Report of the medical superintendent of Yaws Hospitals.

  • Nicholls, H. A. Alford (Henry Alfred Alford) 1851-1926.
Date:
1878-9]
Catalogue details

Licence: Public Domain Mark

Credit: Report of the medical superintendent of Yaws Hospitals. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    In unfavourable cases, and more especially when the patients have been treated ignorantly with mercury and other lowering medicines, the crusts remain for a long period, and then give place to moist fungoid tubereulated growths of a pale pink- bis or reddish colour, and often of a very large size. These masses may ulcerate or become absorbed, the former being the most frequent termination. When ulceration takes place it may extead for a considerable distance beyond the site of the fungus, and the islcer is usually excavated with thick livid inverted edges. A last bone and tendon may be exposed, or nearly half the foot—.which is most commonly affected in this way—may be converted into a huge ulcer with a foul yellowish centre. The disease is then a most formidable one, chronic abs- cesses often form in various parts of the body, and the bones may become nodu- lar ; the ulceration then extends, and if the disease be not arrested, the joints en- large and the flexors contract. At last the patient becomes a pitiable object of deformity, emaciation and disease, and life is terminated by the advent of some fojeign symptom—fluxes from the bowels and dropsy being the mosr, common. When the disease is on the decline, many of the tubercles abort, and give rise to two conditons which some writers have described as distinct varieties of the erup- tion,—they are styled * dartres' and 'pian gratelle.' The pian gratelle consits of papules similar in every respect to the commencing yaws tubercles. Sometimes they look like mere elevations of the skin giving rise to a roughened appearance like cutis anserina, and hence the name 'gratelle.* At other times they have a small yellowish poiut at their apex, but they rarely proceed beyond this stage. I have seen instances, however, where one or more of these papules have developed into gecuice encrusted tubercles. Dartres consist of slightly elevated portions of skin covered with furfuraceoug scales of partially exfoliated epithelium, and they may be mistaken lor spots of lepra or psoriasis. Usually they occur as small round patches, but they may occupy a large area—in soii^e instances indeed they may be to general as to give the skin the appearance of having been dusted over with, flour. When the dartre is small the epidermis at the circumference may frequently be noticed to be split and curled up in the same manner as when the young tubercle forces its way through the skin, and the same appearance may frequently be observed when the gratelle is on the decline. Both dartres and plans gratelles may occur at any period of the disease, but they are mest common at the time when the scabs are falling. Dartres are seen olten- erthan plans gratelles. From the foregoing description of the disease it will be seen that the different appearances, which some writers have considered distinct varieties, are only stages of the same malady. The old designations may therefore with advantage be dis- carded in a scientific description of the disease, for to speak of the respective sta- ges as squamous, papular, encrusted, tubercular and ulcerative would simplif}^ the description and make it more exact. Constitutional Symptoms. There is rarely any constitutional disturbance at the onset, unless the eruption be general, when the irritation may give rise to slight febrile movement; the case is very different, however, if the termination be not favourable, or if the disease be aggravated by bad treatment and the non-observ- ance of hygienic laws. Then, obscure pains in the muscles and bones, fever, and C<AV(3l/mvOw asffiSSi supervene, and unless appropriate remedial agents be employed the patient passes into the last stage ot the disease. During the progress of an ordinary case of yaws there is little suffering, for the tubercles ai^ eeldom painful, and in most instances the same may be said of the ulcers, In the last stage of the disease the patient becomes the subject of cachexia, and an air of listlessness and indifference is more often seen than ©ne of suffering and distress. Duration of the disease and the ajci of persons affected. I have had a series of calculations mads, so as to show with some degree of cerfcaiuty the age of those attacked and the duration of their stay in hospital. The statistics were drawn up from 466 cases discharged from the Central Jiospital, and it was found that the average time of detention was only three months and nineteen days. From the details of these calculations, which ar« given in the appendix in a tabular form, [Appendix C.] it will be seen that the shortest time occupied in a cure -was 27 days, and that th« longest nrasover 16 months.