FRAMBCESIA TROPICA 23 



SYMPTOMATOLOGY. 



■ The symptoms last six to twelve months, frequently longer. 



Three stages have been described : — 



The Primary Stage. — The primary lesion or mother yaw. 



The Secondary Stage. — The characteristic g'eneral granulomatous 

 eruption. 



The Tertiary Stage. — The deep-seated ulcerations and gummatous- 

 like nodules. 



These divisions are very arbitrary. 



INCUBATION. 



This is from two to nineteen weeks, but may be absent. 



PRODROMATA. 



Malaise, rheumatoid pains, headache and irregular temperature, but 

 these may be absent. 



THE PRIMARY STAGE. 



The primary lesion occurs at the seat of inoculation, and is nearly 

 always extragenital on the mammas or hip. 



At first there is a papule the size of a split pea, in seven days it 

 becomes moist, develops a yellow crust, other smaller ones coalescing 

 with it. The crust breaks down, and an ulcer remains with clean-cut 

 edges and a granulating base. This may heal, leaving a white, later, 

 pigmented scar, or it may become a bare granulomatous mass. It is 

 often painful at first, but is never indurated. 



The proximal glands may be enlarged, but do not suppurate. 



This mother yaw may develop on an old ulcer, insect bite or wound. 



The smallest abrasion is sufficient to afford an entrance to the virus. 



The mother yaw is usually still present when the secondary eruption 

 appears. 



The duration of the primarv yaw is a few weeks to a few months. 



THE SECONDARY STAGE. 



From one to three months after the appearance of the primary lesion 

 there may be malaise, headache, pains in the bones, joints and muscles. 



Pin-head papu^les then appear, commonl}- on the limbs and face, 

 but frecjuentlv over the whole body; these soon show a yellow crust. 

 Some disappear, others coalesce, and others increase in size, forming 

 large nodular masses. The vellow crusts conceal a yellowish fungoid 

 granular mass secreting a thin, slightly purulent fluid. 



These ulcerations often form rings about the mouth and anus, 

 enclosing good skin. 



After several months the secondary eruption diminishes and hyper- 

 keratosis sets in, when the papules become hard and warty. 



