436 STRONG. 



of having had yaws five years before. However, it appears that the observer would 

 hardly be justified in drawing definite conclusions in regard to the diagnosis 

 of this case since the lesions might have been those of syphilis. 



Until we have more information on the question of the complement 

 binding reaction, it would be unwise to draw any absolute conclusion from 

 the result of the experiments with it in relation to yaws and syphilis. 



However, from the other data submitted it is believed that the specificity 

 of yaws as a disease has been shown and it is not deemed necessary 

 here to present further the evidence based upon clinical and pathologic 

 observation. 



TREATMENT FORMEKLY RECOMMENDED. 



The consensus of opinion of those who have had a wide personal 

 experience with yaws is that the treatment of the disease is usually 

 unsatisfactory. 



Manson writes : 



All are agreed as to the propriety of endeavoring by good food, tonics and 

 occasional aperients to improve the general health. Most are agreed as to the 

 propriety of endeavoring to procure a copious eruption by stimulating the func- 

 tions of the skin by warm demulcent drinks ; by a daily warm bath with plenty 

 of soap; and, during the outcoming of the eruption, by such diaphoretics as 

 liquor ammonia; acetatis, guaiacum, etc. Confection of sulphur is also recom- 

 mended as a suitable aperient; it may be taken frequently in the early stages 

 of the disease. All are agreed as to the propriety of avoiding everything — such 

 as chill — tending to repress the eruption; warm clothing is therefore indicated. 

 Many use mercury, or potassium iodide, or both, after the eruption is fully de- 

 veloped. These drugs have undoubtedly the power of causing the eruption in 

 yaws to resolve. Some practitioners rarely use them, or, if they do so, only at 

 the latest stages of the disease considering that relapses are more prone to occur 

 after their too early employment. Mercury, owing to its proneness to cause 

 anaemia, is less frequently employed than potassium iodide. Where the eruption 

 is persistently squamous, or papular, arsenic is frequently prescribed. Some 

 touch the yaws with sulphate of copper; some apply nitrate of mercury ointment; 

 others iodoform ointment; others leave them alone, confining their local measures 

 to the enforcement of cleanliness. When the soles of the feet are attacked, the 

 feet ought to be soaked in warm water to soften the epidermis, which should 

 then be cut away sufficiently to liberate the subjacent yaw. Ulceration must 

 be treated on ordinary principles. During convalescence, iron, arsenic and quinine 

 are indicated. 



Scheube favors internal treatment with mercury and iodide, and states that 

 Schuffner has communicated to him that the small number of cases which do 

 not yield to such treatment are usually very favorably influenced by Zittmann's 

 decoction. After antisyphilitic treatment, arsenic is recommended, particularly 

 in weak and anaemic patients. Local solutions of sublimate, and touching with 

 carbolic acid, nitric acid, mercuric nitrate, copper sulphate, silver nitrate, appli- 

 cations of tincture of iodine, iodoform ointment or oil, and mercuric salve are 

 recommended. In cases with excrescences of long duration, curetting with a 

 sharp spoon, or removal with the scissors, is also advised. Scheube mentions that 

 Mense found a watery paste of bismuth subnitrate most successful for local 



