YAWS, the name in use in the British West Indies for a contagious inoculable tropical disease, running a chronic course and characterized by a peculiar eruption, together with more or less constitutional disturbance. It is known by various local names in different parts. In the French Antilles it is called pian; in Brazil, boba; on the west coast of Africa, gattu, dubé and taranga; in Fiji, coko; in the Malay Peninsula, purru; in the Moluccas, bouton d’Amboine; in Samoa, tonga or tono; in Basutoland, makaola; and in Ceylon it is spoken of under the name of parangi. The name framboesia was first given to the disease by Sauvages in 1759 from the likeness of the typical excrescences to a raspberry. For many years yaws was thought to be peculiar to the African negro, either in his home (both west and east coasts) or in the West Indies and Brazil. But a disease the same in every respect has long been known in the East Indies (first mentioned by Bontius early in the 17th century), affecting the Malays rather than the negroes, its chief seats being Amboyna, Ternate, Timor, Celebes, Java and Sumatra. It has been identified by De Rochas and other observers in New Caledonia and Fiji.
The general course of the disease is as follows. Previous to the eruption there may or may not be any disorder of health: in children (who form a large part of the subjects of yaws) there will probably be rheumatic pains in the limbs and joints, with languor, debility and upset of the digestion; in adults of ordinary vigour the eruption is often the first sign, and it is attended with few or no constitutional troubles. The eruption begins as small pimples like a pin’s head, smooth and nearly level with the surface; they have a little whitish speck on their tops, grow rapidly and reach the size of a sixpence or a shilling. The pustules then break and a thick viscid ichor exudes and dries upon them as a whitish slough and around their base as a yellowish-brown crust. Beneath the whitish slough is the raspberry excrescence or yaw proper, a reddish fungous growth with a nodular surface. The favourite seats of the eruption are the forehead, face, neck, arm-pits, groin, genitals, perinaeum and buttocks. Hairs at the seat of a yaw turn white. In young children or infants the corners of the mouth ulcerate, as in syphilis, and the perineal excrescences resemble condylomata. The pustules and excrescences do not all arise in one crop: some are found mature while others are only starting. If the patient be of sound constitution and good reaction, the yaws may reach the full size of a mulberry in a month, in which case they will probably be few; but in persons of poor health they may take three months to attain the size of a wood-strawberry, in which case they will be numerous inversely to their size. Often there is one yaw much larger than the rest, and longer in falling; it is called the “master yaw” “or mother yaw.” On the soles of the feet (less often on the palms of the hands) the bursting yaws are as if imprisoned beneath the horny cuticle; they cause swelling and tenderness of the foot, until set free by paring the callous skin down to the quick; these yaws are called “crab yaws” or tubbas. Usually a yaw is painless unless when rubbed or irritated. The absence of pain is used as a diagnostic sign if there be any doubt as to the nature of the attack: a pustule is opened and a little of the juice of capsicum dropped into it; if it be a yaw, no smarting will be felt. In some cases a few yaws will show themselves long after the primary attack is over; these are called “memba yaws” (from 'remember' ), the term being sometimes applied also to protracted cases with successive crops of eruption. Six weeks is the average time in a good case, from the first of the eruption to the fall of the excrescences; in such regular cases a scar remains, it may be for many months, darker than the rest of the (negro) skin. But the disease is often a much more tedious affair, the more protracted type having become common in the West Indies of recent years. In such cases the eruption comes out by degrees and as if with difficulty, crop after crop; foul, excavating and corroding ulcers may remain, or a limb may be in part seamed and mutilated by the scars of old ulceration. The scars after ulceration are not so dark as the skin around.
Aetiology. — Yaws is a highly contagious disease. It is neither hereditary nor congenital. The disease spreads by contact with previously infected cases, though it has been stated that infection also arises from inhabiting dirty houses, the floors and walls of which are contaminated with yawey matter from former yaw cases; and it is also believed, and has been proved by experiment, that infection may be conveyed by flies, which act as go-betweens, carrying infective material from a yaws sore to an ordinary ulcer. The virus must be introduced directly through a breach of the skin or mucous membrane; an attack in childhood gives a large degree of immunity for the rest of life. A micro coccus was found by Pierez and Nicholls in- the tubercles of yaws, but a pure culture of this micro-organism failed to give rise to yaws in animals into whom it was injected experimentally, and in no instance was it present in the blood. In 1905 Aldo Castellani demonstrated in yaws the presence of a slender spirillum, which he named the Spirochaeta pertenuis or Spirochaeta pallidula. It was also experimentally proved by him (1) that the material taken from persons suffering from yaws and containing the Spirochaeta pertenuis is infective to monkeys; (2) that when the Spirochaeta pertenuis is removed by filtration the material becomes inert; (3) that the injection of blood from the general circulation of a yaws patient gave positive results in monkeys; (4) by means of the Bordet-Gengou reaction it is possible to detect specific yaws anti-bodies and antigen.
The prophylaxis consists in the segregation of the patients suffering from the disease, the antiseptic dressing of the eruption, the application of a covering to protect it from flies, and the thorough cleansing and disinfection of infected houses and clothing, even the demolition of houses in endemic centres, and finally the compulsory notification of cases of yaws to the local sanitary authority.
As regards treatment, the malady in a person of good constitution runs its course and gets well in a few weeks. Whatever tends to check the eruption, such as exposure to chill, is to be avoided. A week’s course of cream of tartar and sulphur (confection of sulphur) at the beginning of the illness is often resorted to, so as to bring the eruption well out. The patient should remain indoors, in a well-aired room, and take daily warm baths and diluent drinks. If the excrescences are flabby and unhealthy, it is an indication for generous diet. When the eruption is declared, iodide of potassium and arsenic are very beneficial. As external applications, weak lotions of zinc or carbolic acid may be used, and, if the excrescences are irritable, a watery solution of opium. Tedious and unhealthy yaws should be dressed with a wash of sulphate of zinc or of copper; the same may be applied to a yaw ulcer. The crab yaws of the horny soles or palms, after they are let through by paring the cuticle, may be dusted with alum powder.
On the whole, the mortality is small. In 7157 West Indian cases treated in various hospitals there were only 185 deaths, a mortality of 25·8 per thousand (Nicholls).