere with the line of vision and finally destroy these organs. There is no pain in the tumours themselves. The superjacent skin is not involved, being healthy-looking and freely movable. The tumours are oval, with the long axes directed downwards and slightly from within outwards. Lamprey's drawings
