YAWS 2 1 / 



or the genitals (fig. 57). When there are few yaws they 

 are more common near mucous orifices ; when abundant 

 the whole body and limbs may be involved (fig. 58). 

 On the extensor surfaces the eruption tends to be more 

 abundant. The scalp and axillae are rarely involved, and 

 the palms and soles only in the later eruptions. The 

 actual duration of each yaw is three or four weeks, and 

 fresh yaws may appear before the subsidence of the 

 earlier ones. 



On moist surfaces, as in the perinaeum and at the angles 

 of the mouth, little or no crust is formed on the yaw, 

 but in drier parts the peculiarly yellow scab is always 

 present. This scab is detached with difficulty, and a 

 slightly milky fluid is found beneath it. The exposed 

 surface bleeds very readily. The glands are not enlarged 

 unless the yaw is injured or secondarily ulcerated. Ulcer- 

 ation may take place in parts exposed to much movement 

 or to friction, and secondary deeper ulceration sometimes, 

 but rarely, occurs. 



The eruption may recur for two or three years, but 

 the later crops are usually scanty, and in this stage are 

 frequently under thick, hardened epidermis, such as the 

 sole of the foot (fig. 59). 



The granulomata in such situations cannot grow to 

 any great size, and are compressed by the thickened 

 epidermis and very painful. These painful granulomata 

 on the soles of the feet may persist for years after all 

 other manifestations of the disease have ceased " crab 

 yaws." 



Sequelae attributed to yaws are numerous, but the evi- 

 dence that they are related to that disease is inadequate. 

 A destructive ulceration of the mucous membrane of 

 the mouth, palate, pharynx, and nares is common in 

 Fiji, and occurs in other countries where yaws is common. 

 It is a disease which occurs usually in early adult life, 

 many years after the last definite manifestation of yaws. 

 It occurs in persons who have not had syphilis, and if 

 not a sequela of yaws is probably a separate and distinct 



