238 The Philippine Journal of Science was 



inoculation and then disappeared spontaneously in two of these 

 cases. The details of these four cases are briefly as follows: 



In the first patient, seen September 19, 1921, the mother yaw 

 appeared on the forehead and was first noticed three months 

 ago. It is now about the size of a peso (about 3.5 centimeters.) 

 The secondary lesions appeared one month after the mother 

 yaw. At present there are numerous granulomata over the 

 forehead, the neck, in the right axilla, over the chest, the 

 abdomen, and both legs, as well as numerous small papules. 

 Recently there has been pain in the bones. One injection of 

 neosalvarsan was given. The pain in the bones disappeared, 

 and the lesions healed so rapidly that the patient did not return 

 to the dispensary until October 3. At this time the granulomata 

 had almost entirely disappeared. A second injection of neosal- 

 varsan was given, and two weeks later there was no discernible 

 evidence of any active lesion. 



The Wassermann reaction on September 19 showed complete 

 fixation with 0.1 cubic centimeter of patient's serum. On Oc- 

 tober 12 the titre had not changed, 0.1 cubic centimeter giving 

 complete fixation. On March 2, 1922, the reaction was negative. 



On March 9, 1922, this patient was reinoculated with yaws, 

 two incisions of the skin being made about 1 centimeter apart. 

 A small piece of tissue was excised from the surface of an 

 active yaw from a patient in the early secondary stage and was 

 used for the inoculation of this group of 4 patients. One week 

 later (March 16) these incisions had healed with very slight 

 elevation of the skin. At the end of the second week (March 

 23) both incisions showed a very distinct elevation. At the end 

 of the third week (March 30) characteristic granulomata had 

 developed at each of the two sites of inoculation and they were 

 surrounded by a bright red areola. The appearance at this 

 date is shown in the accompanying photograph (Plate 1, fig. 2) . 

 Blood was taken for a Wassermann test, and the reaction was 

 negative. A week later (April 6) the two granulomata had 

 coalesced into one. At the end of the fifth week (April 12) 

 there were numerous, minute, discrete papules over the body 

 surrounded by a hypersemic area. These were presumably the 

 beginning of the secondary lesions. There was no sign of re- 

 gression in the mother yaw. One injection of neosalvarsan was 

 given, and the lesions disappeared promptly. 



The second patient was seen first on September 12, 1921. He 

 contracted yaws "much more" than one year ago. The scar of 

 the mother yaw could still be seen in the right popliteal space. 



