CHAPTER XXXIV 



FRAMBESIA TROPICA (YAWS) 



TREPONEMA PERTENUE (PALLIDULUM) (CASTELLANI) 



THIS peculiar, specific, infectious, contagious, chronic febrile 

 disease of the tropics is characterized by the appearance upon the 

 skin of one or more primary papular lesions the yaws bearing 

 some semblance to raspberries, and by subsequent malaise, fever, 

 and other constitutional disturbances. These are later followed by 

 the appearance of a second crop of small papules which grow to the 

 size of a pea or a small nut or may grow to be as large as apples, 

 which become covered with firm scabs and gradually cicatrize. The 

 patient either recovers or suffers from relapses and the appearance of 

 further crops of the lesions. The duration of the disease varies from 

 a few weeks to several years. In most cases the constitutional dis- 

 turbances occur only at the period preceding the development of 

 the eruptions and for a short time afterward. Little children 

 frequently die; older children and adults may die of exhaustion in 

 case extensive lesions with marked ulcerations develop. 



The patients usually recover and pigmented areas remain for 

 some time where the lesions have occurred. 



The disease appears to have been known since 1525, when Oviedo 

 became acquainted with it in St. Domingo. It has always been very 

 puzzling because it bears so many resemblances to syphilis; but the 

 peculiar raspberry-like character of the primary lesion, its dispo- 

 sition to occur upon the face, mouth, nose, eyes, neck, limbs, fingers, 

 and toes, as well as upon the genitals, seem to point in another di- 

 rection, and all authorities now admit that it is not syphilis, but an 

 independent disease. 



It occurs only in tropical countries, and is most frequent in 

 equatorial Africa on the west coast, from Senegambia to Angola. 

 It also occurs in West Soudan, Algeria, the Nile Valley, and in the 

 islands about the east coast of Africa. It has been seen rarely in 

 South Africa. In Asia it occurs in Malabar, Assam, Ceylon, Bur- 

 mah, Siam, Malay Peninsula, the Indian Archipelago, Moluccas, and 

 China. It is also endemic in many of the islands and archipelagos 

 of the southern Pacific. 



The disease rarely makes its appearance in the United States, and 

 it is of interest to know that Wood* has been able to collect nine 

 such cases from the literature. 



* "American Journal of Tropical Medicine," 1915, n, No. 7, p. 431. 



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