SPIRONEMA REFRINGENS 589 
distinct diseases. Paulet' inoculated 14 negroes with the secretion from 
granulomata and all developed yaws, the initial lesion appearing at 
the site of inoculation. There is a possibility that these negroes 
might have been naturally infected, however. Charlouis injected 
32 Chinese prisoners with scrapings from the granulomata of a case 
of yaws and 28 developed the disease, the primary lesion again appear- 
ing at the site of inoculation. This series is suggestive, but not con- 
clusi^'e, because the possibility of natural infection cannot be ruled out. 
On the other hand, when certain precautions are observed with refer- 
ence to time between inoculations, tlie results have been negative. 
According to Castellani,^ yaws and syphilis are distinct diseases, 
because a native who had been inoculated successfully with yaws 
was subsequently infected with material from a chancre; this resulted 
in a typical attack of syphilis superimposed upon the yaws. This 
view is controverted by Butler,^ who has inoculated a case of syphilis 
in the secondary stage with material from a case of florid yaws. The 
result was negative for the time of observation, ten months. 
Pathogenesis. — .4 w^?»o/.— The disease may be transferred to monkeys 
by direct inoculation. The organisms are found in the lesions. 
Hifwan. —The distribution of organisms in the lesions of yaws is 
somewhat different from those in syphilis. In the former the organisms 
are numerous in the spaces between the papillary pegs of the Malpighian 
layer of the epidermis, not necessarily in intimate association with 
bloodvessels; in syphilis the organisms are found in considerable num- 
bers around thickened arteries. The so-called Treponema pertenue 
is found constantly in the primary lesion and in unbroken papules of 
the generalized eruption characteristic of the secondary stage of yaws. 
In broken dowTi lesions many bacteria, including Treponemata indis- 
tinguishable from Treponema refringens, complicate the picture. They 
are frequently not found in the tertiary stage. At autopsy the spleen, 
lymph glands and bone-marrow contain many Treponemata as a rule ; 
the cerebrospinal fluid is free from them antemortem or postmortem. 
The disease is transmissible by direct contact, and is probable 
that the virus may be transmitted by biting insects as well. Robert- 
son"* states that the virus of yaws may be found in flies which have had 
access to the papular eruption of this disease. Present information 
indicates that yaws, found frequently in the young in Haiti and other 
tropical syphilized populations, is syphilis, as is also gangosa of the 
Philippines.^ 
SPIRONEMA REFRINGENS. 
Synonyms. — Spirocheta refringens; Treponema refringens. 
Schaudinn and Hoffmann" observed Spironema refringens both in 
syphilitic lesions in association with Treponema pallidum, and in 
' Quoted by Castellani and Chalmers: Manual of Tropical Medicine. 
2 Lancet, 1905. ii, 468. s u. S. Naval Bulletin, 1914, 8, 561. 
< Jour. Trop. Med. and Hyg., 1908. p. 213. 
6 Butler: U. S. Naval Bulletin, 1915, 9, 51. 
6 Arb, a. d. kais. Gesamte, 1905, 22, Heft 2, 
