401 
minutes all showing the eruption in almost identical form. There is 
small wonder that the profession, having regard to this eruption 
alone, has almost generally fallen into the way of making it constitute 
a distinct disease. 
Alford Nicholls, who has made a thorough anatomical examination 
by sections of the frambesial as well as of the papular and “ macular 
eruptions of yaws (fig. XIX, in his report), shows that the papule oi 
pian gratelle consists of a few hypertrophied papillae infiltrated with 
small round cells, which are also accumulated in the underlying 
dermis; the corneous layer of the epidermis is undergoing over¬ 
growth and exfoliation. This is identical with the structure of a 
papule of syphilitic lichen. (The frambesia is beautifully shown in 
section in fig. XXII.) It consists entirely of very much elongated 
and hypertrophied papillae, with a great infiltration of round cells. 
The epidermis is desquamated so that the ends of the papillae are 
covered only by the secretion and the crust, which is formed of layers 
of dry secretion. The papillae are closely crowded together. This 
structure, without the crust, is identical with that of the syphilitic 
condyloma. The frambesia is, in fact, one of the large papules of 
syphilis. It is not, therefore, a granuloma in the sense that a gumma 
is. The small round cells are certainly the elements of granulation 
tissue, but the whole mass retains its physiological character as a 
group of natural papillae, which do not disappear so as to leave a 
scar. They have undergone an evolution and hypertrophy, and will 
return to their normal size by involution and absorption of the added 
elements. The term granuloma is a misleading one. The red 
granular surface of the frambesia, seen after the removal of the crust, 
to which it owes its name, from the resemblance to a raspberry, is not 
due to granulations such as are on an ulcer. 
The proper pathological description of the frambesia is in the 
term papilloma ; and it is structurally identical with the papillomata 
of syphilis, condylomata and rhagades. In a drying papilloma the 
crust fits into the interstices between the papillae, so as to be difficult 
to remove. But when it is removed, the individuality and tough 
consistence of the papillae can be easily demonstrated. 
On moist surfaces, as on the vulva and around the arms, 
sometimes at the webs of the fingers and toes, the papilloma is naked. 
T^e ends of the papillae are swollen, and squeezed together so 
