Yaws : its nature and treatment an introduction to the study of the disease / by J. Numa Rat.

Rat, Joseph Numa.

Date:: 1891

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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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secondary and tertiary phenomena. Having assumed these facts as established, we must return to the fundamental question, can it he proved that this malady is not, after all, syphilis, modified by race and climate P I will endeavour to state, in the first place, the arguments which seem to imply probability that it is a form of syphilis, and afterwards those which bear in the opposite direction. A SCHEDULE OF THE STAGES OF YAWS DUEING THE FIRST YEAR. (Compiled chiefly from Dr. Numa Rat’s Report.) 1st month. An Incubation Stage of from three to ten weeks. No symptoms, Ulcers, excoriations and wounds are believed to facilitate the implantation of the virus. 2nd month. A primary lesion, which consists of a papule, which at the end of about seven days develops a pale yellow fluid at its apex. A scale is formed, and an ulcer results, with perpendicular edges and a clean base. The ulcer usually heals of itself in about a fortnight, but may last longer (page 8). The lips, the breast, the groin, perineum and genitals are the parts upon which primary sores most frequently occur. There is often considerable fever and severe pains in muscles, joints, &c. The fever is worse at night. 3rd month. As a rule, the primary lesion disappears before the secondary phenomena are observed. An eruption of little red spots covers the patient from head to foot (“ like lichen tropicus.”) It develops in a few days and begins to fade within a week. A few of the spots, however, do not disappear, but develop into papules (page 9) which pass into tubercles, and finally present papillary fungations like cauliflower buds. Non-suppurative periostitis may occur. There is no enlargement of lymphatic glands. 4ti-i month. The tubercles rapidly become paler and shrink until level with the skin. They may vary in number to any extent, there being sometimes only one or two. Several may coalesce and form a large patch of granulation tissue. They frequently unite to form rings round the eyes, nose, mouth, or anus. In some conditions they resemble “ small carbuncles,” and in others “ the mucous patches of syphilis.” The palms and the soles are often affected and in a peculiar manner (page 11), 5th month. “ 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’’ (page 11). [Treatment by mercury ought to have been commenced, according to Dr. Rat’s opinion, as soon as the tubercles were mature, and this practice may possibly have modified his estimate of the duration of the secondary eruptions.] 6th month. Although in most cases the eruption has disappeared spontaneously by the end of the fourth month, yet in many (especially perhaps in feeble and under-fed patients) it may have persisted and become aggravated. 7th month. In most cases the patient is well, but in some the eruption persists. 8th month. In most cases the patient is well, but in some the eruption persists. 9th month. In most cases the patient is well, but in some the eruption persists. 10th month. “ In unhealthy and ill-fed persons, without treatment, the average duration of the eruption is nine months,” but “ tubercles may continue or may disappear and be replaced by others during several years ” (page 11). 11th month. In exceptional cases there may still be patches of fungus growth, and great debility. 12th month. It is only in exceptional cases that symptoms persist- For these treatment by mercury is essential. NOTES ON THE TERTIARY PERIOD OP YAWS. It would appear that in a majority of cases in which symptoms ranked as tertiary occur they are continuous with those of the secondary stage, the patient having never been cured. In others, however, they supervene after a longer or shorter period of health. In the former case they consist chiefly of ulcers extending serpiginously and more or less deeply, and in the latter they begin as subcutaneous swellings, which are classed as “gummata.” The leg is the part most frequently affected. Destructive ulceration of the nares, pharynx and soft palate is also one of the later manifestations of Yaws. It may occur twenty years after the last traces of secondary symptoms. Chronic periostitis may occur. There may be exfoliation of the smaller bones of the hands and feet. In severe cases, especially when the throat is ulceraied, or obstructed by growths of granulation tissue, there may be cachexia, but “ it is surprising to what an extent tertiary lesions may exist without seriously impairing the health.” These tertiary symptoms are, according to our author, curable only by the judicious use of specifics (mercury and iodides), with the local application of iodoform, &c.