The disease called by these names, of which the two last are the local designations, presents many analogies with syphilis. Some European observers have believed it to be syphilis, but those who have actually come into contact with the disease have denied the identity. It is met with almost alone in the coloured races, but this is probably because of local circumstances and habits. It is endemic in certain tropical lands, which are chiefly the tropical parts of America, including the West Indies and parts of North and South America, the West and East Coasts of Africa, many of the African islands, and some of those of the Pacific.

The disease is acquired by contagion or inoculation, and begin mostly in childhood, although the first year is usually exempt. A period of incubation of three to ten weeks is followed by the Primary sore at first in the form of a papule, followed by an ulcer whose floor consists of granulation tissue. The lesion is seldom on the genital organs, and it is not indurated.

There is next a Secondary stage, which usually begins after the primary one has healed. It is associated with fever and general symptoms, and is characterized by a cutaneous eruption. The eruption is at first merely congestive, but papules develop, most of which disappear, but some persist and enlarge, and there are formed areas of protruding fungating granulations which are sometimes called tubercles. These tubercles have been compared to raspberries, and from this is derived the name Framlm-sia (framboise - a raspberry), but they do not usually have the bright red colour of that fruit.

Section of skin in frainbcesia, from a part where the disease was not very far advanced.

Fig. 480. - Section of skin in frainbcesia, from a part where the disease was not very far advanced. The papillary layer of the cutis is seen to bereplaced by granulation tissue, while the epidermis is preserved on the surface, x 75.

There is some discharge of pus from the tubercles. These secondary tubercles may be very few, and they have not a symmetrical arrangement. The microscopic structure is that of ordinary granulations. It is comparable with that of the condylomata of syphilis, but the tubercles are not, like these, limited to the neighbourhood of the mouth and genitals, and they do not occur in the mucous membranes.

The Tertiary stage may, like that of syphilis, supervene long after the healing of the secondary stage, or it may almost directly follow it. There are chiefly extensive ulcerations of the skin, and sometimes of the mucous membranes. There are no proper gummata and there is no caseous condition, but simply an exuberant growth of granulations which break down and form the ulcers. At the advancing edge the granulation tissue may be seen advancing in the superficial layers of the cutis, as in Fig. 480. These ulcerations are most common on the legs, and extensive thickenings and ulcerations may supervene, so as to produce resemblances to elephantiasis and leprosy. In this stage there is an occasional extension to the periosteum, but not apparently to the nervous system.

The analogies with syphilis are obvious from the above description. The points of difference are chiefly the early age of its occurrence, its endemic character, the fact that the secondary stage is characterized by tubercles of granulation tissue rather than polymorphous eruptions, the difference in structure and locality of the tertiary lesions, and the absence of any affection of the lymphatic glands. From the author's own observation of a case of Frambcesia he is convinced that the two diseases are perfectly distinct.

Literature

Frambcesia - See a very complete account of the dis. with literature, etc., by J. Numa Rat, Framboesia (Yaws), with prefatory remarks by Jonathan Hutchinson, 1891.