68 The Philippine Journal of Science ms 



Fifty per cent of the cases of this series were under 15 years 

 of age; 75 per cent, under 20 years of age; and 90 per cent, 

 under 30 years of age. 



In the observations made by McCarthy, (17) in 1906, on the 

 prevalence of tertiary lesions in defined localities and among 

 certain classes of people, he gives the frequency of their occur- 

 rence and their description as follows: 



(1) Chronic thickening of the skin on the palmar surface of the hands 

 and soles of the feet. — The fissures in cases extended only partially through 

 the skin, were painless and dry, and caused no further discomfort than a 

 feeling of uncomfortable roughness over the affected parts. 



In others, the cracks extended down to the muscular layer, exuding a 

 sero-purulent discharge and were extremely tender on pressure. The 

 sensibility of the surface of these parts is greatly diminished. 



(2) Chronic indolent ulceration of various parts of the body. — These 

 ulcers varied in size from small ones to those of the size of a hand or 

 larger. When not associated with periostitis, the ulcers are painless and 

 heal slowly. When multiple, the general health is greatly impaired, anemia 

 and emaciation set in, and chronic invalidism is caused. Ankylosis caused 

 by cicatricial contraction of extensive ulceration on the flexer aspect of 

 joints has been observed in several cases. 



(3) Periostitis and osteitis are other sequelae frequently seen. — The shaft 

 of the tibia, radius, and ulna are the usual sites of these complications. A 

 swelling resembling a syphilitic node, appears over the shaft of the bones 

 involving all the tissues covering it. This is at first painless. As the 

 growth enlarges, the bones become thickened and the surface of the skin is 

 glazed and purplish, and pain on pressure is present. The skin in time 

 breaks down and troublesome ulceration results. When joints are affected, 

 usually the knee, finger, and elbow-joints, with this variety of the disease, 

 ankylosis results. 



Necrosis of the nasal and palate bones resembling the syphilitic affection 

 of this nature, have been seen in several cases. 



(4) Cartilaginous tumors on the elbow and knee joints have been observed 

 in nine cases. These tumors were painless, and caused no discomfort except 

 for their size and position. They were ascribed by the sufferers to an 

 antecedent attack of yaws. 



Rat, (29) Daniels, (13) and Boissiere reported cases with de- 

 struction of the nose and palate and discussed the probability of 

 these lesions being due to yaws. Boissiere also noted tibial in- 

 volvement, joint swelling, and dactylitis. 



Castellani(9) cites the sequelae of two cases as follows: 



Case 1. Young Singhalese girl of about 14 years of age. No history of 

 syphilis either congenital or contracted: five years of age suffered, together 

 with all other members of the family, from yaws and was treated in a 

 Government Hospital from which she was discharged cured a few months 

 later. She remained in till four months ago when she noticed a slight 

 indolent swelling on the right leg which increased in size and finally broke 

 out leaving a rather large ulceration. Two months later when I examined 



