xni, b, 2 Maul: Bone and Joint Lesions of Yaws 71 



during the next four years. During this period of her illness 

 the soft tissues of the middle finger of her left hand became 

 contracted and the finger could not be extended, the external 

 lesions had become large ulcers, and the bone and joints of 

 both extremities were so painful that she suffered constantly. 

 In 1915 she was admitted to a hospital in Manila in a helpless 

 condition. During the two years she remained there the con- 

 dition was but little relieved, and upon returning to her home 

 she became entirely helpless from the pain she suffered. The 

 ulcerations were deep and painful and emitted a foul odor of 

 decomposition. 



When the patient was seen in February, 1917, she weighed 

 22.68 kilograms (50 pounds) and was 1.1 meters (3.5 feet) in 

 height. There were large areas of scar tissue and of ulceration 

 involving the greater part of the lower extremities. She was 

 badly emaciated and ansemic and cried continuously when she 

 attempted to walk or move about. An X-ray survey of all the 

 bones of her body was made and a total of 52 bone lesions, 

 including those on the articular surfaces, was found. She was 

 given the Castellani treatment in full doses three times a day, 

 one-half hour before meals. She continued to take the treat- 

 ment regularly for the next two months, but still suffered from 

 the bone and joint pains. The X-ray pictures taken at this 

 time showed very slight improvement of the bone and joint 

 lesions. She was then given 0.4 gram of salvarsan intravenously* 

 The relief of the symptoms was as marvelous as in the cases 

 cited by Strong in his work on cutaneous yaws, (33) in 1910, and 

 the change in the bone and joint lesions became manifest ra- 

 diographically within a month's time. No more salvarsan was 

 given, but the Castellani treatment was continued until July 1, 

 1917, when the X-ray pictures showed almost complete regenera- 

 tion of the bone where the lesions had been. At first the lesions 

 showed a lessened degree of translucency, then a diminution 

 in size, and later a return of the cancellous-tissue appearance. 



During the treatment she had persistent thirst, some saliva- 

 tion, and nasal catarrh, but no gastric disturbances. 



CASE 4 



D. S., Filipino, 7 years old. The primary lesion was on the 

 neck, in June, 1915. One month later the mother yaw began 

 to disappear, and a general secondary eruption followed after 

 a short febrile period. As the secondary eruption disappeared, 

 rheumatoid pains appeared in several of the joints. 



When the case was first seen on February 10, 1917, the right 



