446 STRONG. 



arms, chest, and legs. They consist of papules measuring from about 3 to 6 milli- 

 meters in diameter and raised for a distance of 3 to 4 millimeters above the 

 surrounding skin. A few are covered with yellow crusts. The patient was 

 given an injection of 0.4 gram of the preparation. After 18 days the skin was 

 perfectly smooth, and only dark pigmented spots remained where the papules had 

 formerly existed. He since has remained well. 



Case XXIV. — Pablo; age 14 years; duration of the disease 2 J years. The 

 patient has been treated at St. Luke's Dispensary for 1* years. The condition 

 was formerly diagnosed "fungus foot." At St. Luke's Dispensary he has treated 

 with mercury and iodides internally, and locally with mercurial ointment, 

 bichloride of mercury, lysol, Peru balsam, silver nitrate and permanganate of 

 potash dressings. The lesions were also cauterized and curetted on several occa- 

 sions. Very slight improvement followed all of this treatment. When seen by 

 the author the lesions were confined to the right foot and ankle. Above the 

 external malleolus there were four ulcerating granulomata measuring from 1 to 

 1.5 centimeter in diameter. Over the dorsum of the foot there was a large 

 ulcerating granulomatous mass measuring about 6 centimeters in diameter. The 

 greater part of the sole of the foot was also occupied by a larger ulcerating mass, 

 the margins of which were very irregular in outline. Spirochaetas were found 

 in several smears from the ulcerating granulomata. A diagnosis of tertiary yaws 

 was made, and the patient was injected with 0.35 gram of the preparation in 

 the usual manner. Before this treatment he had complained of much pain in the 

 foot. Six days after the injection he stated that the pain had entirely dis- 

 appeared. He was seen occasionally by his physician during the next two weeks 

 who reported that a very great improvement had taken place in the condition of 

 the foot, and that the lesions were rapidly healing. He was not seen by the author 

 until li months after the injection. At this time the lesions which existed 

 formerly had entirely disappeared. Where the ulcer and granulomata formerly 

 had been present, only firmly contracted scar tissue remained. Above the external 

 maleolus patches of pigmented skin were present. The patient since has remained 

 entirely well. 



Case XXV. — (Plate XIV.) Juan, age 16. Duration of the diseases 3 weeks, 

 during which time he has been treated with Chinese medicine containing iodides but 

 with no favorable result. Denies syphilis. No sore or scar on penis. The lesions 

 are situated on the forehead, cheeks, nose, upper lip, chin, neck, chest, abdomen, 

 scrotum, shoulders, arms, forearms, palms of hands, thighs, knees, legs, ankles 

 and feet; and posteriorly over the neck, shoulders, back, arms, elbows, forearms, 

 buttocks, legs and ankles. The distribution is almost universal, although the 

 lesions are more marked on the face and upper portion of the trunk. They 

 consist of papules measuring from about 3 millimeters to one centimeter in 

 diameter ; the largest are situated on the face. They are sharply circumscribed, 

 the largest ones raised for a distance of 3 to 4, the smallest for a distance of 

 1 to 2 millimeters above the surface of the surrounding skin. On the face and 

 on many parts of the chest the papillary tumors are covered with yellow crusts. 

 Elsewhere the papules are slightly reddened, with dry surfaces. Smears from 

 the papules show numerous spirochaeta?. For the character and distribution of the 

 lesions see Plate XIV. 



The patient was given an injection of 0.38 gram of the preparation in the 

 buttocks in the usual way. The spirochaetaB had disappeared from the lesions 

 three days later. The lesions gradually disappeared ; after twenty days the skin 

 was clear, as may be seen by Plate XIV. The patient since has remained well. 



