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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    fiable fo be succeeded by ulceration which in rhany cises is indistinguishable froiE onychia maligna. The toes are move often aifected in this way than the fingera;= Very rarely the terbucles are pedunculated, or elongated with a broadened base. In the latter case the disease may be confounded with rupia; but the'diagnostic laraiuated appearance of rupial crusts is always wanting. When the tubercles- grow frona the soles of the feet they have great difficulty iti forcing their way to the surface on account of the thickness of the epidermis, consequently they spread laterally and form a hard and painfbl tumour which causes lameness in the person attacked. This condition is called by the negroes *' Tubbo«,' and by the French^ Creoles Crabe, but the latter term is also applied to a fissured state of the epi-- dermis which is totally distmct from yaws. If by accident, or otherwise, a portion of the superficial crust of a tubercle become detached, there is sometimes seen un-- derneath a moist creamy yellowish substance which however soon hardens by ex- posure to the air. A peculiarly disagreeable odour enamates from a person afflicted with yaws, and I have frequently identified a case of the disease merely by this characteristic enielh The eruption may be met with on any part of the superficies of the body, but it Js commoner on the anterior surface. The more exposed parts are those usually obnoxious to the disease, tlie tubercles not being found very often upon those parts of the body protected by the dress; I have made a careful analysis of a hundred case^sio tbe fully developed primary stage, with well marked characteristic crusts, aud the results are both valuable and interesting. Of the too cases, 5S were males and 42 females, and' the ages varied from 14^ months to 50 years. On the Fnc'e and Head, the eruption occurred in 49 cases; Trunk 20 ' Genitals 1(3 ' ' Perineum 20 Upper Extremities 29 Lower Eitremitins 70 In three cases only were the tubercles found on the scalp, and they were not once met with in the axilla. The results arinved at by these statistics difter from the observations of most writers on the disease. If a yaws crUst be removed, which can easily be done without giving rise to much pain, there will be seen underneath either a foul ulcerating surface, or the framboesial excrescence as described by the old' writers. This appearance al- though common is by no means general, and a case of FrannboeVia may occur with- out showing any sign of the fungoid growth from its commencement to its termin- ation. The excrescence, which has given rise to the name Framboesia, writers having likened it to a wood-strawberry nr raspberry, is as far as my experience goes never found alone, one or other of the stages ]of the disease always being present at the same time. The yellow crust is however invariably seen in pure uncomplicated cases of yaws, and it is rare for what I hav« termed the framboe- sial excrescence'' to exist wiiiiaut at least a portion of its characteristic covering. As the disease is observed in Dominica the crust is a much more constant sigu- than the red tuberculated'growth. The fungoid masses are seen in their simplest form where they are brought into view by the torcible detachmeiit of the yellow crusts which always cover them' in their earlier stages. Then they may fairly be' described as like a strawberry in colour and a mi!Ibsrryin shape, excrenfc that tht^y are often streaked wiih reddish' line?. In persons who have been subjecis oi the disease fof a considerable time, the fungus is much commoner, and it is most common in those who have been brought io a cachetic contiitiau by the combined effects of sad and scanty food, defective sanitaiion, and the irritation caused by the long existence of a loathsome Malady. When a case of yaws terminates favour:ibly the cinsts commence to fall of! in about a week or 'en days, and this process is accomplished in the following way. The fissures deepen, the cruses become darker, they dry and shrivel up and detach themselves from the circumference towards the centre, until they finally fall, leaving their site indicated by a smooth and shining mac'i-la, or by a reddish scarred suif'ace shghtly hardened, elevated and tuberculated; and in the last case there remains for several weeks or even months an induration of the skin which' extends for some distance around. The maoulse are black in the negro, but, in light coloured persons they are nearly white, in both instances oeing aa exaggeration of the colour of the individual