xiii, b, 2 Maul: Bone and Joint Lesions of Yaws 75 



the joints involving the shoulders, elbows, hips, and knees and 

 the phalangeal joints of the fingers and toes. At the time he was 

 seen, February 10, 1917, he was entirely well, except that his 

 right heel was painful. The X-ray pictures showed only one 

 lesion in the os calcis. The case could not be followed. 



CASE 22 



R. C, Filipino, 15 years old. The primary lesion was on the 

 left knee in 1905. The secondary lesions appeared a few months 

 later and persisted until 1913. No treatment was given. The 

 secondary lesions gradually disappeared, but the mother yaw 

 did not heal. From this time the bones and joints of the lower 

 extremities became painful, and by August, 1916, he was unable 

 to walk. He was in this helpless condition when I saw him on 

 February 25, 1917. The X-ray pictures showed a total of 18 

 lesions, involving the os calcis, scaphoid, tibia, fibula, and the 

 articular surfaces of the tibia and femur on the right side and 

 the os calcis, tibia, fibula, and the articular surfaces of the bones 

 of the knee joint on the left side. After one month's treatment 

 by the Castellani mixture he was able to walk with considerable 

 ease. The case failed to come for further treatment and could 

 not be followed. 



Cases 10, 11, 12, 20, 21, 23, 24, 25, 30, and 31 are of minor in- 

 terest and are only referred to in Table I. 



CONCLUSIONS 



1. The majority of cases of yaws with bone and joint in- 

 volvement shows characteristic X-ray lesions. 



2. The radiograph can be used as an additional means of dif- 

 ferentiating yaws from syphilis, when there is involvement of 

 the bone, and as a confirmation of the evidence that the two 

 diseases are distinct. 



3. The pains complained of in the joints are due, in most part, 

 to the presence of the lesions on the articular surfaces. 



4. Twenty per cent of patients infected with yaws develop 

 bone or joint lesions when not treated. 



5. Regeneration of the bone is complete at the site of the 

 lesion, if the destruction has not been too great. 



6. The Castellani treatment causes a gradual disappearance 

 of the bone and joint lesions. 



7. Salvarsan is a specific in these cases, and rapid regenera- 

 tion of bone follows its use. 



I wish to express my appreciation to Doctors Crowell, Guer- 

 rero, Fernandez, Domingo, and Argiielles for their help and 



