278 The Philippine Journal of Science i»23 



This evident widespread injury to polymorphonuclears re- 

 sulting in local disintegration and rapid phagocytosis is worthy 

 of some comment. One would not expect the mere subsiding 

 of the inflammatory process to result in a rapid degeneration of 

 leucocytes without the introduction of some injurious element. 

 The sudden death and destruction of treponemata with the lib- 

 eration of hypothetical toxic products could hardly account for it, 

 for the injury seems to be limited to polymorphonuclears and to 

 small lymphocytes lying in the center of immature follicles in 

 the corium, and affects the former equally, whether in the epi- 

 dermis or deeper in the skin. Necrosis of them tends also to be 

 more marked about some of the smaller blood vessels of papillae, 

 although conspicuous also within the epidermis. The question 

 naturally arises whether neosalvarsan itself may not exert a 

 selective injury upon these cells, and this seems the more-prob- 

 able explanation. In the fresh yaw, with continuous acute 

 exudate through dilated and injured vessels, conditions seem 

 suitable for a direct action of the drug on leucocytes in the 

 tissues. 



The thought arises that such local disintegration of polymor- 

 phonuclears may be favorable to the destruction of treponemata, 

 for it is to be noted in sections of early untreated lesions that 

 these organisms are diminished very greatly in number in older 

 miliary abscesses where disintegration of leucocytes is pro- 

 ceeding. Phagocytosis of treponemata by these cells I have 

 not observed, but they do appear to be effective against the 

 organisms in some degree. 



With the removal of fluid and cellular exudate the epidermis 

 becomes more compact and transparent. The yellow opacity 

 of the untreated fresh yaw is due to its content of leucocytes, 

 and when these disappear the surface becomes gray and semi- 

 transparent, so that the bright color of the circulating blood 

 is rendered visible, for in the early stage of healing there is 

 very little epithelial pigment. In the corium, aside from de- 

 struction of leucocytes and, to a lesser extent, of lymphocytes 

 about the vascular center of immature follicles, and active 

 phagocytosis of their remains, little is to be observed follow- 

 ing treatment. The removal of plasma cells and other mono- 

 nuclear-cell exudate is a very gradual process and is not 

 noticeable within the periods after which lesions were removed. 

 There seems to be a greater degree of hyalinization of plasma 

 cells and a diminution in the oedema. Very quickly (by the 

 seventh day after treatment) pigment-containing connective- 



