1876 DISEASES OF THE RESPIRATORY ORGANS 



Symptomatology. — The affection is characterized by attacking 

 adults, in whom it causes violent fits of sneezing, lasting from a few 

 minutes to two hours, during which time the victim sneezes ten to 

 seventy times, while fluid pours from the nose, tears roll down 

 from the eyes, the conjunctivae are injected, the eyelids swollen, 

 the head aches, and the patient is unable to do his work. The 

 attacks are repeated constantly, and may take place several 

 times during the day, or may not recur for weeks. They may 

 be associated with or followed by dyspnoeic conditions resembling 

 to some extent asthma. At the beginning the mucosa of the 

 inferior turbinated bone may appear hypersemic, but later it 

 becomes swollen, and has a macerated appearance. The disease 

 therefore closely resembles hay fever, but is supposed to be caused 

 by dust acting upon the nasal mucosa of persons, the resistance of 

 whose nervous system has been lowered by long residence in the 

 tropics. We have frequently met with the disease in people 

 exposed to the dust of tea and copra. 



Treatment. — The only successful treatment in many cases is a 

 change of climate, when the symptoms stop at once. When the 

 patient cannot have a change of climate, atropine and strychnine 

 pills, or small doses of quinine, may be recommended, and locally a 

 spray of a solution of cocaine (J or i per cent.) and adrenalin 

 (1-2 per cent.). 



GANGOSA. 



Synonyms. — Rhinopharyngitis mutilans (Leys) ; Granuloma 

 gangrenosum; Kaninloma (Fiji). 



Definition. — Gangosa is an ulcerative condition of the palate, nose, 

 pharynx, and skin surfaces of the body, of unknown cause, though 

 possibly a late sequela of yaws, which slowly spreads to the nose 

 and larynx, destroying cartilage and bone, and causing much 

 deformity. 



History.- — The disease appears to have been first described in 

 1828 by a Spanish Royal Commission to the Marianne or Ladrone 

 Islands under the name ' gangosa,' which means ' nasal voice,' and 

 is derived from gangoser, ' to snuffle.' It was carefully studied by 

 Seligmann in British New Guinea in 1898 and 1904, who describes 

 the implication of the skin of the face, and draws attention to the 

 fact that it is the disease described by Sir William MacGregor as 

 lupus and by the white residents as cancer. In 1906 the disease 

 in the endemic area was studied by Fordyce and Arnold, by Leys 

 in Guam, an island to the south of the Ladrone Islands, and by 

 Mink and McLean in the Ladrone and Caroline Islands. In 1907 

 a paper appeared by Musgrave and Marshall on a case from the 

 Batanes Islands, 120 miles north of Luzon, and by Stitt on a case 

 in a European in Guam. It has been studied by Angeny and Kerr. 

 Breinl has found it on Murray Island, and thinks that it closely 

 resembles the condition known in Fiji as Kaninloma. 



Climatology.- — There appears to be an endemic area for the 



