﻿4 74 MARSHALL. 



leave a wide margin of difference. The differences are that the degener- 

 ation in yaws is confined to the epithelium, the spirochsetse being found 

 in the degenerating areas, while the changes in the cutis are unimpor- 

 tant; that there is no periarterial or endarterial change in yaws; that the 

 infiltrating cells at the early stage of the nodule are different from those 

 in syphilis; and that there are no areas of necrosis and no giant cells 

 in yaws, with the exception of the cases described by G-logner. The 

 clinical appearance of yaws is so characteristic that it is surprising to 

 find how closely the histological description agrees with that of the 

 syphilide. It will be important to make a comparative study of the 

 yaws papule and cond} T loma, examining lesions of the same ages, and 

 using the silver impregnation method in the demonstration of the 

 parasites. The claim is made that syphilis attacks primarily the cutis, 

 while yaws, as we have seen above, is essentially a disease of the 

 epithelium. 1 



1 In an article which has recently arrived, Sehiiffner [Miinchen. med. Wchnsch. 

 (1907), 54, 1364) reviews one hundred and twenty-nine cases of yaws seen in 

 Sumatra, and for the sake of completeness his article is abstracted. In one 

 hundred and four cases he found the treponema, and of those cases examined 

 more than once he found it in 98 per cent. The Ronianowsky stain, or some 

 modification, proved most satisfactory, especially when preceded by osrnie acid 

 or formalin vapor fixation. By the use of Levaditi's silver stain he found that 

 the parasites occurred only in the diseased portion of the epidermis, especially 

 in the deeper layers of prickle cells, and in this situation they were often 

 extremely abundant. They were entirely absent elsewhere, notably in the peri- 

 thelial situation common in syphilis. 



While syphilis and yaws are closely parallel, he is convinced that yaws is an 

 independent affection. 



He gives a brief review of the histologic appearance, but of particular interest 

 is his careful description of unusual skin manifestations in yaws. Under this 

 heading he describes ring-shaped or kidney-shaped efflorescences and others which 

 are impetiginous or vesicular. In others there was a definite roseola. In more 

 than one-fourth of his cases there was a peculiar, macular eruption in which 

 rounded spots from 1 to 3 centimeters in diameter were surrounded by minute 

 papules, often becoming vesicular. Of especial interest is his description of the 

 bone and joint pains in yaws, which he found to occur in 20 per cent of eases 

 in adults. Periostitis was also very common. He thinks from his studies of 

 yaws that as the result of further investigation and discrimination "syphilis 

 will be dissolved into a group of independent diseases." 



