400 
As far, then, as all these differentia are concerned, it is not possible 
to separate the diseases. It is impossible to overlook the tertiary 
stage of yaws. The indications for treatment are the same as for 
syphilis. Even if the "syphilis theory” is not true, it is as if true, 
as Paul Carus would say; and, therefore, it is good to teach and 
useful to believe. Any abstruse difference based upon the frambesial 
eruption can only have an academic interest. 
THE FRAMBESIA OR PAPILLOMATOUS SYPHILIDE 
The frambesia has been variously referred to by writers as a 
tubercle, a sore, granuloma, or a papule. No doubt, it is not of an 
invariable form, but none of these terms are correct. In every case 
the frambesia is raised, and consists of a closely-set group of hyper¬ 
trophied papillae. The dermis is not ulcerated, for properly the 
eruption leaves no scar. The frambesia is sometimes naked and 
moist, but more usually it is covered by a yellow crust. In some 
instances, and especially when the eruption is old, the crust is dark or 
dirty brown, but typically it should be yellow. There may be a 
yellow secretion under the crust, and in the early and active stages 
this is the rule. When old and undergoing resolution the frambesia 
is dry, and the crust, if present, is more adherent. If the yaw has 
been naked, it becomes in the dry stage covered with a film. 
Usually the eruption disappears by slow absorption, each yaw 
becoming imperceptibly smaller day by day. No doubt, yaws 
occasionally ulcerates by accident or by bad treatment, and leaves a 
true scar, but this is by no means its natural tendency. 
As a rule, the frambesiae are scattered more or less profusely over 
the skin. The corners of the mouth, around the anus and on the 
genitals are the favourite sites. Typically each yaw is round or oval, 
and measures 8 to 15 mm. across. But they vary much in size, and 
may be much larger. They are sometimes arranged in a circinate 
manner, and by coalescence of contiguous frambesiae a large, 
irregular or horse-shoe form may be produced. It is, certainly, a 
ery stiiking thing to witness the uniformity of the appearance of a 
number of cases. One can go to a country village in a yaws district, 
as in most parts of St. Vincent, and collect twenty children in five 
