﻿GANGOSA IN THE PHILIPPINES. 397 



the study of our sections no mast cells were encountered, although plasma 

 cells were abundant. Such differences may readily be clue to the varia- 

 tions in the reactive power of different individuals, and to secondary 

 infection and it seems quite probable that the two cases represent the 

 same condition. 



III. RESUME OF LITERATURE. 



There is at the present day some confusion in the differential diagnosis 

 of the various forms of tropical ulceration, and there can be little doubt 

 but that the disease which we treat of in this article has been described 

 at different times under various names. The most complete article 

 dealing with the subject of gangosa which we have found is the 

 recent one by Mink and McLean, and the following summary is taken 

 from this and from the papers of Leys, and of Fordyce and Arnold. 



Gangosa was described in 1828 by the Spanish Commission which 

 visited the Ladrone Islands. Similar cases have been reported from the 

 Caroline Islands, Fiji, British Guiana, Italy, Dominica, Nevis and Pa- 

 nama. It prQbably exists in Ceylon under a different name. 3 



"Gangosa" is a Spanish word and means a "nasal voice." The disease 

 is characterized by a slowly progressing ulceration, starting in the throat, 

 or soft palate, advancing upwards and forwards through the nasal pas- 

 sages, destroying in its progress the septum, hard palate and turbinates, 

 and causing the falling in of the nose. In rather less than 10 per cent 

 of cases the ulceration eventually attacks the anterior nares and leads to 

 more or less complete destruction of the nose, so that it is possible to 

 look through the nose into the mouth and throat. In the later stages 

 the upper lip may be attacked and the process may extend through the 

 lachrymal ducts or* across the face to the eyes, leading to secondary in- 

 flammations and blindness, the orbit filling up with granulation tissue. 

 Out of eighty-one cases tabulated by Mink and McLean there were only 

 two in whom hearing was affected, while the larynx was involved thirty- 

 three times. In our case there was double otitis media. Phonation is 

 always interfered with and the senses of smell and taste are usually lost. 

 It is characteristic that the tongue and muscles of deglutition escape. 

 The ulcers are nearly or quite painless. 



In a case reported by Dr. Eat, the ulceration started from a tubercle 

 on the soft palate. Three of Mink and McLean's cases started with mild 

 sore throat or coryza. At first the ulcer is superficial, moveable and 

 covered with a dirty, brownish-gray pelicle. It spreads rapidly, later it 

 becomes chronic and granulation tissue is formed around the base. The 

 ulceration may advance steadily for many years or may become arrested 

 at any time, leaving a chronic ulcer. In most of the cases of Mink and 



3 On a recent visit to the Batanes Mr. Fergusson, of this Bureau, found several 

 colonies of apparently gangotic sufferers living in quarters more or less isolated 

 from the main villages. These people are regarded as lepers. 

 57712 5 



