Clinical observations on yaws as studied on the west coast of Africa, 1922-1936

Abstract

1. Yaws is a childhood disease transmitted by contact. • 2. It is detrimental to the productivity and working efficiency of a community. • 3. It can cause death. It is also a very strong accessory factor in death from other diseases. • 4. While Gangosa and other effects appear dramatic in their rapidity, they are really the end effects of a slow insidious process. • 5. Yaws is 1. A cause of sterility and hard labour; 2. Definitely detrimental to the fetus in as far as the disease affects the mother; 3. A cause of prolonged ill-health, and permanent deformity in young and growing children; 4. Because of deformity so acquired, may cause or delayed labour in child- birth. • 6. It has not been shown to be hereditary or to affect true nervous tissues. • 7. Acquired immunity to the disease exists but is not certain. • 8. Apparent cure is simple. • 9. Sure and lasting cure is a long and expensive process. • 10. Inadequate treatment may precipitate the tertiary stage, especially of the bony type in the patient, and may destroy or put a stop to the development of the immunising process. • 11. Inadequate treatment may nevertheless render the patient noninfective to the community. • 12. While individual treatment is the thing to be aimed at, in Yaw communities mass treatment is often necessary, and should be carried out with a view to the hindrance of the spread of the disease in the first instance . • 13. In this regard tertiary Yaws stands by itself as it is not infectious. • 14. Treatment of the tertiary stage should be carried out not only with regard to Yaws, but also to the eradication of the conditions which the reaction in the tissues has brought about. • 15. Treatment of co-existent diseases and morbid conditions in the patient greatly accelerates and assists in the effectivity of the treatment. • 16. Choice of a spirillicid depends on the condition of the patient and the chance of prolonged treatment being carried out. • 17. Eye conditions may not be due to yaws, but the treatment of cases showing eye symptoms must be carried out with discretion. • 18. Yaws in its type and virulence depends not only on climate and altitude but on the hygiene and standard of living of the people. Special attention should therefore be paid to these things in any anti-yaw campaign. • 19. Though allied to non -venereal and venereal syphillis, under test it retains its own characteristics. • 20. In its earlier stages it might be confounded with non- venereal Syphillis as found among the Arabs, in its later stage with either venereal or non - venereal syphillis, but its association, onset and progress should differentiate it. • 21. Yaws of Syphillis can co -exist but the immunising forces, and yaws being a Disease of the unclothed and Syphillis of the clothed militate against it. • 22. Clinically the differentiation between yaws and Syphillis is:- 1. For of usual acquisition. Venereal and NonVenereal; 2. Age Incidence; 3. Typical Secondary rash of Yaws; 4. Tissue selectivity in Tertiary Stage; 5. Spinal fluid reactions.

POINTS FOR FURTHER INVESTIGATION. 1. The effects, if any, of the imposition of clothing and education on the tertiary manifestations of yaws on those who have had yaws in childhood. • 2. The reaction of the Spinal fluid in cases tending to show Central Nervous effects during the third stage, e.g. Headache. The paraplegias may easily be extra theeal. • 3. How far supposed tertiary manifestations are really active yaws. • 4. Enquiring into heart and lung conditions. Whether these are a fibrosis following Yaws. • 5. Further enquiry into the hard nodular placenta so often met with in the Gold Coast Colony after delivery of a healthy infant.