CHAPTER XXXII. 

 FRAMBESIA TROPICA (YAWS). 



TREPONEMA PERTENUE (CASTELLANI). 



THIS peculiar, specific, infectious, contagious, chronic fe- 

 brile disease of the tropics is characterized by the appearance 

 of one or more primary papular lesions the yaws bearing 

 some resemblance to raspberries, upon the skin, 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 re- 

 covers 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 con- 

 stitutional disturbances occur only at the period preceding 

 the development of the eruptions and for a short time after- 

 ward. Little children frequently die; older children and 

 adults may die of exhaustion in case extensive lesions with 

 marked ulcer ations 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 resem- 

 blances to syphilis; but the peculiar raspberry-like character 

 of the primary lesion, its disposition to occur upon the face, 

 mouth, nose, eyes, neck, limbs, fingers, and toes, as well as 

 upon the genitals, seem to point in another direction, 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 



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