1878 DISEASES OF THE RESPIRATORY ORGANS 



of large vacuolated cells with pale vesicular nuclei. Some diplo- 

 cocci, micrococci, and bacilli have been noted, but no acid-fast 

 bacilli or Treponemata have been seen. 



Symptomatology. — The disease begins sometimes as a sore throat, 

 and on examination a nodule maybe seen on the back of the pharynx, 

 the posterior pillars of the fauces, or the edge of the soft palate. This 

 becomes a superficial ulcer covered with a brownish-grey slough. 

 This ulcer spreads rapidly at first, but more slowly later, and eats 

 away first the soft |parts, and then the bone of the palate, the nasal 



Fig. 772. — Gangosa. 

 (From a photograph by Arnold.) 



septum, and the cartilages of the nose, so that the skin falls in, and 

 the nose and mouth are converted into one cavity. It may then 

 extend on to the face or lip, or affect the larynx. When it spreads 

 over the face it may involve the eyelids, erode the cornea, and even 

 destroy the vision. In some advanced cases the entire front of the 

 face is replaced by a large opening ringed about by foul ulcers. 

 Sensation is diminished over the ulcer, and a most objectionable 

 odour is exhaled, while a slight discharge of granular and necrotic 

 debris is generally present. The ulcers may also appear on the 

 skin of the extremities or on parts of the body not usually covered 



