Yaws : its nature and treatment an introduction to the study of the disease / by J. Numa Rat.
- Rat, Joseph Numa.
- Date:
- 1891
Licence: Public Domain Mark
Credit: Yaws : its nature and treatment an introduction to the study of the disease / by J. Numa Rat. Source: Wellcome Collection.
23/74 (page 11)
![Variations in the development of the eruption.—The variations in the nature and development of the secondary eruption are as follows:—The tubercles may he larger or smaller, fewer or more abundant than normal, being generally most numerous when smallest. They may vary in number to any extent, there being sometimes only one tubercle. Several may coalesce and form a large patch of granulation tissue (under a single crust) which may occupy the whole forehead or cheek or chin, or extend along the entire outer aspect of the upper or lower limbs, below the elbow or knee. They frequently unite to form rings round the eyes, nose, mouth or anus, always preserving their crusts, except in the last-named locality, where the latter are generally rubbed off by friction and the tubercle assumes the appearance of the mucous patches of syphilis. In favourable cases, the secretion from the tubercle is plastic, moderate in quantity and readily inspissates to form a crust. In scrofulous and otherwise unhealthy patients, it is thin and abundant, and exudes freely from beneath the crust. It is generally seen to be creamy white on the surface of the granulation tissue, when the scab is removed from the tubercle; but, in debilitated subjects, it is of a dirty brown colour. As it flows from beneath the crusts it is usually a pale yellow fluid like serum ; but when it escapes from a large patch of coalescent tubercles on the lower limb, it sometimes assumes a reddish or even a purple tint from the presence of red blood corpuscles, the quantity of the exudation and its depth of colour being increased by the dependent position of the leg. _ In place of a single, general crop of tubercles, these may appear at certain spots only, and disappear to break out again at others, on repeated occasions. This frequently occurs when, as has been already explained, the eruption alternates with an ulcer or with attacks of chronic diarrhoea ; but these paroxysmal outbursts of tubercles may exist without such alternations, being apparently induced by such affections as malarial fever or by such conditions as the erysipelatoid inflammation of the skin which attends elephantiasis. Circumscribed inflammation of the skin sometimes accompanies the tubercles, producing subcutaneous suppuration and a condition similar to that which obtains in the case of carbuncles. The parts thus affected are most commonly the buttocks, shoulders, and back of the neck. The normal end of the tubercle is its disappearance, by interstitial absorption, at the end of about six weeks from the time of its development; but, in those among whom the disease generally prevails, i.e., the unhealthy, ill-fed and badly housed, the average duration of the eruption is about nine months, when no treatment has been used. Judicious remedies, nourishing food and healthy surroundings tend to shorten this period; while, under unfavourable circum¬ stances, the tubercles may continue or disappear and be replaced by others during several years. The tubercles may ulcerate, forming comparatively shallow ulcers, the dimensions of which depend on the number which had previously coalesced. Such ulcers are covered with yellow or greenish yellow or brownish crusts, the colour varying with the age of the ulcer and the physical condition of the patient. They are not difficult to heal under appropriate treatment, during which they cicatrize at the end of a few weeks. The scars they form are of the same colour as the adjacent skin, and are either level with it or only slightly raised and covered by a thin, shiny cuticle like a mucous membrane, or resemble the irregular and elevated cicatrices of scrofulous ulcers. These shiny scars are sometimes the result of external applications by which premature cicatrization has been induced, and they suggest the probability of the continued presence of the disease in the system in a latent form. Tubercles, fyc., of the palms and soles.—The palms and soles are not exempt from the eruption ; but, on account of the thickness of the skin over them, the tubercles do not protrude here with the same facility as at other parts of the body. In those who go barefooted or whose hands are hardened by manual labour, the lumps of granulation tissue cannot penetrate to the surface. They become compressed and hardened; and they can sometimes be felt in the palm like large sized shot. In the feet they cause pain by the pressure on the nerves, especially in walking. This gives the patient a very uncertain tread; and, from the fancied resemblance of his gait to that of the crustacean, the disease, when it attacks the sole, is known as “ the crab.” When the skin has been pared off at the tender points, the tubercles beneath are found to be of exactly the same nature as they are elsewhere, but sometimes harder when they have been long subjected to pressure. In cases in which the top of an old tubercle of the sole has been frequently destroyed by caustic, on removing the thickened epidermis over it, the recurrent mass is seen to rise from the bottom of the cavity thus formed as a diminutive red cone of flesh, smooth and firm, about a quarter of an inch in height, with a base an eighth of an inch in diameter. Occasionally the tubercle in the sole ulcerates, and produces a deep narrow perforating ulcer which is usually situated in the ball of the great toe. The irritation, caused by the presence of the tubercles, developes a chronic inflammation of the skin of the palm and sole, which produces fissures and exfoliations of the epidermis. The latter, under such circumstances, presents the appearance of having been nibbled at by an insect, or of having been perforated at numerous points. Though, these lesions of the palm and sole may not occur for several months after the tubercles have disappeared from the rest of the body, they are included among the symptoms of the secondary stage, as frequently having their origin during that period. The same coalescence of tubercles, which has already been noticed as occurring over other parts of the body, sometimes takes place beneath the thickened epidermis of the sole. These tubercles, after a time, force their way to the surface (usually at the heel), and the appearance is then presented of a mass of granulation tissue with a very irregular surface and several inches in diameter, standing an inch or more above the level of the adjacent skin. As this ocours only in [174674] 6](https://iiif.wellcomecollection.org/image/b30556752_0023.jp2/full/800%2C/0/default.jpg)
