CHAPTER XXVII
GANGOSA
History and Geographical Distribution
History.—It is known that in 1828 a Spanish Commission, investigating the diseases of the Ladrone Islands, reported the existence, in those islands, of a disease which was called gangosa, by reason of the muffled character of the voice, the Spanish word gangosa meaning muffled voice. The Commission recommended that cases of this disease, as well as those with leprosy, be isolated, thus showing that the disease was differentiated from leprosy at that time.
Daniels, who studied similar naso-pharyngeal lesions in Fiji, considered the disease as a sequel of yaws and stated that if it were not a stage of yaws it was probably a separate and distinct disease. Leys, who studied gangosa in Guam, in 1904, gave it the name rhino-pharyngitis mutilans and described it as a disease sui generis.
Geographical Distribution.—The disease is very prevalent in Guam, and is also present in other islands of the Caroline group. It exists in Fiji and many cases have been reported by Numa Rat from the island of Dominica, in the West Indies. Cases have also been reported from the Philippines and Ceylon.
Etiology and Epidemiology
Etiology.—The two most prominent views as to its etiology are that it is a sequel of either yaws or syphilis. The fact that gangosa responds to antisyphilitic treatment is no proof as to its luetic origin because yaws yields equally well to such remedies.
Gangosa cases also give a considerable percentage of positive Wassermann reactions, 105 positives in 281 cases. Halton who made these tests found 100% positive reactions in cases of yaws and 46% of positives in those who had had yaws several years previously.
The main points against the syphilitic nature of the disease are absence of either congenital or acquired syphilis among the natives of Guam. There is an absence of Hutchinson’s teeth and interstitial keratitis. Leys states that neither primary nor secondary syphilis had been seen in a native of Guam during a year in which a very large number, including several prostitutes, had been treated. Recently a positive luetin reaction has been obtained in 253 out of 369 cases of gangosa, of which 143 were papular type reactions, 65 pustular and 45 torpid reactions (taking ten days or more for the reaction to manifest itself). The syphilitic and yaws antigens seem to be reciprocal so that these tests do not throw out yaws. The great stumbling block of the advocates of the luetic etiology has been to show the presence of syphilis among the people of Guam. Under tropical ulcer it will be noted that Jeanselme failed to find the eye or teeth signs of congenital syphilis among natives of Indo-China with the disease.