THE SPECIFIC CURE OF YAWS. 441 



papules shows spirochetal. This child had been treated previously with native 

 remedies but with no favorable results (see Plate III). He was given an 

 injection of 0.25 gram dioxj'-diarnido-arsenobenzol dissolved in 20 cubic centimeters 

 distilled water, one-half of the amount being injected deeply into each buttock. 

 Nine day's later the lesions had completely disappeared, as may be seen from 

 Plate IV, which was taken at that time. The skin was then everywhere clean 

 and smooth, and only pigmented patches, more marked on the legs and arms, 

 remained as an evidence of the pre-existing lesions. There has been no relapse, 

 and the patient since has remained entirely well. 



Case III. — (Plates V and VI.) Fausto; male, age 9 years; states duration of 

 the disease about two months. The lesions are situated on the forehead, neck, 

 shoulders, left arm, at the bend of each elbow, forearms, thighs and legs, and 

 posteriorly over the back, buttocks, thighs, popliteal spaces, legs and ankles. 

 They consist of granulomatous tumors and papules sharply circumscribed, meas- 

 uring from about 4 or 5 millimeters to about 4 centimeters in diameter. On 

 the forehead and neck the lesions measure about 4 centimeters in diameter, and 

 are distinctly granulomatous and raised for a distance of about 0.5 centimeter 

 above the surrounding skin. The same character of lesion, although smaller in 

 diameter, occurs at the bend of the elbows and over the region of the left popliteal 

 spaces; elsewhere the lesions are more distinctly papular in character. On the 

 left heel is an ulcerating granulomatous lesion (see Plate V). A smear from 

 one of the papules shows spirochsetae. There are two other members of this boy's 

 family afflicted with yaws, the father and brother. The brother's condition is 

 reported as Case No. IV. The present patient was injected with 0.3 gram of 

 dioxy-diamido-arsenobenzol in 20 cubic centimeters distilled water, the injuction 

 being given into the buttocks in the usual manner. Nine days later the lesions 

 had practically disappeared. Dry, scaly patches remained in the left popliteal 

 space, and anteriorly at the bend of the elbows and over one spot on the neck. 

 The lesion on the left foot was covered by a clean scab. These scaly patches had 

 disappeared, and the ulcer on the heel entirely healed, five days later. (See 

 Plate VI.) The case since has remained entirely well. 



Case IV. — (Plates VII and VIII.) Enrique; age 4 years; brother of Case III; 

 duration of disease 2 years. The lesions are situated particularly about the 

 lower lip and chin, the right axilla, bends of the elbows, forearms and thighs, 

 and posteriorly in the right axillary fold, at the bends of the elbows, the gluteal 

 fold, buttocks, popliteal .spaces and legs. They consist of ulcerating granulom- 

 atous masses measuring 5 or 6 centimeters in diameter, raised in some instances 

 a centimeter and a half above the surrounding skin, and partially covered 

 by yellow crusts. There are large scars over the back of the legs, right thigh, 

 ankle, and numerous small pigmented patches on the legs, arms and a few on . 

 the chest, the results of healed lesions (see Plate VII). Smears from the 

 ulcerating lesions reveal several forms of bacteria and spirochoeta?. The patient 

 was given an injection of 0.28 gram of dioxy-diamido-arsenobenzol. Nine days 

 later a very remarkable change had taken place in the lesions. These on the 

 arms and legs were very greatly reduced in size, but had not entirely disap- 

 peared. However, the appearance of the remaining lesions was entirely unlike 

 that of granulomata, they being composed mostly of contracted scar tissue. The 

 lesions about the mouth had almost disappeared, a thin scab being visible on 

 the chin. Some of these changes may be noted in the photograph, Plate VIII, 

 fig. 1. Unfortunately, the photographer had not another plate with him so that 

 no posterior view of the patient could be taken at this time. The patient was 

 seen twelve days later and again examined and photographed (see Plate VIII, 

 figs. 2 and 3). The lesions were then almost healed with the exception of a 



