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FRAMBCESIA TROPICA 



primary lesion or framboesoma ; a secondary or granulomatous stage, 

 during which the characteristic framboetic granulomatous eruption 

 appears; a tertiary or late stage, in which the late manifestations 

 of the disease develop — deep ulcerations and gummatous-like 

 nodules. A fourth period may perhaps be added (paraframboesial 

 affections). This division into three or four periods is, of course, 

 somewhat arbitrary, as symptoms considered to be characteristic 

 of one period may make their appearance in another: tertiary 

 symptoms, for instance, may appear during the secondary stage. 



It has been stated again and again that the whole course of the 

 disease lasts from three to six months in children, and six to twelve 

 in adults, but according to our experience it has a much longer 

 duration, and unless it becomes extinct after the secondary stage 

 it may extend to many years. Indeed, we believe that in a certain 

 number of cases, although there are periods during which the patient 

 is apparently free from symptoms, the infection is merely latent, 

 and sooner or later gives rise to renewed manifestations. 



The Primary Stage : Framboesoma. — ^After a period of incu- 

 bation, varying in time between two to four weeks, characterized 

 often by signs of malaise, rheumatoid pains, headache, irregular 

 rise of temperature, the primary lesion or framboesoma appears at 

 the seat of inoculation, which is always extragenital. The primary 

 lesion is a papule, which after about a week becomes moist, develop- 

 ing a yellowish secretion, which dries into a crust. Often at the 

 place of inoculation several papules appear, become moist, and 

 coalesce into a single element, covered by a thick crust. If after 

 some days the crust is removed, the primary sore will appear as an 

 alcer, not rarely of large dimensions, with clean-cut edges and a 

 granulating fundus. This ulcer may heal, leaving a whitish scar, 

 which may later become pigmented; or in other cases it may 

 develop into a granulomatous mass, not dissimilar to the granulo- 

 mata of the secondary eruption, which appear later on, but fre- 

 quently much larger. This large single projecting nodule is called 

 ' mother yaw,' or ' maman pian' in French patois, ' buba madre ' 

 in Columbia of South America. Occasionally round it, before the 

 general eruption begins, several smaller granulomata develop like 

 satellites. The primary sore never feels indurated, and is often 

 painful during the first stage of development. Later it may be quite 

 painless. Occasionally there may be pruritus. The proximal 

 lymphatic glands may become hard and enlarged, but they do not 

 suppurate. 



The seat of the primary sore is usually extragenital. The lesion 

 may develop on an old ulceration, an itch pustule, an insect bite, a 

 wound, or a vaccination mark. The smallest abrasion is sufficient 

 for the entrance of the virus. Most of our female patients pre- 

 sented the primary sore on one of the mammae, developing on some 

 crack or abrasion of the nipple and areola. In several other women 

 the primary lesion was found on the skin of the trunk, just above 

 the hip, this being due to the custom of the Ceylon woman carrying 



