xiii, b, * Guerrero et al.: Treatment of Yaws 195 



body. She complained of pain in the bones and joints, but no swelling was 

 found. She stayed in the hospital twenty-three days and took 66 doses. 

 When she was discharged, all the eruptions had completely healed. The 

 last three cases were relatives living in one house. Their infection seems 

 to originate from the visitor mentioned in case XL 



Case XIV. — F. 0., male, 8 years old. He developed secondary yaws nine 

 months ago. On examination there were found secondary lesions, espe- 

 cially on the penis and about the anus, and an ulcer with granulomatous, 

 irregular border on the left internal malleolus. The diagnosis was tertiary 

 yaws. Thirty doses produced complete cicatrization of the ulcers. 



Case XV. — E. C, female, 42 years old, had yaws in 1898. At the time 

 of the examination she presented an ulcer on the posterior surface of the 

 right forearm below the elbow. The surface of the ulcer was granular and 

 was covered with fetid, purulent grayish secretion. It measured about 8 

 centimeters in its longest, and 5 centimeters in its shortest, diameter. It 

 began as an induration of about 0.5 centimeter. It gradually increased in 

 diameter to about 3 centimeters. The diagnosis was tertiary yaws. The' 

 ulcer healed without local treatment after the patient had received 30 doses 

 of Castellani's mixture. 



Case XVI. — I. P., female, 30 years old, had had yaws at the age of 7 

 years. About three years ago she was hit on the right knee. A nodule 

 appeared on this knee. Later it became an ulcer with deep, irregular 

 borders and fetid yellowish gray secretion. The joint was swollen and 

 painful, incapacitating the patient for walking. The diagnosis was tertiary 

 yaws. She was given 36 doses of Castellani's mixture, and the ulcer 

 completely healed. 



The treatment of Castellani undoubtedly exerts a curative in- 

 fluence on the various manifestations of framboesia. In six or 

 seven days of treatment the granuloma takes on a livid appear- 

 ance, becomes surrounded by a pinkish halo, and begins to flatten. 

 The crust dries and gradually disappears, leaving a macule that 

 eventually disappears. In deep and extensive ulcers cicatriza- 

 tion takes place gradually and concentrically, the entire process 

 lasting from fifteen to thirty days. Pain in the bones, pain and 

 swelling of the joints, and pruritus are relieved early in the 

 treatment, although sometimes the pain in the bones and joints 

 recurs even after complete healing of the lesions. 



The relapses and incomplete recovery observed in some cases 

 are to be ascribed to an incomplete medication, due to the sus- 

 pension of treatment before the destruction of Spirochxta per- 

 tenuis was complete. Some of our cases discontinued the treat- 

 ment after the disappearance of granulomata and ulcers ; while 

 others, who were not under our direct supervision, could take 

 only a few doses irregularly. We were not able to supply the 

 patients with the adequate amount of the medicine, because 

 the experiments were carried out in neighboring towns, where 

 we had to distribute the preparation gratis. On the whole, the 



