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.
27/74 (page 15)
![expelled from the system, and though the patient may be robust and in apparently good health. It generally. begins about the age of puberty, in those cases in which the earlier symptoms occurred during childhood ; hut it may, also, commence in childhood and soon after the secondary period. These lesions, whether occurring in the nose or throat, are preceded by a slight fever, generally an intermittent of the quotidian type, which begins towards sunset. After a week the patient either develops the symptoms of ozcena or complains of sore throat. On examination, the tubercle may be readily detected in the anterior nares, or may be discovered by means of a speculum in the posterior nares, or the throat may appear congested with the uvula elongated and oedematous. In the latter instance, a mirror will reveal the tubercle behind the uvula. After about a month, ulceration begins ; and, in a month or six weeks more, the uvula, velum palati and septum nasi have disappeared, and the pharynx is deeply grooved and covered with a greenish white, tenacious secretion. The throat may be attacked independently of the nose, and vice versa ; but, when the ulceration begins in either, it usually extends to the other. The ulceration generally ceases about the palate, after destroying the uvula and velum palati; but it usually lingers chronically about the posterior nares and pharynx. Adhesions may occur between the velum palati and the pharynx, and the posterior nares may be blocked by an excessive growth of granulation tissue which may also project downwards as far as the oesophagus, leaving a very narrow passage by which respiration and deglutition are performed with great difficulty. The percentage of those attacked with the milder form of this ulceration is considerable in some localities in which Taws is endemic. In a district with a population of about 2,000 sixty persons thus affected have come under my notice, and possibly many more in the same place were similarly afflicted. It appears to be specially prevalent in certain parts and rare in others. The above figures refer to a certain quarter of the Windward district of Dominica, in which it is exceedingly common, and to which it seems to be entirely limited in that island. It is, on the other hand, very rare in South America and the West Coast of Africa, where comparatively few cases came under my observation. Lesions of the Osseous System. The nodules which have been described as occurring under the skin, are found also under tbe periosteum, over the clavicle, sternum, ulna, tibia, and the metacarpal and metatarsal bones. They seldom suppurate or ulcerate in these situations, but they usually disappear by absorption or persist indefinitely. They generally inflame, when situated over the external malleolus, and discharge a yellow serum. Unlike the subcutaneous, the subperiosteal nodules are attended, at their inception, with considerable pain, which gradually abates as they become absorbed, but persists and increases when they inflame. There is a diffused chronic periostitis at the parts above-mentioned, which is noticed at this period, and which is characterised by repeated attacks of pain along the subjacent bones. It sometimes extends to the deeper tissues, causing destruction of the smaller bones of the hands and feet, with considerable distortion of those parts. Dactylitis is another result of this inflammation; the finger presenting the appearance of the syphilitic or scrofulous affection. Some of the joints are occasionally affected with a chronic inflammation which is not accompanied by redness of the skin, and is attended with but little pain when at rest, though with considerable swelling. This occurs in anaemic subjects; and the joints most usually affected are those of the hand and knee. The condition is very like that of the white swelling of scrofula; but the subjects of the affection are entirely free from any of the symptoms of that disease. Lesions of the Muscular System. The contractures of the flexor muscles, already mentioned as originating during the secondary, may extend to the tertiary period. There is also a myositis of the limbs peculiar to this stage of the disease which may cause either atrophy or permanent contracture. A burning sensation, formication, numbness, and pain of the muscles are the symptoms of this condition, which is sometimes so severe as to prevent all motion of the limb, which feels as if affected by paralysis ; the changes induced in the muscles by disease and want of use causing a wasting of the limb, which gradually arrives at a condition best described as “nothing but skin and bone.” After repeated attacks, at intervals of about three weeks, of burning, formication, numbness, cramp and pain of the flexor muscles, attended with quotidian ague, a contracture of the limb gradually supervenes and becomes permanent. In the case of the lower limb the contraction compels the patient to walk on the ball of his great toe. Lesions of the Nervous System. I have not been able to obtain any direct proof of the presence of chronic neuritis during the tertiary period of Yaws ; but I have noticed cases in which there was persistent or paroxvsmal [174674] 7](https://iiif.wellcomecollection.org/image/b30556752_0027.jp2/full/800%2C/0/default.jpg)
