4 io 
Case 34. — Female; 7 years; Black. 
1906. Large irregular branched ulcer on a thickened base and with raised 
edges, on the back of the left heel. Glands in both groins and shotty glands in 
neck. 
Several frambesiae on cheek and neck. Very large frambesiae at side and 
back of one knee, dry crusted papillomata on forehead and back of neck. These 
are essentially the same as yaws, but are dry, and have dark scabs. A 
symmetrical lichen covers both buttocks and back of thighs. 
Case 35.—L. K.; 19 years; Coloured. 
April, 1906.—Had a venereal chancre last year accompanied by fever and 
rheumatoid pains. Glands in both groins enlarged. Profuse eruptions of 
frambesiform syphilides over both knees, extending to front of thighs and legs. 
These are about 12 mm. each. Some are moist with yellow pellicles, under 
which is a granular surface of elongated papillae. Some have dry brown crusts, 
which when removed expose a frambesial surface. 
There are pigmented pits of a recent vesicular eruption on the right arm and 
the thighs. 
The eruption in this case would have been called yaws by anyone. 
It was atypical in two respects. It was quite symmetrical, and the 
frambesiae were crowded together so as to be sometimes confluent. 
Hut neither of th,ese features are exclusive of yaws. Such cases of 
yaws following a venereal infection are, perhaps, more common than 
is known. A syphilitic history is rarely enquired into when a patient 
displays yaws. 
Case 36. — M. W.; 6 years, Black. 
July 16th, 1906. Oval, flat, callous ulcer, with a glazed surface and pigmentec 
areola, on the front of the left shin. Enlarged glands in both groins and both 
elbows, several large glands in the neck. 
A crop of small frambesiae with dirty-brown crusts on the forehead. Several 
larger flat condylomata with slight crusts, or naked with moist yellow surface, on 
t e ront of the neck and right cheek. Numerous papules varying in size 
scattered on the face. On the left cheek a group larger, and almost frambesiform. 
■ mall frambesia on the vulva. A profuse eruption of dry papules of all sizes 
up to 4 or 5 mm. over both buttocks and back of thighs. On the elbows a warty 
erupt, °" of lar 8 e Papules with hard dry horny tops. Many of the papules else- 
" ere have a horny plug or horny apex of epithelium. There is a fine papular 
erup ion on the front of the knees. Few scattered papules all over the skin. 
is case well exemplifies the polymorphism of the yaws eruptions. There were 
at least five syphilides of different appearance present at once 
TREATMENT OF SYPHILIS IN NEGROES 
If we decide to treat yaws, whether it be syphilis or not. with 
mercury, it is necessary to appreciate that the'treatment must be 
p severed in for many months. The frequent experience of the 
recurrence of frambesial eruptions after being presumablv “ cured " by 
mercury, indicates that the mercury must be continued, as in syphilis. 
