24 DISEASES DUE TO PROTOZOA 



Most of the lesions usually dry up within six months (three to six 

 months in children) and disappear. In some cases the lesions may 

 persist for years, in other cases the eruption may reappear every few 

 months. Each granuloma lasts about two months. 



The ofifensive sour odour given off is probably due to the secondary 

 infection. 



The eruption is seldom painful except when it attacks the palms 

 of the hands and soles of the feet, when the pain may be considerable. 



The eruption may attack the margins of the nails, when the latter 

 may become hard, brittle, thick, and finallv be shed. 



White patches may peel off the palms and soles, thus simulating 

 syphilitic psoriasis. 



The centre of the papules may fall out, leaving a pitted appearance 

 which may persist for years. 



Fever is common and is intermittent or remittent in type, but it 

 only occurs prior to the secondary eruption. 



The cervical and inguinal lymphatic glands often enlarge, become 

 hard, but do not suppurate. 



Joints sometimes become acutely painful and swollen simulating 

 rheumatism, but sodium salicylates are useless. As a rule no fever 

 accompanies this condition. 



Periostitis is common and often affects the digital phalanges. 



Contractures of the flexors of the forearm may become permanent. 



Neuritis and neuralgia pains occur frecjuentlv. 



Hyperidrosis is often limited to the face, hands and feet. 



Anaemia is common but is not severe, from three to four millions. 



THE TERTIARY STAGE. 



This may not develop ; some denv its existence altogether. Daniels 

 affirms it in Fiji cases. 



Gummatous nodules and deep ulcerations may follow the secondary 

 eruption after several years. On the other hand, they may not ensue 

 at all. 



When the skin is affected the ulcers are rounded or irregular in 

 outline, with very thick and undermined edges and a granulating base. 

 There may be painful nodes under the periosteum of the ribs or 

 sternum. vSome cases show a chronic periostitis which alters the shape 

 of the bones. Bahr has described acute and chronic periostitis, 

 osteitis, epiphysitis, synovitis, ulceration and gangosa. There may 

 be ulcerations about the nasal bones resulting in rhinopharyngitis 

 mutilans. 



Internal affections have not yet been described. 



