CHAP PA 413 



No organisms can be found. 

 ( The source of the irritation: why this pariicular spot should be 

 cliosen, and why a fibrotic ring is caused, has not yet been made clear. 



SYMPTOMATOLOGY. 



There is no general disturbance. 



It begins on the inner side of the digito-plantar furrow. 



An ulcer may form that causes pain. 



The condition may last two to fifteen years until the toe is severed. 



In 10 per cent, of cases the fourth toe is affected. 



TREATMENT. 



No known treatment is of any avail. 



Some divide the fibriotic ring early so as to save the toe, but the 

 condition usually progresses. 



CHAPPA. 



This is seen in Lagos. 



There are severe pains in the muscles and the joints of the 

 ■extremities. 



After a few months the pain increases and the joints swell. 



Nodules, subcutaneous, the size of a goose Qgg appear in different 

 parts of the body. The skin over them ulcerates, later exposing a fatty 

 base. There may be one or many nodules. 



When ulcerating thev ma}' coalesce. 



Some of the nodules are absorbed without ulceration. 



The ulcers may last for years. 



The joints may become permanenll\- disorganized and the bones 

 affected. 



It may be a tertiary phase of yaws (Manson). Mercury and 

 iodides are useless. 



Scraping and antiseptics are good measures. 



Neosalvarsan could be tried. 



PONOS ( = pain). 



This disease, affecting young children of Spezzia and Hydra in the 

 Grecian Achipelago, resembles infantile biliary cirrhosis of Indian 

 towns in that — 



It is confined to very young children. 



It is endemic in particular districts. 



It tends to run in families. 



It is invariablv associated with the disease of an abdominal viscus. 



