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

  • Rat, Joseph Numa.
Date:
1891
Catalogue details

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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    THE RELATION OF TAWS TO SYPHILIS, Facts in favour of Identity of Yaws with Syphilis. 1st. The stages observed by Yaws are very similar to those of syphilis.—In order to bring out the facts more clearly, I have drawn up from the data supplied hy Dr. Rat, in many respects confirmed hy others, the preceding schedule of the stages of Yaws. It is arranged, as being most convenient to the reader, in the space-for-time method. I will now proceed to ask attention to the facts which appear to favour the opinion that syphilis and Yaws are one and the same disease. It would appear that in many cases the initial lesion is not easily identified, and in these, of course, the length of the incubation period cannot be accurately estimated. So far as the facts go, how¬ ever, it would seem probable that about a month elapses between the reception of the virus and the development of peculiarities in the part inoculated. The stage of fever, osteocopic pains and eruption, follows in a few weeks. These are almost exactly the stage-periods of syphilis. The development of fungating rupial sores, which follow what we may call the exanthem eruption, occurs also just at the time when in syphilis the first eruption may slide, under ineffectual or prejudicial treatment, into rupia. (An exceptional but still a well-recognised event.) 2nd.—The tertiary symptoms of yaws very closely resemble those of syphilis, and occur after intervals of much the same irregularity of duration which we notice in the case of syphilis.—Thus in some instances they begin as soon as the secondary stage is well over, and in others they are delayed through many years of latency. Gfummata in the cellular tissue and ulcerative destruction of the palate are precisely the occurrences most common in similar stages of syphilis. 3rd.—The methods of cure as regards the constitutional and later stages of Yaws are precisely those adapted for syphilis.—As I have already pointed out the strongest argument against the identity of the two diseases with former writers was the spontaneous curability of Yaws. We were told that without treatment it always got well, and that it had no sequelae. This argument is, however, wholly overthrown by Dr. Rat, who not only describes the tertiary symptoms but alleges that they may last indefinitely unless they are cured by the very drugs which are found to be specifics for syphilis. The j udicious rules as to treatment which he lays down are precisely those which many would propound as regards English syphilis. He is not a strong mercurialist, and has no notion of an abortive or early treatment, believing rather that the first stages are made worse by mercury, and reserving the remedy for the later ones. We must remember, however, that these are precisely the doctrines which until recently were extensively held as regards the use of the drug in syphilis. It may easily be the fact that when an abortive plan by small doses is carefully tried in Yaws it will be found to be as effectual in preventing the phenomena of that malady as it is in respect to those of syphilis. 4th.—The character of the secondary eruption would appear to vary much as in syphilis.— Thus, while Dr. Rat calls it “ erythematous ” I find other writers speaking of it as “ scaly ” and “ papular ” (see Hirsch, page 102). 5th.—Its restriction to certain localities.—Another argument in opposition to the idea that Yaws depends upon a specific virus distinct from that of syphilis may be based upon the fact that the disease (or perhaps we should rather say its peculiarities) appears to be restricted to certain races and regions. No Englishman comes back to us the subject of Yaws. It would appear that it is a malady which cannot leave its home. Now it is a priori far more likely that race and climate should be able to stamp such a disease as syphilis with peculiarity than that they should be able to confine to themselves the operation of a powerful specific poison. We have, so far as I know, no other instance of a specific animal poison which is restricted in its operation by race and climate. Papillary excrescences are known also in syphilis.—The tendency to papillary outgrowth and the production of fungating excrescences which is the most obvious peculiarity of Yaws is by no means wholly absent in syphilis as seen in European practice. I have myself repeatedly asked attention to this tendency to outgrowth as sometimes seen on the tongue in the secondary stage of syphilis, whilst syphilitic warts and condylomata (a form of papillary outgrowth) have long been well known The tendency to papillary outgrowth appears to be a peculiarity of the [174674] 2