August

FRAMBCESIA OR YAWS: POWELL.

1898.]

281

No treatment was adopted from November to March so as to observe the undisturbed course of events, and note if any inflammation or ulceration would ensue.

#rrgiital

8

FURTHER OBSERVATIONS ON FRAMBCESIA OR YAWS: ITS

>00

SEQUELS:

"FOWL YAWS." By ARTHUR

POWELL,

jKalaiti, Gachar,

M. Ch?

B.A.,

Assam,

In the October number of this Gazette I expressed the opinion that disease of the bones was a very rare sequel of yaws, and stated that I had never met a case in which the bones I have now to record the folwere attacked. The bones reached their maximum of expanlowing two cases in which a remarkable sym- sion by the end of November, and remained metrical, uniform swelling of the proximal absolutely without change till March, when phalanges occurred during an eruption of fram- mercurial inunction was begun, on the hands, boesia three years after its commencement. groins, abdomen, &c. Case I.?-S., female, cet. 4, was vaccinated in R. was violently salivated, and the fingers reOctober, 1894, when her brother was suffering sumed their natural size in three or four weeks. from a general eruption of yaws. A granu- S.'s fingers assumed their natural thickness loma developed on the vaccine scar and was in six weeks, but perhaps the phalanges are soon followed by a general somewhat elongated. There are still a few eruption. Case II.?R., cet. 37, mother of case I, became granulomata on both patients. inoculated on the scar of a breast abscess, and I would draw attention to the following developed a general eruption of framboesia, the points as worthy of notice :? first spot being observed in January, 1895. (1) The simultaneous onset and maturation She gave birth to a healthy child on April 15th, in both mother and child. 1896, which continued so till it developed (2) The symmetry. yaws in January, 1897. (3) The identity and similar localisation in Except that case II had an eruption of both cases. scabies at the end of 1896, the symptoms of (i) The very marked sensation of lightness both cases were similar. An eruption of gra- or expansion obtained on handling, "as if they nulomatous buttons continued in greater or less were the bones of a bird," to use the expression abundance for over three years. No other form of the Hospital Assistant. of eruption nor any symptoms suggestive of (5) The uniformity of the enlargement, syphilis occurred, but the child's mouth is sur- which was nowhere nodular. rounded by a permanent scai\ To explain the causation of this bone exIn November, 1897, the mother showed me pansion, we have to choose from the theories her own and the child's hands, stating that that it is :? both had got a chill a week previously and had (1) a sequel of framboesia; pain and stiffness in the fingers. All pain had (2) a sequel of syphilis ; then gone. (3) a result of over-dosing with mercury, or The accompanying photograph will show (4) an idiopathic affection. In favour of No. 1 is the fact that it occurred the condition and perfect identity of the signs in both cases so that one description will serve. during an attack of yaws, though I am unable The entire length of the proximal phalanges of to find any record of a similar affection in the the index, middle and ring fingers is uniformly records of that disease. In favour of both Nos. 1 and 2 is the fact that enlarged and gives one the decided impression of expansion, and that the bone is much lighter it was cured with large doses of mercury. than normal, such as we see in the osteoporosis In favour of syphilis is the scarring round the of horses. There is no pain, tenderness, redness, child's mouth. Against it are the facts that both rise of temperature, nor any sign of inflammation. have for three years been under daily observaThe skin is of normal hue and no structure but tion, and had no symptom of syphilis; the the bone is affected. The range and freedom birth of a healthy child, two years ago, shows of movement is surprisingly good.

THE INDIAN MEDICAL GAZETTE.

282

that if

syphilis existed, it must be very old, and therefore the lesions would not be symmetrical,

which they were to a remarkable degree. That there were neither nodes, necrosis nor apparently sclerosis. It was not a dactylitis as the bone only was affected. A drawing from the American Text-book of Children's Diseases showing

[August

1898.

one each of dysentery, pulmonary tubercle and whooping-cough. A few have been lost sight of. In addition to the above, I lately traced two who bolted from hospital in 1893. Shortly after leaving they infected their parents. All four are now well, and say they never had any ulceration or bone disease.

cholera,

Fowl Yaws.

Mr. Shattock at

?,?

?

i

recent meeting of the shewed some specimens of Molluscum contagiosum in the sparrow. In the discussion Dr. Colcott Fox stated that Fowl Yaws" from the some specimens of West Indies, which lie examined, were neither more nor less than M. contagiosum. I had given Mr. Shattock some sections of "Fowl Yaws" in 1896, but neither he nor I then identified them with Molluscum. I have since examined some better sections of material also obtained from the West Indies, The tumours were on the eyelids, beak and wattles of a young turkey. They differed from yaws, and resembled Molluscum in that, except at a central umbilicus they were covered with a thin epidermis, and in that the sections were microscopically markedly "cheesey." Under the microscope sections shewed that the tumours were composed of a number of epithelial lobules or processes held together by fibrous tissue. The individual lobules were bounded by a layer of columnar epithelium which stains deeply. Next come successive layers of more or less rounded cells which gradually increase in size and lose their affinity for stains, till in the centre we find large oval cells perfectly stainless except in their nuclei. The fibrous stroma is in parts scarce, where the epithelial lobules Elsewhere it is lose are packed closely together. threads of fibrin. oedematous shewing ?) (and For comparison 1 have cut some sections of Molluscum contagiosum from a Bengali lad, and, except that the fibrous stroma is nowhere expanded or oedematous, the resemblance is a

Pathological Society

V

"

syphilitic dactylitis is given

for

comparison

with

my cases. If due to mercury, we are met with the fact that it was evidently cured by that drug. Both patients before the bones were affected were, contrary to my usual practice, vigorously treated with mercury from February to September, 1897. It may be said that the mother suffered all that time from an intermittent salivation of the "good old quart-a-day type." The intermissions were only sufficiently long to steady her teeth for renewed dosing. The simultaneous onset and the identity of the symptoms may suggest an idiopathic osteoporosis. I am not aware that any such disease lias been recorded in man. Condition

op

In four recent

the

cases

Lymphatics

I have noted

glands in the groin all complicated with

ment of the

in

Yaws. an

enlarge-

neck. These scabies between cases were the toes and in the groin, and fold of the buttocks as well as on the hands and wrists. During the present month of June, I have inspected all cases in the district who formerly suffered from yaws and have recovered. They Their framboesia comwere 136 in number. menced from eight to three years ago, and they have been under continual observation ever since. They were on the whole a remarkably healthy lot. Not one has, or has had any symptom suggestive of tertiary syphilis. A number have, of course, splenic enlargement, but perhaps than the other inhabitants a smaller proportion of the district. One is remarkably thin with for her condition. One has no lesion to account tubercular deposits in both lungs, a scrofulodermatous condition on the right instep, in the neck and left groin where some glands have suppurated. Seven have died, two of malaria, two of or

striking.

In the sections of "Fowl Yaws" which I described in The Indian Medical Gazette in October, there was a scattered infiltration of round cells in the fibrous stroma, which gave the appearance of granulation tissue. It is possible that the tumour from which they were cut was in a state of inflammation or incipient suppuration.

Correction.?From my paper in the October issue of this journal, it might be inferred that in none of Charlouis' cases did an ulcer form at the site of inoculation. This is not so. Especially where he failed to produce the disease, a pustule arose in a few days, broke down into an ulcer with inflammation of the lymphatics up to the

August

1898.]

PLAGUE INFECTION THROUGH CUTS: GREEN.

gland. When we read that his method of inoculation was the burying of a scab in a sac formed in the skin, it will be readily recognised that this was the result of sepsis, especially as he states that identical lesions were produced by inoculating the matter from acne pustules. nearest

283

Further Observations on Frambœsia or Yaws.

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