74 The Philippine Journal of Science ms 



meters in diameter, in the form of a large round ulcer with more 

 or less irregular edges and elevated granulating surface, from 

 which an abundance of serum could be expressed. Examination 

 of this serum showed twenty or more Treponema pertenue to 

 every field. One cubic centimeter of this serum was taken from 

 this lesion for inoculation of animals. In the latter part of Oc- 

 tober, 1916, the secondary eruption appeared on the face, scalp, 

 neck, abdomen, and vulva. When the patient was admitted 

 to the hospital, these lesions were nearly all circular in outline, 

 although a few of the lesions on the face were more or less 

 elliptical. They were raised from the surface and covered by 

 a thick, hard yellowish crust. Removal of the crust left a 

 raw, granulating surface. Some of the lesions of the face and 

 abdomen were flattened out and deeply pigmented at the edges. 



The pains in the bones and joints started in December, 1916, 

 and gradually became more and more intense, until she could 

 hardly walk. The phalangeal joints of the fingers were swollen 

 and painful. No other joints were swollen, but pressure on the 

 bones and other joints produced intense pain. There was no 

 fever nor headache. 



Rontgenograms of her hands were at this time taken by Doc- 

 tors Fernandez and Argiielles, and an abundance of lesions 

 was present in all the bones. The Castellani treatment was 

 given to her by Doctor Guerrero until she left the hospital. I 

 saw the case again on February 25, 1917. The external lesions 

 were healed, but she still complained of pains in the bones. She 

 had continued to take the Castellani treatment rather irregularly. 

 She was induced to take her medicine as prescribed until March 

 2, when it was learned that she refused to continue with the 

 treatment. Nevertheless she readily submitted to treatment by 

 salvarsan, and 0.4 gram was given intravenously on March 4. 

 The X-ray pictures taken on the same day showed no changes 

 from those taken in February at the hospital. There was a 

 total of 113 lesions. By the end of the second week, after this 

 injection, the patient was entirely relieved of pain. In April 

 the X-ray picture showed a very definite regeneration of the 

 bone at the sites of the lesions. By the early part of July 

 only a few places could be recognized where the lesions had 

 existed. 



CASE 9 



R. F., Filipino, 16 years old. The primary lesion occurred 

 on the right knee in September. 1911. The secondary eruption 

 appeared one month later and gradually disappeared without 

 treatment. He stated that in 1914 he suffered with pains in 



