1552 



FRAMBCESIA TROPICA 



is present. The cervical and inguinal glands are most frequently 

 enlarged. 



Alimentary System— As a rule the digestive functions are not 

 disturbed. In children slight diarrhoea may be occasionally noticed 

 preceding the general eruption. The spleen and liver are fre- 

 quently found enlarged in children, but this is probably due to 

 preceding or concomitant malaria infection. The microscopical 

 examination of the faeces of framboesia patients will frequently reveal 

 ova of various worms — Ascaris himbricoides , Trichuris trichiura, 

 and occasionally Ancylostoma duodenale — ^but this is of frequent 

 occurrence also in normal natives. 



Respiratory System.— As a rule the respiratory, as well as the 

 circulatory, system is not affecied. Occasionally small granulo- 

 matous ulcers are to be found in the nasal mucosa and more rarely 

 in the larynx. 



LocoMOTORY System— Joints.- — ^In some patients several of the 

 large articulations may become swollen and very painful. The con- 

 dition is often of an acute character, and may be accompanied by 

 fever, so that an attack of articular rheumatism complicating the 

 framboetic infection might be suspected. Sodium salicylate, how- 

 ever, is not beneficial, while the administration of large doses of 

 potassium iodide speedily reduces the temperature to normal and 

 cause the swelling of the articulation to subside. At other times 

 one articulation only is involved, and the symptoms may become 

 so serious as to suggest purulent arthritis. In many cases the 

 smaller articulations become involved. The symptoms in such 

 cases are not acute, and there is usually no fever. 



Bones. — Inflammation of the periosteum of various bones is of 

 common occurrence. Very frequent is a form of multiple periostitis 

 of the digital phalanges, the cause of the multiple dactylitis so often 

 seen in framboesia patients. 



Maul has investigated the bone and joint lesions of Framboesia, and has 

 noted that, in the Philippine Islands, 20 per cent, of the cases are suffering 

 from such lesions, which may simulate tubercular or central septic abscesses, 

 gammata, hydatid cyst, benign cyst, fibrous osteitis, enchondroma, endo- 

 thelioma, secondary carcinoma, myeloma, and sarcoma. The same author 

 has made a careful roentgenological survey, and has found that in the majority 

 of cases the bone lesions appear as rarefied areas, irregularly oval, with the 

 long axis parallel to that of the bone, from a few millimetres to 2 or 3 centi- 

 metres in length. Most of the lesions seem to originate in the interior of 

 the bone, but some appear as small excavations on its outer surface. 



Muscles. — Contractures of various groups of muscles may be 

 observed. Fairly common is a contracture of the flexor muscles 

 of the forearms. This contracture is often permanent, and in our 

 opinion is probably due to pathological alteration of the peripheral 

 nerves, rather than being of direct muscular origin. 



Nervous System — ■Neuritis. — -Neuralgic pains are often observed, 

 but also a true form of neuritis must be admitted. We have seen 

 in several cases clear symptoms of neuritis of the sciatic nerve, with 



