iblic-health Aspects of Yaws 261 



gradual or sudden decline in interest resulting in merely spas- 

 modic activity or even in cessation of the work. 



PERMANENCY OF RESULTS 



The available data indicate that there is but little tendency 

 to recurrence or reinfection after treatment with salvarsan. In 

 the Windward Islands in 1912-1913, only 5 per cent of relapses 

 occurred after treatment with salvarsan (606). (D Bergen 

 noted 4.9 per cent of relapses, or possibly reinfections, following 

 the intravenous treatment of 1,626 cases of yaws with salvarsan 

 after a period of thirty-four months; 2.6 per cent of relapses 

 occurred in 655 cases treated intramuscularly. Kurien(7) re- 

 cords 11 per cent of relapses in the treatment of about 3,000 

 cases with various preparations of salvarsan, but apparently 

 90 per cent of the patients received only one injection. Thorough 

 treatment of a community at once reduces to a minimum the 

 foci of infection. It is probable that, having once had the 

 disease, many patients will profit by their lesson. 



Fairly extensive treatment of yaws has been practiced of 

 late years, particularly in some of the hospitals of the West 

 Indies. There are doubtless valuable reports from such hos- 

 pitals to which I have not had access. Indeed, it would be very 

 important to secure information concerning the incidence of 

 yaws in a community in which intensive treatment with sal- 

 varsan had been practiced consistently for several years. In 

 Java, in 1913, the treatment of yaws with salvarsan (606) was 

 given thorough consideration. The decision was referred to 

 Kloppers,(6) who concluded that the plan was not feasible on 

 account of the great expense of salvarsan at that time. Mc- 

 Donald, (9) in 1915, suggested measures leading to the absolute 

 eradication of yaws in Antigua, a small island of about 108 

 square miles in the Leeward group in the West Indies. 



SUMMARY 



Neosalvarsan in the hands of medical men can, with proper 

 precautions, be used safely on an extensive scale under field 

 conditions. The diagnosis of the granulomatous stages of yaws 

 is simple. A Wassermann outfit, though not indispensable, is 

 a valuable adjunct even in field work. The treatment presents 

 no special difficulties. In the Tropics, routine examination of 

 the urine is not a prerequisite before administering neosalvarsan. 



Certain details of field operations are still sub judice, or are 

 subject to modification according to varying local conditions. 



