5 YMPTOMA TOLOG Y—PROPH YLA XI S 1879 



with the clothing. At times the ulcers may remain quite super- 

 ficial, spreading at one edge while healing at another. Scarring 

 similar to that seen after burns may result, which by contraction 

 may lead to obliteration of the palpebral fissures, the nasal orifices, 

 and to reduce the size of the mouth, as well as to produce great 

 deformities in the hands and feet. It may cause a chronic osteitis 

 resembling that seen in syphiHs. It appears to be in some way 

 self-limited, as it does not attack the trachea or genital organs. 

 The ulceration may progress continuously for a period of ten to 

 thirty-five years, or it may advance at certain times and be quiescent 

 at others, or it may cease at any time, leaving a chronic ulcer. Its 

 duration varies, therefore, from a few months to many years. 



With regard to the blood, Musgrave and Marshall report that 

 their case showed no marked leucocytosis and no abnormal elements. 

 The haemoglobin was 80 per cent., the leucocytes 11,600 per cubic 

 millimetre, the small lymphocytes 10 per cent., large lymphocytes 

 4-6 per cent., polymorphonuclears 82 per cent., eosinophiles 2-6 per 

 cent., basophiles 0-4 per cent. Wassermann's reaction is often 

 positive. Kerr believes this to be due to pregressed yaws. Noguchi's 

 cuti-reaction may be positive. 



The disease is not limited to the throat and nose, but, as already 

 stated, may spread to the face or appear on the extremities, but as 

 a rule the general health is but little affected. 



Variety. — fulminating variety has been described by Mink and 

 McLean in children, which is fatal in forty-eight hours, and closely 

 resembles diphtheria, without, however, the presence of the specific 

 bacilli. 



Diagnosis. — ^The diagnosis has been practically discussed in the 

 iEtiology, and need not be repeated, except to say that it must be 

 made by a process of exclusion. 



Prognosis. — ^The disease is rarely fatal, and all cases tend to ulti- 

 mate recovery, but the course is very long and the disfigurement 

 great. The general health is also good as a rule, although death 

 may take place from intercurrent disorders, such as tuberculosis, 

 dysentery, and other internal causes. 



Treatment. — ^Mercury is useless and potassium iodide has little 

 action on the condition. Salvarsan and neosalvarsan, or their 

 substitutes, seem to give much better results. An application of a 

 strong solution (i per cent.) of permanganate of potash is recom- 

 mended as a deodorant, and local application of tincture of iodine or 

 the actual cautery. 



Prophylaxis. — ^Nothing definite can be said under this heading, 

 as the aetiology is not known with certainty, but segregation of the 

 patients in a colony or special hospital until they are cured is advis- 

 able. In Guam, according to Angeny, the disease is steadilj; 

 decreasing, thanks to the measures taken of segregating the patients, 

 and possibly to the thorough treatment of yaws patients, and also 

 probably to the improvement in general sanitation since the 

 American occupation. 



