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XLVIII] give a more elongated form and horizontal direction. The swellings, according to Maclaud, when of moderate dimensions, look something like two half-eggs laid alongside the nose, one on each side. The nostrils are bulged inwards, and more or less obstructed; but, in the later stages at all events, there is no discharge, neither can any breach of the mucous surface be detected. The hard palate is not affected in any way.

Maclaud had no opportunity of ascertaining by post-mortem examination, or by surgical operation,

Fig. 222.—Goundou. (From photograph in the Journ. of Trop. Med.)

the nature of this singular disease. He inclines to the opinion that, in the first instance, the process is started by the larvæ of some insect which find their way into the nostrils. I would point out, however, that the symmetry of the growths is difficult to account for on this hypothesis. Maclaud observed a similar affection in a chimpanzee.

Strachan records and illustrates an instance of goundou in a West Indian negro child. (Fig. 223.) In this case the swellings were congenital, and had only increased in proportion to the child's growth. They were hard, smooth, bony masses, somewhat of the shape and size of an elongated pigeon's egg, and sprang from the nasal process of the superior