THE SPECIFIC CURE OF YAWS. 437 



application, while Hirsch recommends one part of lactic acid and eight parts of 

 nitrate of mercury ointment for this purpose. 



Plehn states that mercury and iodide should in all cases be tried. Cauteriza- 

 tion of the lesions with a hot iron or sharp curetting of them is not recommended. 

 Bismuth paste is preferred for local treatment. In native children calomel powder 

 is advised for internal administration several times daily in doses of 0.002 to 0.01 

 gram, according to the age. In case the eruption is not too extensive, it is 

 recommended to cover the lesions with calomel powder or grey salve. Painting 

 with a thin paste of calomel and salt water is also advised. For ulcerating 

 granulomata about the lips or corners of the mouth an alcoholic sublimate solution 

 1 to 100 or 20 to 30 per cent chromic acid solution is recommended. A contin- 

 uation of the treatment after disappearance of the lesions, in order to prevent 

 their return is not thought to be necessary. 



Castellani states, the long duration of frambcesia and its great contagiousness 

 render it a serious malady. Patients suffering from it are unable to attend 

 to their work. In Ceylon the majority of European practitioners use mercury 

 and potassium iodide. Others affirm these drugs to be quite useless, and believe 

 that cleanliness and good and abundant food are quite sufficient to bring about 

 a cure. In Castellani's clinic the conclusion arrived at was that potassium iodide 

 was the most effective- means of treatment. He states that some cases may 

 recover spontaneously, but this is certainly the exception, not the rule. The 

 potassium iodide should be given in large doses; in adults, 15 grains (1 gram) 

 and in children 5 grains (0.33 gram), three times daily. Occasional eases are 

 met with refractory to treatment, and tertiary lesions are often intractable. 

 Mercury is of very little use as a rule. In some very stubborn cases a course 

 of potassium iodide, followed by one of atoxyl injections is recommended. Cas- 

 tellani further states: — 'An important point often overlooked by the practitioner 

 is that the treatment should be prolonged for a considerable time after the com- 

 plete disappearance of the eruption, inasmuch as clinical experience, as well as 

 experiments on inoculated monkeys, prove that the specific treponemata may, 

 and do persist in the lymphatic glands and internal organs long after the cutaneous 

 manifestations have disappeared. Local treatment consists chiefly in keeping 

 the skin scrupulously clean, washing the eruption twice daily with a perchloride 

 of mercury solution (1 to 1,000) which greatly allays the itching. The ulcerated 

 lesions niay be dusted with iodoform, euruphen, or boracic acid. Mercury oint- 

 ments may be beneficial, but in our experience are not sufficient to hinder second- 

 ary pyogenic infections. Caustics are not called for unless the ulcers become 

 phagedenic. In such cases pure carbolic acid is best. Though the external 

 treatment may be useful, one must bear in mind that it is not. as a rule, sufficient 

 alone to cure the disease.' 



Jeanselme believes that mercurial treatment has a certain influence upon yaws, 

 but it does not prevent relapses. The author treated sixteen children from 3 to 

 12 years of age with mercury. They took regularly during fifteen days from 

 two to four teaspoonfuls of "liqueur de Van-Swieten," according to the age of the 

 child. The lesions dried up rapidly, and became covered with thin, sulphur-yellow 

 crusts. When the author was obliged to terminate the experiment, Ave of the 

 patients had a clear skin; the lesions in nine patients were visibly ameliorated; 

 only two of the children did not receive any benefit from the treatment. Dressings 

 and lotions of sublimate are said to influence very favorably the eruption. Jean- 

 selme states that potassium iodide employed in the same doses as in syphilis has 

 an unquestionable action upon yaws. It causes the eruption rapidly to recede. 

 In obstinate cases cauterization of the vegetative ulcerations with sulphate of 



