1544 



FRAMBCESIA TROPICA 



In some cases the scar is small and smooth, in others it is large and 

 very thick. It is to be noted, however, that in Ceylon the dis- 

 figuring scar so frequently seen is partly due to the custom the 

 natives have of cauterizing the sore deeply by very primitive 

 methods. In other cases the large disfiguring cicatrix is due to 

 thie framboesoma having developed on an old ulcer, which on healing 

 leaves a coarse scar. 



Fig. 689. — ^Frambcesia : General Granulomatous Eruption. 



The Secondary or Granulomatous Stage.— The general eruption 

 usually begins between one and three months after the first appear- 

 ance of the primary lesion. It is preceded by malaise, headache, 

 severe pains in the muscles, joints, and bones. In some cases there 

 may be fever of an intermittent type. The patient, however, is 

 ordinarily able to attend to his work. The general eruption develops 

 as follows: minute roundish papules, the size of pin-heads, appear 

 on various parts of the body; some papules soon show a yellow 

 point or minute yellow crust at their apex. Most of the papules 



