0.4 
GANGOSA, RHINOPHARYNGITIS MUTILANS, 
AND GOUNDOU 
GanGosa was found to be not uncommon in both Liberia and in the central 
Belgian Congo (Nos. 233-239). More or less extensive destructive nasopha- 
ryngeal lesions were not uncommonly found to be associated with the condi- 
tions known as n’gonde. Any or all of the structures of the nose might be 
attacked or even completely destroyed. The same process was also observed 
involving the pharynx and the upper lip. 
In gangosa we also have a lesion about which it is often impossible to say 
whether it is a late manifestation of yaws or of syphilis. The majority of those 
who have recently written upon the condition have expressed the opinion that 
it is a tertiary manifestation of yaws. Such an opinion has probably in some 
instances been given particularly on account of the fact that yaws in child- 
hood, prevails in those districts where gangosa is also found, and where, gener- 
ally, genital syphilis is not observed to be common. 
Among the recent observers who record gangosa as a manifestation of yaws 
are Van Driel, Gutierrez, Van Dijke, Bakkar and Hoessen, Dubois, Waar, 
Callanan,! Bittner,? Maass* and Acheson.* On the other hand, Beurnier and 
Clapier, Maxwell ® and Araujo ® do not regard it as a manifestation of yaws, 
but rather of syphilis. Blonden‘ has reported upon a case of destruction of the 
nose, upper lip, and part of the cheeks by syphilis, which was said to have been 
cured by a course of treatment with 914, given by rectum. Mayer ® believes that 
while the condition has been associated with leprosy, tuberculosis, and syphilis, 
such relationship has certainly not been established. He also states that it has not 
been conclusively demonstrated that yaws is the cause of true gangosa, although 
he adds that tertiary framboesia can cause the same destruction. He also refers 
to the fact that leishmaniasis can sometimes produce the same appearance and 
refers to a case in New Guinea in which Brein] found a Blastomyces (Cryptococcus 
mutilans) which he believed to be the cause. Ziemann ° whose wide experience in 
tropical infections gives special weight to his view, also does not consider that 
Cited by Stannus: Trop. Dis. Bull. (1926), XXIII, 84. 
Bittner: Amer. Jour. Trop. Med. (1926), VI, 123. 
Maass: Jour. Trop. Med. and Hyg. (1928), XX XI, 102. 
Acheson: Northern Rhodesia Med. Report on Health and San. Conditions (1925-1926), p. 125. 
Maxwell: Trop. Dis. Bull. (1926), X XIII, 84. 
Araujo: Bull. Soc. Path. Exot. (1928), X XI, 387. 
Blonden: Bull. Soc. Path. Exot. (1927), XX, 6969. 
Mayer: ‘‘Exotische Krankheiten,” Berlin (1929), p. 325. 
Ziemann: Beihefte, Arch. f. Schiffs-u. Tropen-Hyg. (1926), XXX, 161; and Abhandlungen aus 
dem Gebiet der Auslandskunde, Hamburg (1927), X XVI, 618. 
308 
ors An &@ wo He 
