TREATMENT 



1563 



To Europeans it is advisable to give half doses, as they do not stand 

 full doses so well as do natives. 



The active drugs in the mixture are the potassium iodide and the 

 tartar emetic; the salicylate of soda does not influence the yaws 

 lesions, but seems to hasten the disappearance of the thick crusts, 

 while the bicarbonate of soda, though rendering the mixture cloudy 

 and inelegant, prevents to a great extent the symptoms of iodism 

 and decreases the emetic properties of the mixture, in this way 

 rendering possible the administration of massive doses of potas- 

 sium iodide, and large doses of tartar emetic. In the few cases in 

 which emesis is produced, the bicarbonate may be increased, or 

 a small amount of liq. morphiae or codein given before each dose; 

 and in the comparatively rare cases in which severe iodism appears, 

 epinephrine, as suggested by Milian, in grm. 0-002 doses, may be 

 given by the mouth or by subcutaneous injection, twice daily. 



The mixture as set down is cloudy, although it becomes clear 

 when diluted with water at the time of administering it. At the 

 suggestion of Dr. Dawson Williams some experiments were carried 

 out to obtain a clear mixture, and it was found that the addition 

 of sodium tartar, gr. x., or of glycerine 3ii. or of syrup 3i- per dose, 

 was sufficient to keep the mixture clear for weeks. The modified 

 formula of the mixture is therefore as follows: — ^Tartar emetic, 

 gr. i. ; potass, iodid., 3i. ; sodii salicyl., gr. x.; sodii bicarb., gr. xv. ; 

 sodii tartarat., gr. x., or glycerine, 5ii., or syrup, 3i., Aq. ad |i. It is 

 given in the same doses as the original mixture, and well diluted in 

 water to prevent a severe sensation of burning in the stomach. 



Either the original or the modified mixture is given in the doses 

 mentioned for ten to fifteen days, then it is discontinued for about 

 a week, and then given again for another ten to fifteen days. The 

 results, as shown by Castellani, Spaar, Thomson, and more recently 

 by Guerrero, Domingo, and Argiielles, who have carefully investi- 

 gated this method of treatment in the Philippines, are usually very 

 satisfactory in recent and fairly recent cases when they may be com- 

 pared with those obtained by the salvarsan treatment. In chronic 

 cases the results are not so striking, but as a rule much better than 

 with any other known treatment, except salvarsan or neo-salvarsan. 



The natives treat the disease in various ways. In Samoa the patient is 

 rubbed down with sand and washed in the sea, after which the yaws are 

 scraped with a shell. In the West Indies boiled and beaten-up leaves of 

 the ' physic-nut' are applied ,or powdered alum and sulphur used. In the 

 Congo pieces of forge scoriae are made incandescent and the yaws lesions 

 touched with them. In Ceylon the vedaralas (native doctors) apply concoctions 

 of various herbs, and give decoctions of sarsaparilla and other roots. They 

 also use mercury disguised in various ways. The majority of European 

 practitioners use potassium iodide. Others affirm this drug to be quite useless, 

 and believe that cleanliness and good and abundant food are quite sufficient 

 to bring about a cure. 



In the Colombo Clinic for Tropical Diseases some experiments have been 

 made on the various treatments, and the conclusion arrived at has been that 

 the salvarsan and neo-salvarsan treatment is the most effective of all, while 

 the mixture tartar emetic, potass, iodide, bicarb, of soda, and sod. salyc. is 



