they may proceed to the formation of typical yaws. The recurrences are usually preceded by feverishness, pains in the bones and joints; and the successive crops may either be limited and partial in their distribution, or they may be general. In Fiji, Daniels states, the average duration of an attack of yaws is about one year.
The general health.— Except during the initial fever, or during one of the recurring febrile relapses, the general health is not, as a rule, affected. Occasionally, however, there is debility and cachexia; or there may be enlargement and tenderness of the lymphatic glands. In other instances the rheumatic pains are a principal feature, and may be very severe.
Persistent yaws.— That yaws sometimes effects a permanent hold is shown by the persistency with which it occasionally continues to recur during many years. In such cases the lesion has always the characters of a true yaw, and cannot be regarded as a " secondary " or " tertiary " manifestation in the sense in which these terms are applied to the late lesions of syphilis.
Dactylitis.— Powell describes two cases, mother and child, in whom, concurrently, a uniform swelling of the proximal phalanges of both hands occurred during the third year of an attack of yaws. To the touch the bones gave the impression of being rarefied. Such swellings are not uncommon in yaws.
Question of a primary sore.— An interesting point in the symptomatology of yaws is the question of the occurrence of a primary sore, as in syphilis. Numa Rat says there is such a sore, but that it is usually overlooked. He describes it as a papule with a pale yellow material at its apex, which may remain a papule, or which, after seven days, may ulcerate and subsequently cicatrize. Other observers do not agree with this. They say that though yaws virus applied to a pre-existing ulcer may render it unhealthy-looking and cause it to fungate like an ordinary yaw, yet successful puncture inoculations, although they sometimes give rise to a yaw at the point of inoculation, do not by any means always produce a local lesion,
