CLIMA TOLOG Y— HI STOP A THOLOG Y 



1877 



disease, it being common in the Batanes Islands (where the cases 

 are mistaken for leprosy), in the Ladrone Islands, Guam, and the 

 Caroline Islands. Cases occur also in Fiji, Murray Island, Panama, 

 British Guiana, Ceylon, Nevis, Dominica, and Equatorial Africa. 

 In the Anglo-Egyptian Sudan there is a disease closely resembling 

 gangosa, though probably syphilitic. 



etiology. — Daniels and several other authors believe it to be a 

 sequel to yaws, but Rat is opposed to this, as are Mink, McLean, 

 Musgrave, and Marshall and Angeny, who point out that the disease 

 is absent or very rare in many countries where yaws is common. 

 Kerr, however, has noted that yaws is an almost constant antece- 

 dent of gangosa. Alverez suggested that it was syphilis, but 

 Musgrave, Marshall, and Leys are opposed to this, because no 

 syphilis exists in Guam, where gangosa is common. There are no 

 signs or symptoms of syphilis in this disease. Treponemata cannot 

 be found, and mercury is without effect. It is not leprosy, because 

 of the absence of nodules, infiltration, anaesthesia, and Hansen's 

 bacillus. It is distinguished from epithelioma by the absence of the 

 histological characters and metastases, as well as by the rapid onset 

 and protracted course. It is excluded from tuberculosis by the 

 absence of Koch's bacillus and other symptoms of the disease, and 

 the failure to inoculate guinea-pigs successfully. It may therefore 

 be a separate disease of unknown causation, though we believe that 

 it is probably a late manifestation of yaws. Schmitter regards it as 

 a sequela of a special variety of yaws. It appears to be equally 

 common in males and females. 



Pathology. — It appears to begin sometimes as a sore throat or 

 coryza, or as a tubercle on the palate. In any case, an ulcer soon 

 forms, which, though superficial at first, eats through cartilage and 

 bone, with periods of quiescence and of activity. This ulceration 

 is due to a necrosis of the tissue elements, with very little reaction 

 on the part of the body. This reaction is apparently limited 

 to a small-celled infiltration, some giant-celled formation, and 

 proliferation of bloodvessels with formation of granulation tissue. 



Morbid Anatomy. — The post-mortem may reveal signs of some 

 concomitant affection — -for example, tuberculosis, pleurisy, or 

 cardiac hypertrophy — which have nothing to do with the disease, 

 the important features of which are ulceration and destruction, 

 together with scar formation in the larynx, pharynx, palate, nose, 

 and perhaps the antrum of Highmore. 



Histopathology. — Microscopically, the following changes are ob- 

 served as the diseased area is approached from healthy tissue: First 

 there is an oedematous infiltration, then an infiltration with round 

 cells, which are principally lymphocytes, associated with another 

 variety possessing more protoplasm, and a small dark nucleus. 

 Sometimes there are giant cells and proliferating vessels, and there 

 are always haemorrhages. Then comes a layer of necrosis, forming 

 the surface of the ulcer, at the edges of which the epithelium can be 

 seen sending processes into the subcutaneous tissue, which consist 



