1558 



FRAMBCESIA TROPICA 



common to both countries. In Samoa, according to Turner, syphilis 

 was unknown up to at least 1880, while framboesia has been endemic 

 there ever since the group was discovered. In Fiji, too, up to a few 

 years ago syphilis was not present, while framboesia was almost 

 universal. Daniels has made the interesting observation that in 

 British Guiana framboesia of late has disappeared, while syphilis 

 is still rampant. As regards clinical features, framboesia differs 

 from syphilis by the following characters: the primary lesion is, 

 as a rule, extragenital; the principal type of eruption is a papule, 

 which proliferates into a characteristic framboesiform granulo- 

 matous growth; there is an extremely well-marked pruritus. The 

 disease is apparently not hereditary; in fact, in contrast to syphilis, 

 parents generally contract the malady from their children. The 

 histopathology differs also in the two diseases. In framboesia the 

 proliferative changes of the epidermis are much more marked, the 

 granulomata present a more diffuse plasma cell infiltration, and 

 their bloodvessels have no tendency to the thickening of their walls. 



Fig. 703. — Frambcesia: Tertiary Stage. 



which is so characteristic of syphilis. Giant cells are generally 

 absent. Naturally these differential histological details must be 

 considered collectively, as there is no individual histological char- 

 acter which exceptionally might not be present in both syphilis 

 and framboesia. 



Boubas and Pian. — Some of the older authors believed that under 

 the names of yaws, boubas, and pian three different diseases were 

 indicated. All those, however, who have had opportunity to in- 

 vestigate framboesia in different parts of the tropics have come 

 to the conclusion that these various denominations are simply local 

 synonyms indicating the same pathological entity, though, of course, 

 each of these terms is sometimes used by natives to indicate, 

 besides framboesia, other clinically similar conditions. Comparative 

 experimental investigations made by one of us have led to the same 

 result, inasmuch as he has been able to demonstrate that monkeys 

 successfully inoculated with Ceylon framboesia become immune to 

 boubas and pian, and vice versa. 



Breda and De Amicis, in Italy, have not found T. pertenue in 



