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.
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![remaining of its natural tint for months until interstitial absorption is about to take place, when it then becomes inflamed and ulcerates. It sometimes happens, however, that absorption occurs without any discolouration or ulceration of 'the integument above the framboesial gumma. The concomitant diagnostic symptoms are those affections of the organs of sense which have been shewn by Hutchinson to be so frequently found in inherited syphilis and those alterations in the shin and nose which Butler humorously refers to in Hudibras. We never find, in Yaws, interstitial keratitis, a sunken nose bridge, sudden bilateral deafness, notched teeth, sabre-shaped tibiae, philosophic foreheads, periostitic gummata of the cranial bones, &c. Unfortunately for diagnostic purposes, it is very seldom indeed that the eyes, ears and teeth are affected by syphilis in the African races. In them these organs generally remain intact amid the ruins which syphilis works in their skin and bones. With regard to the sunken bridge of the nose and the sabre-shaped tibiae, these are naturally somewhat characteristic of the African. The cranium of the African child hardly ever shews those deformities which are so often met with among Europeans. One is, therefore, under a great disadvantage in distinguishing between the two diseases under such circumstances, as the lesions are often limited to those which are common to the tertiary stages of both affections, viz. : cutaneous ulcerations, hypertrophic dermatitis, periostitis, osteitis, osteo-periostitis, synovitis, and teno-synovitis ; and iodide of potassium and mercury, whose beneficial effects in syphilis serve to diagnose that disease in doubtful cases, are as useful in the treatment of Yaws as in that of the former affection. Diagnosis between Yaws and Scrofula. The lymphatic system is specially and specifically affected in Scrofula and not in Yaws. While the materials of which scrofulous growths consist are the products of a special inflammatory process, the granulation tumours of Yaws are neoplasms in the truest sense of the term. The inflammatory zones around scrofulous lesions are absent in those of Yaws. The usual signs of inflammation are present in Scrofula and absent in the secondary symptoms of Yaws, The giant cells of Scrofula have not been found in Yaws. Yaws tubercles disappear by interstitial absorption, which is not the end of the cell-growths of Scrofula. Caseation occurs in Scrofula but not in Yaws. Scrofula is found in all countries. Y aws is limited to certain parts of the tropics. The statements of observers differ considerably with regard to the extent to which Scrofula prevails in the tropics. I agree with those who consider it a comparatively rare disease in tropical countries. It appears to be greatly due to want of light, ventilation, and food, three factors which tend to produce it in cold and temperate regions, but which are absent, generally speaking, in warm climates where the inhabitants can procure food with little labour and spend the greater part of their lives in the open air. Kingsley, writing of Port of Spain, the capital of Trinidad, says: “Next, the stranger will remark, here, as at Grenada, that everyone he passes looks strong, healthy, and well fed. One meets few or none of those figures and faces, small, scrofulous, squinny and haggard, which disgrace the so-called civilization of a British city. Nowhere in Port of Spain will you see such human beings as in certain streets of London, Liverpool or Glasgow. Everyone plainly can live and thrive, if they choose.” The following are the remarks of Treves, with regard to the ages at which scrofula occurs most frequently:— “ With regard to age, scrofula is most common between the ages of three and fifteen. Before the age of one year struma is quite uncommon, and if it does occur before that age, it is usually severe in its character. An outbreak of the disease is not uncommon between twenty and thirty, or again a little later after thirty, especially in females : and scrofula may also appear quite late in life and that also in some instances for the first time (senile struma). Sex appears to have no influence in the production of scrofula, the only facts worth noting being that gland disease appears to be more common in the female, and joint affection in the male.” Diagnosis between Yaws and Lupus. The following characteristics of Lupus Vulgaris, summarised from one of Hutchinson’s post graduate lectures, will serve to distinguish the lesions of this disease from those of Yaws. There is a congested zone around the ulcerative patches of Lupus. There is haemorrhage from the surface of the patches after the removal of the crusts when these exist. The crust over a Lupus growth is not a single common covering, but is produced by the coalescence of the crusts of the various smaller growths which constitute the mass, so that, on its removal, it is found to send processes between the latter. The “ apple jelly ” growth is common in Lupus. Lupus is always serpiginous. It seldom attacks infants or young children. It does not spread to the bones or the joints. It is restricted to the skins and mucous membrane. To these differences may be added the following :— The granulations of Lupus are much softer than those of Yaws. Its crusts are yellowish brown, while those of Yaws are straw or amber coloured. [174674] 9](https://iiif.wellcomecollection.org/image/b30556752_0035.jp2/full/800%2C/0/default.jpg)
