Of 81 cases studied by McLean and Mink the eye was involved in 21. The larynx was involved in 33 of these cases. It is the frequent perforation of the hard palate that gives these patients the nasal voice, whence the name of the disease is derived.
Symptomatology
Patients with the disease have rarely been observed prior to the full development of the mutilating ulcerations. In a few cases, however, it was noted that a patch of membrane first appeared in the region of the soft palate. This membrane rapidly became honeycombed and an examination three or four days later showed underneath a deep ulcer, surrounded by an area of marked congestion.
The ulcerating process advances rapidly, destroying bone as well as soft parts. The process seems to extend from within outward, giving a funnel-shaped loss of tissue. The ulceration advances upward and forward, destroying the nasal septum and structures forming the tip of the nose, leaving the upper lip as the lower border of this external opening.
The active process tends to become quiescent in one or two years, the cases then showing extensive loss of tissue with cicatricial borders. Occasionally active ulceration may again set in after a period of quiescence.
The voice character is that of any case where there is a perforation of the hard palate and is not distinctive of the victims of this disease.
During active ulceration there is a malodorous sero-purulent discharge which makes the patients very objectionable. These cases seem to suffer very little impairment of the general health even when the process is active.
Although the destructive lesions about the nasopharynx and the region of the face are the most striking ones it would appear that similar ulcers on the extremities are of the same nature as those more prominently situated.
In an examination of the blood of 10 of these cases in Guam I did not observe any abnormal findings, other than an eosinophilia, which was present to an equal degree in those unaffected. Musgrave and Marshall reported a slight leucocytosis in their case.