438 STRONG. 



copper, with acid nitrate of mercury, and scraping with a curette, following with 

 igneous cauterization, gives good results. 



Firth states the first essential in the actual treatment of the attack to be the 

 cleansing of the patient by means of warm baths and soap. Special care must 

 be taken to avoid chills, as exposure to cold often causes a disappearance of the 

 eruption, accompanied by much constitutional disturbance. The food must be 

 nourishing, consisting of fresh meat, fish, rice, yams, and diluent drinks, combined 

 with medicinal tonics. Locally, disinfectant lotions of boric or carbolic acids, 

 or of corrosive sublimate, are of the first importance. The acid reaction of the 

 secretion from yaws tubercles has suggested the use of alkali as a local dressing. 

 Both Modder and Rat state that excellent results follow the use of lotions con- 

 taining either bicarbonate of soda or carbonate of ammonia of the strength of 

 ten grains to the ounce. Sulphate of copper is efficacious as a topical applica- 

 tion; so likewise are iodoform and weak nitrate of mercury ointment. The use 

 of mercury in this disease needs the Utmost care and supervision, as its abuse 

 has been largely responsible in the past for the severity and fatality of many 

 cases; it can not be regarded as a specific remedy for the disease, as it is for 

 syphilis, but, given in minute doses for a short time, mercury seems to act as 

 a beneficial alterative. Of other internal remedies, iodide of potassium with 

 arsenic is very valuable, while in some cases iron and sulphocarbolate of calcium 

 are of the greatest benefit. Arsenic is very successful in the cases in which the 

 eruption is badly developed or scaly, as in the pian darte variety. When the feet 

 and hands are affected, prolonged soaking in hot water is often required in order 

 to soften and remove the thick epidermis; the exposed yaws growth can then 

 successfully be treated on the lines indicated above. During convalescence iron 

 and arsenic should both be administered over long periods; while in all stages 

 of the affection perfect cleanliness and the best hygienic conditions are needed, 

 both for the sake of the sick and of those brought into contact with them. 



Woolley recommends potassium iodide internally and local applications of 

 bichloride of mercury followed by iodoform. 



Daniels states that probably no drug influences the duration of the disease. 

 Mercury and arsenic certainly do not. Potassium iodide is uncertain in its 

 action. The eruption will sometimes disappear rapidly when iodides are given, 

 but even in such cases when the use of the drug is continued, fresh eruptions 

 appear. The use of iodide is therefore limited. Local applications that merely 

 serve to keep the granuloma clean are valuable, but escharotics and irritants, 

 although they may destroy the yaws, are likely to cause the formation of scars. 

 The painful granulomata on the feet are best removed by the action of nitric 

 acid, acid nitrate of mercury, or silver nitrate. 



From this summary of the literature of the treatment of the disease, 

 it appears that a number of eminent authors regard its local treatment 

 as very important, and that even the most successful drug (potassium 

 iodide) frequently fails to produce a cuTe, and that in many cases the 

 treatment of yaws, to be successful, must be a very prolonged one. 



SPECIFIC TREATMENT OF TAWS. 



A few months ago, through the kindness of Professor Ehrlich, I 

 received a shipment of dioxy-diamido-arsenobenzol 4 for use for experi- 

 mental purposes in syphilis. 1 take great pleasure in publicly acknowl- 



1 (NH, . OH . C 6 H 3 . As : As . C H 3 . OH . NH 3 ) . 



