22,3 Goodpasture and De Leon: Reaction in Yaws 227 



sera will spontaneously become negative in the course of a few 

 months, it is not necessary in treating the disease on a large 

 scale to continue therapy until a negative reaction is accom- 

 plished. A better guide would seem to be the complete healing 

 of all clinical manifestation of activity of the disease. 



Bearing upon this point and supporting the above conclusion 

 is the reported alteration of the Wassermann reaction following 

 treatment of yaws with mercury. 



Baermann and Wetter state that the reaction became negative 

 in about 50 per cent of cases of yaws following a single course 

 of treatment with mercury. In contrast to syphilis they noted 

 frequently a diminution in strength of the reaction or a com- 

 plete alteration after even two or three injections of the salicyl- 

 ate. The reaction in their experience seemed to remain negative 

 in yaws after treatment longer than in syphilis. Although these 

 authors do not state the exact time in which a reversal in reac- 

 tion took place they probably mean within a few weeks. This 

 is not the case following injections of neosalvarsan, although 

 this drug is incomparably more effective than mercury in the 

 treatment of yaws. Evidently no great clinical importance can 

 be attached to reported changes in the Wassermann reaction 

 following mercury therapy. 



In order to observe the effect of mercury on the cutaneous 

 lesions of yaws and on the Wassermann reaction we made ob- 

 servations on four acute cases, all of whom were Filipinos of 

 about the same age, with abundant fresh secondary lesions. The 

 following protocol of one of these cases will serve to illustrate 

 this group. The treatment given each of these cases was the 

 same and in each case it proved equally ineffective. 



The patient was admitted to the Philippine General Hospital with early 

 secondary lesions of yaws. He received three intramuscular injections 

 of 0.25 cubic centimeter succinamide of mercury (1 per cent) at four-day 

 intervals, four 0.5 cubic centimeter injections at three-day intervals, two 

 1 cubic centimeter injections at two-day intervals, and two 0.5 cubic centi- 

 meter injections of mercury salicylate with an interval of seven days 

 between doses. The period of treatment was from September 24 to October 

 81. There was no noticeable effect on the skin lesions and 0.45 gram of 

 neosalvarsan was given intravenously and was followed by immediate 

 healing. 



Table 4 presents the results of Wassermann tests performed 

 before treatment, and twice during treatment. 



While a moderate initial diminution in complement-fixing 

 strength is evident in Table 4, after five weeks of treatment no 



