f infection
to the first appearance of the local lesion at the sight of
inoculation. It varies from three to ten weeks. The symptoms are vague,
possibly palpitation, vertigo, edema of the limbs and eyelids. The
primary stage begins with the initial lesion, which consists of a
papule which may be found most anywhere on the body. This papule
ulcerates. The secondary stage commences about a fortnight after the
papule has healed. There is intermittent fever, headache, backache,
and shooting pains in the limbs and intercostal spaces, like those of
dengue, with nocturnal exacerbations. An eruption of minute red spots
appears first on the face, and gradually extends so that the whole body
is covered at the end of three days. By the seventh day the apex of the
papule is of a pale yellow color, and the black skin has the appearance
of being dotted over with yellow wax. The papule then develops into
nodules of cylindric shape, with a dome-shaped, thick, yellow crust. It
is only with the crust off that there is any resemblance to a
raspberry. During the month following the raspberry appearance the skin
is covered with scabs which, falling off, leave a pale macula; in dark
races the macula becomes darker than normal, but in pale races it
becomes paler than the natural skin, and in neither case is it scarcely
ever obliterated. Intense itching is almost always present, and anemia
is also a constant symptom. The disease is essentially contagious and
occurs at all ages and among all sexes, to a lesser degree in whites
and hybrids, and is never congenital. It seems to have a tendency to
undergo spontaneous recovery.

Furunculus orientalis, or its synonyms, Oriental boil, Aleppo boil,
Delhi boil, Biskra button, etc., is a local disease occurring chiefly
on the face and other uncovered spots, endemic in limited districts in
hot climates, characterized by the formation of a papule, a nodule, and
a scab, and beneath the last a sharply punched-out ulcer. Its different
names indicate the districts in which it is common, nearly always in
tropical or subtropical climates. It differs from yaws in the absence
of febrile symptoms, in its unity, its occurrence often on the feet and
the backs of the hands, its duration, and the deep scar which it
leaves. A fatal issue is rare, but disfiguring and disabling cicatrices
may be left unless great care is employed.

Pigmentary Processes.--Friction, pressure, or scratching, if long
continued, may produc