22,3 Sellards and Goodpasture: Immunity in Yaws 241 



leucocytic infiltration of the epithelium. The epithelial layer 

 is very thin in the center and is covered by leucocytic exudate. 

 On either side, the epidermis is slightly thickened and filled with 

 fluid and cellular exudate. The superficial layer of corium is 

 acutely inflamed, showing dilatation of capillaries, oedema, and 

 polynuclear cell exudate. Below this there is a dense infiltration 

 with large and small lymphocytes and a few plasma cells. There 

 is also a mononuclear cell exudate about the sweat glands. The 

 appearance is characteristic of yaws. A Levaditi preparation 

 shows no treponema. 



The other lesion developing at the upper incision was not 

 disturbed, in order to determine whether it would regress 

 spontaneously. The Wassermann reaction was practically nega- 

 tive. At the end of the fourth week (April 6) the lesion 

 along the upper incision had disappeared completely. Primary 

 healing had taken place along the line of excision of the gra- 

 nuloma removed for study ; however, one month later, six small 

 granulomata developed with some induration of the underlying 

 tissue. These gradually coalesced into one large yaw. The 

 appearance on May 25 is shown in the accompanying pho- 

 tograph (Plate 2, fig. 3). It was not pedunculated as might 

 possibly be inferred from the illustration. 



At this time there was no suggestion of any secondary lesions, 

 and the primary yaw had begun to regress gradually. On June 

 20 an area representing almost one quarter of the yaw had 

 practically healed along the upper edge of the yaw. Some 

 weeks later, however, there was a slight extension of the yaw 

 along its lower edge. The remainder of the body was entirely 

 free from any lesions of the skin. On July 13, a little more than 

 four months after inoculation, treatment with neosalvarsan was 

 commenced. 



On reinoculating these four cases with yaws the urine was 

 tested for arsenic biologically, using Penicilium brevicaule. 

 The results were negative, but the control tests were not entirely 

 satisfactory. However, neoarsphenamine is excreted rather 

 rapidly after intravenous injection. Moreover, the results in 

 these cases could hardly be explained by incomplete excretion of 

 arsenic. 



TREATMENT WITH SERUM 



In addition to these investigations on the effect of reinocula- 

 tion, some observations were made on the supposed beneficial 

 action of the serum of patients undergoing salvarsan treatment. 



