TERTlARViOR LATE STAGE 



1555 



denied by many observers, but having been able to watch cases for 

 several years through the whole course of the disease, we have no 

 doubt as to their existence. Sometimes the secondary and tertiary 

 stages merge into each other, but 

 frequently the tertiary symptoms 

 appear after the lesions ^of the 

 secondary stage have undergone 

 complete involution. The interval 

 of time varies considerably in length, 

 and may extend to many years. The 

 characteristic lesions of the tertiary 

 period are gummatous-like nodules 

 .and deep ulcerative processes. These 

 gummatous nodules may develop in 

 any tissues. When developed in the 

 skin and subcutaneous tissues, they 

 are indolent, and by their softening 

 and breaking down ulcers are pro- 

 duced which may occasionally present 

 clear-cut margins and a granulating 

 fundus, and when several contiguous 

 nodules break down, serpiginous ulcers 

 are left. In other cases deep, irregu- 

 larly shaped ulcerations with very 

 thick and undermined edges are seen; 

 in others — and these are the more 

 numerous — ^large fungating ulcers are 

 present. On healing, these various 

 ulcers leave whitish scars, which are 

 often thick and disfiguring. Fre- 

 quently the scar-tissue undergoes re- 

 traction, and thereby causes per- 

 manent contractures and disfigure- 

 ment. Lesions of the osseous type 

 are very frequent, painful nodes 

 developing under the periosteum of 

 several bones, ribs, sternum, etc., 

 and we are inclined to believe that 

 Gangosa (p. 1876), an ulcerative 

 •condition of the palate, nose, and 

 pharynx, is in reality a tertiary mani- 

 festation of yaws. In other cases a 

 diffuse chronic periostitis is present, 

 altering the normal shape of the 

 ^ones. Contractures of various groups 

 of muscles are frequently seen. 

 Tertiary affections of the internal 



•organs and of the central nervous system seem to be rare. Cases 

 of aneurysm considered to be of framboesial origin have ' been 



Fig. 701. — Frambcesia; 

 Tertiary Stage. 



