22.3 Sellards and Goodpasture: Immunity in Yaivs 239 



There have been successive crops of secondary lesions; the scars 

 of several can still be seen plainly on the chest and the abdomen. 

 Granulomata have persisted continuously around the anus. The 

 first injection of neosalvarsan was given at this time. Septem- 

 ber 21 the lesions have almost completely dried. A second 

 injection of neosalvarsan was given. October 3 the patient 

 appeared clinically cured; nevertheless, a third injection of 

 neosalvarsan was given. 



The Wassermann reaction on September 12 showed complete 

 fixation with 0.01 cubic centimeter of serum in a system designed 

 for the use of 0.1 cubic centimeter of patient's serum. On Oc- 

 tober 12, 0.005 cubic centimeter gave complete fixation. On 

 March 9, 1922, 0.1 cubic centimeter gave partial fixation and 

 0.01 allowed complete haemolysis. On this date, minute pieces 

 of yaws tissue were implanted in incisions of the skin about 0.5 

 centimeter apart. The patient was not seen again until two 

 weeks later. At this time both incisions showed distinct eleva- 

 tion. At the end of the third week (March 30) the elevated 

 ridge of epithelium along the upper incision was drying up. 

 At the lower incision there was a small dry papule. The ap- 

 pearance is shown in the accompanying photograph (Plate 1, 

 fig. 3). The Wassermann reaction taken at this time showed 

 the same titre as on March 9. At the end of the fourth week 

 these epithelial lesions had desquamated completely, leaving only 

 the barely discernible linear scar of the incision. On May 16, 

 the Wassermann reaction still showed the same titre as on March 

 9 and March 30. No more Wassermann tests were taken ; a final 

 clinical observation was made July 20, there being no suggestion 

 of any lesions of the skin. 



The third patient was seen September 22, 1921. The mother 

 yaw appeared almost two years ago, and the patient is certain 

 that it healed more than one year ago. There are numerous 

 evidences of healed secondary lesions on various parts of 

 the body. There is one cluster of granulomata on the back of 

 the neck now, but the lesions are dry and show signs of regres- 

 sion. For three months the patient has noticed pain in the 

 bones of the hands and the feet. The first injection of neosal- 

 varsan was given at this time. October 3 the pain in the bones 

 has disappeared, and the skin lesions have cleared up completely. 

 A second injection of neosalvarsan was given. 



The Wassermann reaction on September 22 showed complete 

 fixation with 0.1 cubic centimeter of serum and almost complete 

 fixation with 0.01 cubic centimeter. On October 12, 0.1 cubic 



