PROGNOSIS 



1559 



Italian emigrants returning from Brazil, and suffering from what 

 they considered to be boubas; but Splendore has shown their cases 

 to have been cases of leishmaniasis and blastomycosis. The fact 

 is, that in South America the term boubas is used by the natives to 

 cover several clinically similar diseases, while most medical writers 

 use the term as a synonym for framboesia. Rivas, Linderman, and 

 Robledo have found the T. pertenue in their cases of boubas in 

 Venezuela, Brazil, and Colombia. It is not to be excluded, how- 

 ever — in fact, it is probable — that future investigation will show 

 that there are several varieties of T. pertenue. 



Figs. 704 and 705. — Framecesia Before and Apter Ten Days' Treat- 

 ment WITH CaSTELLANI's MIXTURE. 



Cutaneous Leishmaniasis. — A type of cutaneous leishmaniasis 

 (Bush-Yaws), fairly common in the West Indies, may simulate 

 yaws, but the presence of leishmania bodies and absence of the 

 Treponema pertenue will clear the diagnosis. 



Prognosis.— The prognosis is not serious so far as life is con- 

 cerned. In 1908, in the Ceylon hospitals, 3,246 cases were treated, 

 wich twenty-three deaths; in 1904, out of 3,591 cases, sixteen died; 

 in 1903, out of 3,254 cases, ten only died. The prognosis is far more 

 serious in children than in adults. When the disease ends fatally the 

 termination is gradually due to secondary infection, the framboetic 



