1.546 



FRAMBCESIA TROPICA 



hard, verrucose-like protuberances. In the majority of cases — 

 within three to six months in children, and six to twelve months 

 in adults — ^the granulomata dry up, shrink, and disappear, leaving 

 dark hyperpigmented spots, or occasionally apigmented areas, on 

 their site, which are most persistent. In some cases the granulo- 

 matous eruption may continue for several years, new crops of 

 nodules appearing from time to time in succession. Each fram- 

 boetic granuloma generally undergoes involution within two to four 

 months, leaving behind, as a rule, a dark area or, more rarely, a 

 depigmented spot. Occasionally, however, the granuloma does not 

 regress so soon. In one of our patients a single granuloma persisted 

 for two years after all the others had disappeared. 



Fig. 691. — -Framboesia: General Eruption of the Secondary Stage. 



The granulomata are seldom painful, unless they develop between 

 the^ toes, on the soles of the feet, or round the nails. They very 

 often cause itching. The patient often exhales a peculiar offensive 

 odour, which has been variously described as sour or musty. This 

 is probably due to the growth of various bacteria, representing 

 secondary infections beneath the crusts of the granulomata. This 

 offensive odour is especially noticeable when the secondary infec- 

 tion is due to bacilli of Vincent's fusiform type and coarse spiro- 

 chaetes. In such cases, if the sores are well washed with perchloride 

 solution for two or three days, these organisms disappear, and the 

 smell is no longer noticeable, though the granulomata do not under- 

 go any change. Though the framboetic granuloma is the charac- 



