22.3 Goodpasture: The Histology of Healing Yaws 265 



from there to the epidermis where conditions of growth are 'sub- 

 sequently more favorable. 



However, following the first and yet undetermined lesion, 

 there are continued injury and reaction which result in a fully 

 developed papillary nodule. The architecture of the nodule is 

 well known, the essential feature of it being a small papule, 

 or papillary, frambcesiform granuloma, irregularly round or 

 oval, discrete or confluent, elevated a few millimeters to a centi- 

 meter or more above the surrounding skin, and covered in its 

 earlier stages by a soft yellow scab, beneath which is a granular 

 seropurulent, sometimes hagmorrhagic surface formed of elon- 

 gated papillae, almost reaching the exterior and bleading easily, 

 with thickened epidermis between. Later the surface is drier 

 and coated with keratinized epithelium. Microscopically the 

 epidermis is greatly thickened, swollen with fluid, infiltrated with 

 leucocytes distributed diffusely and as miliary abscesses. The 

 epithelium is prematurely desquamated and shows various de- 

 generative changes, later developing a hyperkeratosis. The 

 elongated papillae are cedematous, haemorrhagic, and infiltrated 

 with cells of various types, and deeper in the corium are dense 

 aggregations of mononuclear cells; in the earlier stages those 

 of the large lymphocytic type predominate, but later the ag- 

 gregations are composed almost entirely of plasma cells, a stage 

 which Unna(l3) described. Several observers note the absence 

 of vascular thickenings and of definite perivascular cellular in- 

 filtration in the corium, in contrast to cutaneous lesions of 

 syphilis. 



In the following descriptions the histological structure of 

 stages observed will be considered in detail with the changes 

 noted in them following treatment by intravenous injection of 

 neosalvarsan. 



MATERIAL AND METHOD 



Typical early secondary yaws of from one to four months' 

 duration were removed from four individuals before they had 

 received treatment. From one of these persons (case 1) a 

 second yaw, as nearly at the same stage of development as pos- 

 sible, was excised forty hours after intravenous injection of 

 neosalvarsan. From another (case 2) a second yaw was ex- 

 cised three days after treatment and a third seven days. Only 

 lesions removed before treatment were studied from the remain- 

 ing two cases of early yaws (cases 3 and 4) . 



