﻿390 MUSGRAVE AND MARSHALL. 



an old, adhesive pleuritis on the right side; the right lung contains several 

 areas similar to those in the left and there is also a small tuberculous 

 cavity in its apex. There is a moderate bronchitis, and a few areas of 

 beginning broncho-pneumonia in both organs. Nothing abnormal is 

 found in the heart or its membranes. 



The abdomen is free from adhesions, the tissues and organs appear to 

 be anaemic and with slight enlargement of some of the mesenteric lyni- 

 phatics. No marked departure from the normal is seen in any of the 

 organs except the stomach. This shows a general hemorrhagic catarrh 

 of the mucosa. 



In order to preserve good museum specimens, the soft tissues of the neck were 

 divided at the upper end of the sterum, carefully dissected up from the cervical 

 column and the latter cut by sawing through the first cervical section. The 

 brain was removed, but nothing abnormal was found in this organ. The rest of 

 the head and soft tissues of the neck were placed in formalin for two days and 

 then, after hardening, they were divided antero-posteriorly in the median line. 

 By this method a careful study of the lesions of both bone and soft tissues was 

 made possible. 



In these specimens a condition typical of that described for gangosa 

 is found. There is marked destruction and some scar formation of the 

 soft parts, including the larynx, pharynx, soft palate, uvula and nasal 

 tissues. The nasal septum and a considerable area in the bridge of the 

 nose, including both bone and cartilage, are destroyed. The palate is 

 also partially destroyed. The process in addition has extended into the 

 sinuses of the cheek bones and here it has included both bone and soft 

 tissues. There is no evidence of acute inflammation, the surface of the 

 destroyed areas is covered with a dirty, granular material, which when 

 removed leaves a gray, sponge-like tissue. Scrapings from the diseased 

 areas are free from acid-fast bacilli and treponema. 



Smears from the pneumonic areas in the lungs showed a single filarial 

 embryo but no others were observed during the examination of many 

 preparations from similar locations. 



Anatomic diagnosis. — Chronic ulceration of the naso-pharyngeal tissues 

 including destruction of the palate, nasal septum, turbinates and involve- 

 ment of the maxillary sinuses; together with extensive destruction and 

 scar formation of the adjacent soft parts of the larynx, pharynx and 

 nasal tissues. Tuberculosis of the right lung with a small cavity in the 

 right apex. Terminal broncho-pneumonia. Moderate lymphadenitis, 

 more marked in the region of the neck. Acute haemorrhagic catarrh of 

 gastric mucosa. 2 



= The only other autopsy which has been made upon a patient with gangosa 

 is one reported by Mink and McLean. In their case, a male of 18, the entire 

 nasal passages, hard and soft palate were destroyed; the tonsils and pillars were 

 replaced by scar tissue; there was cardiac hypertrophy, and fine adhesions existed 

 between the lungs and pleaurae. The diagnosis in their case was "native epidemic 

 asthma." 



