﻿GANGOSA IN THE PHILIPPINES. 389 



Differential count. 



Per cent. 



Small lymphocytes 10.0 



Large lymphocytes 4.0 



Polymorphonuclears 82.0 



Eosinophils 2.6 



Basophiles -4 



There was slight cough at times during the patient's stay in the hospital, 

 hut it was never annoying and the expectoration, if any, was swallowed. 

 A physical examination of the chest on admission showed signs of some 

 bronchitis. There were no subsequent examinations. The sputum was 

 not examined because none could be obtained. The tongue was con- 

 stantly coated with a heavy, brownish fur, but no ulceration took place. 

 The appetite was poor, the patient had to be fed largely by a tube, there 

 was no vomiting or pain. The bowels were constipated, moving but 

 seldom except from cathartics or enemas. Microscopic examination of the 

 feces showed ova of Trichuris trichiura. There were no disturbances 

 of the urinary function. Examination of the urine showed a trace of 

 albumin and a few hyaline casts. This patient never complained of pain ; 

 as a rule sleep was sufficient, but during the last week of his illness there 

 was considerable restlessness and insomnia. The reflexes were normal. 

 The eyes were apparently normal, but hearing became somewhat defective 

 toward the end. The sense of smell was almost nil and speech was of 

 the Gangosa type, its peculiarity resulting from destruction of the palate. 

 Treatment. — A probable diagnosis of syphilis was made when the 

 patient was first admitted to the hospital; antisyphilitic treatment was 

 instituted and continued for three months. This treatment consisted of 

 intramuscular injections of mercury to the point of toleration, of potas- 

 sum iodide by mouth and intravenously in closes up to 10 grams per day. 

 Mercury was also tried by inunction. 



The antisyphilitic treatment did not cause any improvement and it 

 was discontinued after three months. This was followed by copper 

 sulphate in 0.015 doses, three times a day for about one month without 

 any improvement and no further specific therapeutic measures were under- 

 taken. Death occurred January 23, 1907. Clinical diagnosis, Gangosa. 



II. AUTOPSY REPORT. 



Autopsy. — Four hours after death. The body is markedly emaciated, 

 rigor mortis of moderate grade present, one old, grayish colored ulcer on 

 the left leg about 8 millimeters in diameter extends to the deeper layers 

 of the skin. The muscles are wasted and pale. The superficial lym- 

 phatics in the groins moderately enlarged, pale in color and quite firm. 



The left lung contains a few, reddish-colored infarcts from 7 milli- 

 meters to 1 centimeter in diameter, mostly in the lower lobe. There is 



