22, s Sellards and Goodpasture: Immunity in Yaws 237 



taken (Plate 1, fig. 1) showing this lesion and also, in poor 

 focus, some spontaneous granulomata on the neck. Treatment 

 with neosalvarsan was commenced at this time. 



Two other cases of yaws of a very different type were 

 reinoculated. Both of these were cases of clavos who had re- 

 covered spontaneously from the granulomatous stage many years 

 ago. It seemed desirable to test experimentally the possibility 

 of producing a typical granuloma in patients during the late 

 stage of the disease. 



Both of these patients gave clear intelligent histories. One 

 had typical yaws twenty years ago and now has thickened and 

 excoriated skin over the soles of both feet and similar lesions 

 in the palm of one hand. When the patient is at work there 

 is moderately severe pain. The other patient had a granulo- 

 matous eruption of yaws of three years' duration ending ten 

 years ago. He now has moderate thickening and excoriation 

 of the skin over the sole of one foot only. There is practically 

 no pain. Neither of these men has had any return of the 

 granulomata. The Wassermann reaction was performed and 

 showed complete fixation in both cases. There was nothing in 

 the history or examination of these patients suggestive of 

 syphilitic infection. 



Implantation of yaws tissue was made in two incisions in 

 the skin over the deltoid in each patient. One week later a 

 papillary eruption was developing rapidly at the site of each 

 implant in both patients. At the end of the second week, 

 however, the reactions had almost completely subsided, no suit- 

 able material being available even for microscopic study. The 

 observations were discontinued and neosalvarsan injections 

 were commenced for the treatment of clavos. 



INOCULATION OF PATIENTS WITH YAWS AFTER TREATMENT WITH 

 NEOSALVARSAN 



A group of four cases of yaws in the secondary stage received 

 treatment with neosalvarsan. Nearly six months later, small 

 pieces of yaws tissue were implanted in an incision in the 

 skin. Observations were continued for four and one-half 

 months. Some instructive results were obtained. In one 

 patient, a typical granuloma developed at the site of inoculation 

 and progressed rapidly; with the appearance of early secondary 

 lesions, neosalvarsan was given. In the other three patients, 

 small granulomata appeared after a short time at the site of 



