22,3 Sellards: Public-health Aspects of Yaws 255 



field equipment is probably an individual question and might 

 well be allowed to vary according to local conditions. It is 

 certainly superfluous for the diagnosis and treatment of the 

 ordinary granulomatous stage, being indeed without value as 

 a guide in the immediate effect of treatment. The Wasser- 

 mann reaction is of distinct value in eliminating some of the 

 nonspecific ulcers which would not be benefited by salvarsan. 

 As a means of diagnosis the more practical procedure could 

 be substituted of the therapeutic test of injecting salvarsan. 

 Unfortunately this procedure is slow, and the results are often 

 masked by the extensive secondary infection. The employment 

 of the Wassermann reaction requires at most only one addi- 

 tional member in the personnel and adds immeasurably to the 

 satisfaction of the work. 



TREATMENT 



No difficulty whatever exists in deciding upon the remedy 

 which is most suitable for field use. Neosalvarsan at present 

 stands alone in its efficacy, its relative ease of administration, 

 and its availability. Nevertheless, it is a powerful agent and 

 must be employed judiciously by medical men, or under 

 their immediate personal supervision. From the viewpoint of 

 modern hospital practice, intravenous injection is often re- 

 garded as the ideal attainment in therapy. Indeed, to many 

 it would seem to be a step backward to suggest oral adminis- 

 tration in place of intravenous injection. However, a drug 

 which is efficacious only when injected into the tissues of the 

 body suffers a very real limitation in its general use even in 

 a modern community. For example, the control that exists 

 over malaria to-day in the better-regulated communities would 

 be greatly hampered if quinine could be administered only by 

 injection by trained individuals. 



The various salvarsan preparations fall short of the ideal 

 in this requirement for they are not sufficiently efficacious when 

 administered by mouth for the practical treatment of yaws. 

 Brochard(4) reported fairly successful results in the treatment 

 of nine cases of yaws with old salvarsan administered by mouth. 

 Recently Doctor Albert, in association with Doctor Rosal at the 

 Philippine General Hospital, has tested the oral administration 

 of salvarsan in the treatment of yaws. Neosalvarsan given 

 in dilute solution in daily doses of 60 milligrams was borne 

 without serious nausea by children of 12 years of age. After 

 a week of treatment no noticeable improvement had occurred. 



