GANGOSA                                       857

GANGOSA¹

Synonyms.—Rhinopharyngitis Mutilans.

This peculiar and rare malady known as gangosa (Spanish word,
meaning muffled voice) has recently been studied by Leys, Rat, Stitt,
Mink and McLean, Fordyce and Arnold, Branch, Musgrave and Mar­
shall, Geiger, and others. It is an acute or chronic destructive ulcera-
tive process, involving, primarily, the soft and hard palate and neigh­
boring pharyngeal and laryngeal parts; and, later, the nasal cavity, nose,
and contiguous cutaneous and other tissues, sometimes to the extent
of from a portion to almost the whole face. According to Leys and Mink
and McLean, in the very beginning, if the case is seen early enough, a
superficial ulcer is found on the back of the pharynx, on a posterior faucial
pillar, or on the free edge of the palate, covered with a thin, dirty, brown­
ish-gray pellicle of slough; this Leys believes to be probably the initial
lesion of the malady. In extreme instances the destruction is great,
both of soft and bony structures, and the resulting ulcerative and cica-
tricial disfigurement striking and repulsive. In its rough clinical aspects
it has some features suggestive of syphilis, tuberculosis, frambœsia,
rhinoscleroma, and an unchecked Vincent’s angina; and less markedly
of actinomycosis and blastomycosis. As a rule, there are no constitu­
tional symptoms, except at its very onset, when, with symptoms pointing
to a tonsillitis, pharyngitis, or laryngitis of mild degree, there may be a
slight rise in temperature (Mink and McLean).²

Its course is slowly or rapidly progressive, the active stage lasting
from one to several years or longer; a stage of relative or complete quies­
cence then ensues, which may persist, or which may at any time give
way to another period of variable activity. The malady has its greatest
prevalence in Guam, affecting 2 per cent. (Mink and McLean) or more
(Arnold) of the native population; but cases or suggestive cases have
also been reported from the Ladrone and Caroline Islands, Fiji, British
Guiana, Jamaica, Italy, Dominica, Nevis, Philippine Islands, and Pan­
ama. It is most common in the pure blood natives; infrequent in those
of mixed white and native blood, and Stitt’s case³ is the only one that
has been observed in the white race. Fordyce’s case was in a negro

¹ Recent literature: Breda, “Frambœsia brasiliana o Bouba,” Giorn. ital, 1900, p.
489; Leys, “Report on the U. S. Naval Station, Island of Guam, Report of Surgeon-
General U. S. Navy, 1905, p. 91, and Rhinopharyngitis mutilans,” Jour. Trop. Med.,
Feb. 15, 1906, p. 47; Fordyce and Arnold, “A Case of Tropical Ulceration,” Jour.
Cutan. Dis., 1906, p. 1 (with case and histologic plates and references); Rat, "Rhino-
pharyngeal Lesions in Yaws,” Jour. Trop. Med., May 1, 1906, p. 135 (correspondence);
Mink and McLean, “Gangosa,” Jour. Amer. Med. Assoc, 1906, vol. xlvii, p. 1166
(illustrations of cases and tabulation of cases); and, “Gangosa with Additional Notes,”
Jour. Cutan. Dis., 1907, p. 503 (review and illustrations of cases and references);
Branch, “Rhinopharyngitis Mutilans,” Jour. Trop. Med., May 15, 1906, p. 156;
Musgrave and Marshall, “Gangosa in the Philippine Islands,” Philippine Jour, of
Science, 2, 1907, p. 387; Stitt, “A Case of Gangosa in a White Man,” U.S. Naval
Med. Bull., July, 1907, p. 96; Geiger, “A Preliminary Report on Gangosa and Allied
Diseases in Guam,” U. S. Naval Med. Bull., Jan., 1908, p. 1.

² Mink and McLean refer to a fulminating type of the disease, exceptionally seen in
young children, with symptoms suggestive of malignant diphtheria, and terminating
fatally within a few days.

³ This was a U. S. Marine, who had been in Guam for several years, an intimate
associate with families in which were gangosa cases.

858

NEW GROWTHS

from Panama. It is exceptional in the very young or very old; in 80
cases, 38 appeared during the second decade, 23 in the third, and 13 in
the fourth (Mink and McLean). The disease is considered to be con­
tagious, but as yet there is no unanimity as to the organism to which it
is due.¹ There seems good reason for the generally accepted belief that
it is in no way related to syphilis or to any other of the diseases above
named, to which it may bear resemblance; but that it is a distinct entity.²
The pathologic histology has been studied by Fordyce, Musgrave and
Marshall, and Geiger, with some differences as to their findings, although
indicating, on the whole, that the process is of a granulomatous nature;

Fig. 207.—Gangosa (courtesy of Dr. J. A. Fig. 208.—Gangosa, extreme case (courtesy
Fordyce).                                  of Drs. O. J. Mink and N. T. McLean).

the histologic picture, according to Fordyce, showing most resemblance
to that of tuberculosis.³

Prognosis and Treatment.—The disease never kills per se
(Mink and McLean), but unless halted or kept in check by treatment
it may continue its ravages indefinitely. Segregation, hygienic condi­
tions, nutritious food, tonics, and antiseptic applications are the control
measures usually resorted to; and of the antiseptic and deodorant appli-

¹ Geiger describes and pictures a bacillus (which he names Bacillus gangosæ) found
in all his active cases scarcely, if at all, distinguishable from the Bacillus diphtheriæ.

² Rat (loc. cit.) states that he was (Treatise on Yaws, 1901) of the opinion that these
rhinopharyngeal symptoms were later manifestations of yaws, but adds that in the
cases he saw the bone structure was not attacked; Branch (loc. cit.) believes the con­
dition syphilitic, but offers no proof to sustain this; on the contrary, the observations of
other writers and the available clinical and other facts and therapeutic tests seem con­
clusively against such an assumption.

³ Fordyce’s investigations (loc. cit.) as to its possible tuberculous nature, including
experimental inoculations in guinea-pigs, were all negative. In a case, thoroughly in­
vestigated by Musgrave and Marshall (loc. cit.), dying of bronchopneumonia, the local
histologic conditions were negative; they found, however, tuberculous nodules in the
cervical lymphatic gland, in the lungs, spleen, and pancreas.

VERRUGA PERUANA

859

cations, potassium permanganate, in 1 per cent, solution, seems to be the
favorite. Should a case come under observation at its very beginning,
then any coated plaque or ulcer in the throat or contiguous parts should
be actively cauterized (Leys). Mink and McLean commend the tincture
of iodin as an efficient destructive application for the infected areas.
It is not impossible that benefit might accrue from the x-ray and other
forms of light treatment.

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