THE SPECIFIC CURE OF YAWS. 447 



CONCLUSION. 



Dioxy-dianiido-arsenobenzol appears to be an ideal specific for yaws. 

 Three or four days after the injection of the drug, the granulomatous 

 lesions begin to disappear and in the course of from ten to twenty days 

 they usually have disappeared entirely leaving a perfectly smooth, pig- 

 mented skin where the lesions previously existed. The absorption of 

 tumor masses measuring several centimeters in diameter and about a 

 centimeter in thickness in so short a time, and under the influence of no 

 local treatment whatever, has been very striking and surprising. Indeed, 

 in the severe cases the disappearance of the lesions and the cures produced 

 could be most aptly spoken of as marvelous. Even in cases where large 

 granulomatous masses or deep ulcerations existed, these were healed 

 within from two to four weeks. I do not know of any more striking 

 example in medicine of a specific action than of that produced by dioxy- 

 diamido-arsenobenzol on the lesions of yaws. 



A slight reddening appears about the margins of the lesions in from 

 twenty-four to forty-eight hours after the injection of the preparation. 

 The center of the lesion then usually assumes a purplish or bluish, con- 

 gested appearance. Phagocytes are attracted to this area which now 

 assumes a grayish or brownish hue. The spirochetes quickly disappear 

 and the granulomatous tissue becomes absorbed, leaving dark, pigmented 

 areas of skin which later resume their normal color. In the cases where 

 crusts have existed, these frequently are not absorbed, but drop off. 



As stated above, none of the cases have shown any signs of relapse, 

 although they received but a single injection, and over four months have 

 elapsed since most of them were inoculated. 



Nevertheless, I believe that in a few of the most severe instances of 

 the disease, where the ulcerations are extensive and of long standing, a 

 second inoculation given about three weeks after the first one may be 

 advisable. In a case of syphilis in a European who had been treated with 

 mercury and iodides, according to his statements, for two years, in which 

 the testicle was swollen to a diameter of about 15 centimeters and a large 

 ulcer measuring about 10 centimeters in diameter was situated on the 

 scrotum, 0.4 gram of dioxy-diamido-arsenobenzol was given by injection 

 into the buttocks. A very rapid diminution in the size of the testicle 

 and of the ulcer occurred during the following three weeks, but the ulcer 

 did not entirely heal nor did the testicle reach its normal size until a 

 second intravenous injection of 0.4 gram of the drug was given. Then 

 apparently a perfectly normal condition was brought about. Only in 

 Number IV of the yaws cases which I treated with this preparation was 

 there any question as to whether a second dose should have been given 

 and as to whether a second one might not have hastened the cure. 



