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XLVIII] but there is no implication of joints. The disease relapses from time to time, more especially during the rainy season. In one case recorded by Maclean severe pain would be provoked at any time by application of cold water.

Maxwell (Journ. of Trop. Med., March 15, 1905) reports a similar condition in natives of Formosa. As in Maclean's cases, the patients were young adults from 20 to 25 years of age. In Maxwell's cases the disease, although very painful, seemed to be of a more chronic character. In one instance the patient's sufferings were much relieved by trephining the affected bones. This curious condition somewhat resembles goundou. So far, we have no clue to its etiology. It is probably not syphilitic. Iodide of potassium did not relieve Maxwell's cases.

Yale Massey describes (Journ. of Trop. Med., September 1, 1904, April 1, 1907), under the above title, a peculiar disease occurring among the natives of Portuguese West Africa, and also on the Lualaba River. It is characterized by the formation of a number of vesicles, distended with blood, from ¼ to ½ in. in diameter, on the hard palate and on the inside of the cheeks. Some of the vesicles are umbilicated. They differ from ordinary blood blisters by the presence of numerous trabeculæ and the semi-coagulation of the contents; this makes the vesicle difficult to empty. The urine apparently invariably contains free blood. Occasionally the disease is accompanied by fever, and although with one exception all Yale Massey's cases recovered within a week to ten days, the natives regard the disease with dread owing to its reputation for deadliness. The etiology is quite unknown.