YAWS OR FRAMBŒSIA.1

2
171 YAWS OR FRAMBCESIA. travel at a velocity of 760 millimetres per second * If the I sewer was large enough to take rain water it was impossible to obtain these conditions. Again, to obtain a safficient fall to ensure this self-cleansing velocity it would be necessary to raise the sewage in a great number of different places, and the raising of rain water increased the cost twentyfold. M. Masson urged that the rain water, which had washed the streets of a town, was as foul as sewage proper, and should therefore be treated as such. The discussion on the Liernur system of drainage, though very animated, did not lead to the proposal or adoption of any resolution. Another very interesting discussion was held on the warming and ventilation of dwellings. M. Ch. A. Gautier, president of the Society of Architects holding the Government diploma, read a paper on the subject. He denounced chimneys as warming badly ; objected to the looking-glass placed on the mantelpiece as checking the heat that might otherwise come from the wall ; found that stoves were unwholesome and sometimes dangerous; and proposed the warming of dwellings by steam coils in the walls of the rooms. M. Emile Trélat had here an excellent opportunity to bring forward his well-known theories on the subject, and it was gratifying to note how well these theories were appreciated and understood by all present. Everybody agreed with him that warming should be by radiation and not by convection. It was the walls, the floor, the ceiling, and the furniture that should radiate heat on the persons within, but the air should not be warmed ; it should, on the contrary, be as cold as possible. Differences of opinion only arose when M. Emile Tlélat urged that even unwholesome dried air or a portable stove might be employed to heat a room so long as no one was in the room; then the stove should be removed or the supply of dry, hot air cut off, the windows thrown open, and kept open while anyone was in the room. Some members of the Congress thought that traces of carbon monoxide might still remain in the room even when the windows were wide open. Many argued that the nearest approach to M. Trelat’s ideal was the placing of hot steam pipes in the walls and the ample opening of windows. A great deal was said about the injury done by stoves, notably to people who lived in apartments above, and who suffered from the defective construction of chimneys. A resolution was passed that chimneys, before they are used, should be tested by the authorities in the same manner as soil-pipes are tested to see that there is no leakage. This wap, perhaps, one of the most original and practical suggestions made during the whole of the Congress. Such, briefly, are some of the main subjects discussed at the Congress during the course of the week. It must be con- fessed that some of the architects and engineers present showed that they had only just commenced to study sanitary questions. Several of the speeches were but lame repro- ductions of what had been said at previous congresses. This, however, was to be expected. The Congress was more disappointing in so far as the engineers and architects did not bring forward as many plans and projects for the prac- tical application of sanitary principles as had been anti- cipated. Nevertheless, the Organising Committee and M. Desmenard, its energetic secretary, are to be con- gratulated on having grouped together some 300 persons in a congress, particularly as most of the members were architects and engineers, and there were, comparatively speaking, but few medical men and old tried sanitary reformers. So it may be said that new ground has been opened up, that a new class of sanitary reformers have come forward, and all this will help in the good cause. Paris, July 15th. YAWS OR FRAMBŒSIA.1 THrs large and voluminous blue-book, consisting of 368 pages and illustrated by numerous coloured plates and draw- ings, is an exhaustive contribution by Dr. H. A. Alford Nicholls, the Special Commissioner selected by the Secretary of State to conduct an investigation and furnish a report to I, the Colonial Office on the subject of which it treats. Dr. ’, 1 Report on Yaws in Tobago, Grenada, St. Vincent, St. Lucia, and the Leeward Islands, addressed to the Right Honourable Lord Knutsford, G.C.M.G., H.M.’s Principal Secretary of State for the Colonies, by H. A. Alford Nicholls, M.D., F.L.S. London: Printed for Her Majesty’s Stationery Office. 1894. Nicholls in describing the nature and scope of his inquiry alludes to the fact that he had received a communication from the late Sir George Buchanan, the medical officer of the Local Government Board, containing suggestions as to certain matters relating to the investigation and the line of action to be followed. The question is one of great importance in those tropical countries in which the disease prevails, and the facts which Dr. Nicholls has been fortunate enough to make public are not only of interest in themselves, but they tend to throw a new light upon the subject and to call for a reconsideration of the theories respecting it which have been put forward by previous writers. Dr. Nicholls is of opinion that the great obstacle to the successful treatment of the disease in its different types has been the ignorance which has hitherto prevailed about its pathology. He has therefore set himself to work this out in order to place its treatment on a proper scientific basis. It would be impossible within any reasonable compass to consider the large mass of material which accumulated in Dr. Nicholls’s hands during the course of his mission to the various islands. The consideration which he has bestowed upon its arangement and analysis will no doubt prove of value- in the way of reference to future inquirers, but the material is still very voluminous and not easily condensed four the purposes of a review. The disease known as yaws or framboesia was, he tells us, unquestionably introduced into the West Indies by negroes brought from the coasts of Africa as slaves ; indeed, some of the older West Iadian medical writers mention the fact of negroes sufferirg from yaws being landed from slave ships from Guinea. But there is no definite information obtainable, in regard to each island, as to whether the spread of the disease among the slaves on the plantations was due to the direct importation of affected persons from Africa or to an introduction and spread of the infection from a neighbouring colony. Yaws is the name that has been applied to the disease by the English from the time of the slave trade. The name "framboesia" was constructed by Sauvages in 1761 to, designate the cutaneous tumours which, when divested of their crusts, were considered to resemble raspberries. The French word Irantboise was Latinised into framboesia. Several other names have also been given to the malady. Dr. Nicholls considers that the Celtic word ias, pronounced yas, and meaning heat, boiling or bubbling up, is the- source of the English derivation of yaws. His experience- teaches him, he says, that yaws is not a cachectic, impetiginous, or an exanthematous disease, but that, it properly belongs to the group which the late Dr. Tilbury Fox called the diathetic diseases, and is to be included in the same category as scrofula, syphilis, and leprosy. It is not simply a local cutaneous affec;ion, but seems to be a general disease, of which the eruption- is only the local manifestation. The mistaken belief of so many authors that yaws is identical with syphilis has caused the question of the origin of the two diseases to be brought into a state of confusion. The considerations of this matter, in view of disentangling the difficulties surrounding the origin of yaws and of those connected with the geogra- phical distribution of the disease, are well worked out, by Dr. Nicholls. Yaws prevails throughout the tropics of the New World. It is found in various parts of South Ameiica- and Central America, and is especially prevalpnt in the West Indies and in Brazil-in fact, in those countries of tropical America to which most of the African slaves went. It is said to exist in all parts of tropical Africa, but the west. coast appears to be its endemic focus. The African islands’ off Mozambique, including Madagascar, are also reported to be infected, and naturally cases are occasionally met with in the northern countries bordering on the Mediterranean. There does not seem to be any conclusive evidence, however, that it prevails in any Asiatic country. For a description of the symptoms of the disease our readers cannot do better than refer to Dr. Nicholls’ report, to the plates’ illustrating its local features and manifestations, and the narrative of cases given by him and others. Without doubt one of the most important and disastrous complicaticns of yaws is syphilis. When yaws and syphilis occur as imer- current affections very destructive ulcerations may ensue. Mercury is necessary for the treatment of the syphilis, but its effect is very prejudicial in yaws. Dr. Nicholls and Mr. Francis Watts, the GoverEmfnt chemist of Antigua, performed a good deal of patholcgicaL and bacteriological work together at the Chemical Labora- tory in Antigua in connexion with this inquiry ; and with the."

Transcript of YAWS OR FRAMBŒSIA.1

Page 1: YAWS OR FRAMBŒSIA.1

171YAWS OR FRAMBCESIA.

travel at a velocity of 760 millimetres per second * If the Isewer was large enough to take rain water it was impossibleto obtain these conditions. Again, to obtain a safficient fallto ensure this self-cleansing velocity it would be necessary toraise the sewage in a great number of different places, andthe raising of rain water increased the cost twentyfold.M. Masson urged that the rain water, which had washed thestreets of a town, was as foul as sewage proper, and shouldtherefore be treated as such. The discussion on the Liernursystem of drainage, though very animated, did not lead tothe proposal or adoption of any resolution.Another very interesting discussion was held on

the warming and ventilation of dwellings. M. Ch. A.Gautier, president of the Society of Architects holdingthe Government diploma, read a paper on the subject.He denounced chimneys as warming badly ; objectedto the looking-glass placed on the mantelpiece as checkingthe heat that might otherwise come from the wall ;found that stoves were unwholesome and sometimes

dangerous; and proposed the warming of dwellings by steamcoils in the walls of the rooms. M. Emile Trélat had here anexcellent opportunity to bring forward his well-knowntheories on the subject, and it was gratifying to note howwell these theories were appreciated and understood by allpresent. Everybody agreed with him that warming shouldbe by radiation and not by convection. It was the walls, thefloor, the ceiling, and the furniture that should radiate heaton the persons within, but the air should not be warmed ; itshould, on the contrary, be as cold as possible. Differencesof opinion only arose when M. Emile Tlélat urged thateven unwholesome dried air or a portable stove mightbe employed to heat a room so long as no one was inthe room; then the stove should be removed or the

supply of dry, hot air cut off, the windows thrown open,and kept open while anyone was in the room. Somemembers of the Congress thought that traces of carbonmonoxide might still remain in the room even when thewindows were wide open. Many argued that the nearestapproach to M. Trelat’s ideal was the placing of hot steampipes in the walls and the ample opening of windows. A

great deal was said about the injury done by stoves, notablyto people who lived in apartments above, and who sufferedfrom the defective construction of chimneys. A resolutionwas passed that chimneys, before they are used, should betested by the authorities in the same manner as soil-pipes aretested to see that there is no leakage. This wap, perhaps,one of the most original and practical suggestions madeduring the whole of the Congress.

Such, briefly, are some of the main subjects discussed at theCongress during the course of the week. It must be con-fessed that some of the architects and engineers presentshowed that they had only just commenced to study sanitaryquestions. Several of the speeches were but lame repro-ductions of what had been said at previous congresses.This, however, was to be expected. The Congress was moredisappointing in so far as the engineers and architects didnot bring forward as many plans and projects for the prac-tical application of sanitary principles as had been anti-cipated. Nevertheless, the Organising Committee andM. Desmenard, its energetic secretary, are to be con-

gratulated on having grouped together some 300 persons in acongress, particularly as most of the members were architectsand engineers, and there were, comparatively speaking, butfew medical men and old tried sanitary reformers. So itmay be said that new ground has been opened up, that anew class of sanitary reformers have come forward, and allthis will help in the good cause.

Paris, July 15th.

YAWS OR FRAMBŒSIA.1

THrs large and voluminous blue-book, consisting of 368pages and illustrated by numerous coloured plates and draw-ings, is an exhaustive contribution by Dr. H. A. Alford

Nicholls, the Special Commissioner selected by the Secretaryof State to conduct an investigation and furnish a report to I,the Colonial Office on the subject of which it treats. Dr. ’,

1 Report on Yaws in Tobago, Grenada, St. Vincent, St. Lucia, and theLeeward Islands, addressed to the Right Honourable Lord Knutsford,G.C.M.G., H.M.’s Principal Secretary of State for the Colonies, byH. A. Alford Nicholls, M.D., F.L.S. London: Printed for Her Majesty’sStationery Office. 1894.

Nicholls in describing the nature and scope of his inquiryalludes to the fact that he had received a communicationfrom the late Sir George Buchanan, the medical officer ofthe Local Government Board, containing suggestions as tocertain matters relating to the investigation and the lineof action to be followed. The question is one of greatimportance in those tropical countries in which the diseaseprevails, and the facts which Dr. Nicholls has been fortunateenough to make public are not only of interest in themselves,but they tend to throw a new light upon the subject and tocall for a reconsideration of the theories respecting it whichhave been put forward by previous writers. Dr. Nicholls is ofopinion that the great obstacle to the successful treatment ofthe disease in its different types has been the ignorancewhich has hitherto prevailed about its pathology. He hastherefore set himself to work this out in order to place itstreatment on a proper scientific basis.

It would be impossible within any reasonable compass toconsider the large mass of material which accumulated inDr. Nicholls’s hands during the course of his mission to thevarious islands. The consideration which he has bestowedupon its arangement and analysis will no doubt prove of value-in the way of reference to future inquirers, but the materialis still very voluminous and not easily condensed four the

purposes of a review. The disease known as yaws orframboesia was, he tells us, unquestionably introduced intothe West Indies by negroes brought from the coasts of Africaas slaves ; indeed, some of the older West Iadian medicalwriters mention the fact of negroes sufferirg from yaws beinglanded from slave ships from Guinea. But there is nodefinite information obtainable, in regard to each island, asto whether the spread of the disease among the slaves on theplantations was due to the direct importation of affected

persons from Africa or to an introduction and spreadof the infection from a neighbouring colony. Yawsis the name that has been applied to the disease bythe English from the time of the slave trade. Thename "framboesia" was constructed by Sauvages in 1761 to,designate the cutaneous tumours which, when divested oftheir crusts, were considered to resemble raspberries. TheFrench word Irantboise was Latinised into framboesia.Several other names have also been given to the malady.Dr. Nicholls considers that the Celtic word ias, pronouncedyas, and meaning heat, boiling or bubbling up, is the-source of the English derivation of yaws. His experience-teaches him, he says, that yaws is not a cachectic,impetiginous, or an exanthematous disease, but that,it properly belongs to the group which the late Dr.Tilbury Fox called the diathetic diseases, and is to beincluded in the same category as scrofula, syphilis, andleprosy. It is not simply a local cutaneous affec;ion,but seems to be a general disease, of which the eruption-is only the local manifestation. The mistaken beliefof so many authors that yaws is identical with syphilis hascaused the question of the origin of the two diseases to bebrought into a state of confusion. The considerations of thismatter, in view of disentangling the difficulties surroundingthe origin of yaws and of those connected with the geogra-phical distribution of the disease, are well worked out, byDr. Nicholls. Yaws prevails throughout the tropics of theNew World. It is found in various parts of South Ameiica-and Central America, and is especially prevalpnt in the WestIndies and in Brazil-in fact, in those countries of tropicalAmerica to which most of the African slaves went. It issaid to exist in all parts of tropical Africa, but the west.coast appears to be its endemic focus. The African islands’off Mozambique, including Madagascar, are also reported tobe infected, and naturally cases are occasionally met with inthe northern countries bordering on the Mediterranean.There does not seem to be any conclusive evidence, however,that it prevails in any Asiatic country. For a descriptionof the symptoms of the disease our readers cannot dobetter than refer to Dr. Nicholls’ report, to the plates’illustrating its local features and manifestations, and thenarrative of cases given by him and others. Without doubtone of the most important and disastrous complicaticns ofyaws is syphilis. When yaws and syphilis occur as imer-current affections very destructive ulcerations may ensue.Mercury is necessary for the treatment of the syphilis, butits effect is very prejudicial in yaws.

Dr. Nicholls and Mr. Francis Watts, the GoverEmfntchemist of Antigua, performed a good deal of patholcgicaLand bacteriological work together at the Chemical Labora-tory in Antigua in connexion with this inquiry ; and with the."

Page 2: YAWS OR FRAMBŒSIA.1

172 THE ROYAL OOLLEGE OF PHYSICIANS OF LONDON.

aid of scientific apparatus from England Dr. Nicholls wasable to carry on and complete these investigations on hissubsequent return to Dominica. Some of the results of theseresearches are summed up as follows :-C:A microbe in the form of a micrococcus was found con-stantly in the secretion from the granulomata characteristicof yaws, which was successfully cultivated in nutrient media,and pure cultures were obtained to the third generation.The microbe was discovered in abundance in the affectedtissues of persons suffering from the disease, and no otherpathogenic microbe was found in association with it. In’mo instance was this micro-organism discovered in theblood, although it was successfully multiplied in the serum indrop cultures. It was found and successfully caltivated inAntigua, St, Kitts, and Dominica, and under identical con-ditions in these three islands. Pure cultivations of themicrococcus of yaws showed that its microscopical cha-racters were constant, and that its macroscopical appear-ances differed from those of micrococci already discoveredand described in various works on bacteriology, Thelower animals are probably immune, inoculations givingmegative results, as did also the inoculations from thesecretions of the granulomata. In the absence of the

- concluding proofs of the pathogenesis of the microbe-viz, the production of the disease in healthy animals by’inoculation of pure cultivations and the after discovery of themicro-organism in the fluids or tissues-it cannot yet be Ipositively declared that the micrococcus is the contagium ofthe disease. But Dr. Nicholls and Mr. Watts, in view of theattributes of the disease being clearly indicative of its origin.and causal connexion with a microbe, and of the fact that theywere able to establish that a micrococcus is its constant

accompaniment, as well as of the subsequent discovery by’Dr. Nicholls of the microbe in the lymphatic system and invarious organs of a patient who died from yaws, consider"themselves jastified in inferring that the micrococcusis nevertheless the cause of the disease and that itinvades the system through the lymphatics. It is

important to observe, in connexion with the bearingit has on the mode of propagation of this malady,that the micro organism has been found in the dust on thefloor of rooms in which yaws patients have been living, andthat, as a matter of experiment, it is capable of retaining itsvitality of growth and multiplication for a considerable time,The clinging of the contagion to certain huts and localities,and the occurrence of a sudden outbreak of the disease whenthe heavy rains of a tropical climate moisten the earthenfloors are therefore capable of explanation.We have said enough to show that the results of the latest

investigations, if ratified by subsequent researches, are likelyto throw a new light upon the subject of yaws, and to call fora reconsideration of the views that have been previously heldin respect to it. We may usefully conclude this article byreferring our readers to one that appeared in THE LANCET of- June 21st, 1873, on the disease in question.

THE ROYAL COLLEGE OF PHYSICIANSOF LONDON.

THE WEBER-PARKES PRIZE AND MEDALS.

WE have received from Dr. Edward Liveing, the Registrarof the College, the following particulars respecting Dr.Hermann Weber’s Friz3 Foundation in the College, and havepleasure in calling the attention of the profession to them.The prize is of the value of C150 or thereabouts, and will

be awarded triennially to the author of the best essay uponsome branch of the subject of Tuberculosis, especially withreference to pulmonary consumption in man. The first awardwill be made in 1897, and the adjudicators have selectedas the subject for the essay " The Means, Prophylacticor Curative. deemed by the author to have value in the’control of Tuberculosis, especial regard being had to theirapplication to Human Tuberculosis." This subject was.selected by Dr. J. E. Pollock, Dr. Thorne Thorne, and Pro-fessor W. S. Greenfield, who were nominated by the Pre-sident of the College, and these gentlemen will have theonus of adjudicating between the essays. The essay mustbe based on original work and observations (experimental orother) of the author, and inubt include a detailed expositionof the methods employed and their mode of application.

The following are the full regulations for the guidance ofintsudiog competitors :-

THE WEBER-PARKES PRIZE AND MEDALS.

Regulatians.1. That the prize founded by Dr. Hermann Weber, in memory of the

late E. A. Parkes, M. D., be termed the " Weber-Parkes Prize.2. That the prize be awarded triennially to the writer of the best

essay upon some subject connected with the etiology, prevention,pathology, or treatment of tuberculosis, especially with reference topulmonary consumption in man; that in making the award theCollege have regard to careful collection of facts and original research.

3. That the value of the prize be 150 guineas, or such sum as theinterest accrued on the capital, after payment of expenses, will permit.

4. That a bronze medal be awarded to the holder of the prize, and asimilar medal, to be distinguished as the second medal, to the essayistwho comes next in order ot merit.

5. That an Adjudication Committee be nominated on each occasionby the President from among the Fellows of the College, and that it bethe duty of such committee to select the particular subject forcompetition.

6. That the same committee which selects the subject shall adjudicateupon the essays sent in upon that subject, the President havingpower to fill up any vacancies which may have occurred meantime inthe committee.

7. That the adjudieation. he made every three years at some timeprevious to St. Luke’s Day, when the prize and medals will be presentedto the winners.

8. If, in the opinion of the judges, no essays are presented of sufficientmerit to deserve either the prize and lirst medal or the second medalrespectively, that the College be at liberty, on the recommendation ofthe judges, to award either one or both to the author or authors of anyoriginal work or works on the subject produced within the precedmgthree years which may be deemed worthy of the same; and in theabsence of such work or works that the corresponding award or awardsbe not made, and the sum assigned for the same be added to the capitalamount.

9. That the subject for the next ensuing competition be selected andadvertised within a period of three months from the last presentation;or, failing any award, from the day on which the prize would havebeen presented had an award been made; and that the competing essaysbe delivered to the Registrar on or before July 1st in the year of theaward.

10. That the competition be open to members of the medical pro-fession in all countries. The essays to be typewritten and in English;or if written in a foreign language to be accompanied by a transtationinto English.

11. That each essay bear a motto, selected by the writer, who shallinsert his name within a sealed envelope having the motto on thecover, the envelope being transmitted with the essay to the Registrar,who shall return the unsuccessful essays to their authors.

12. That the prize essay become the property of the College, and thatthe College may grant its author permission to publish it if lie sodesire.

13. That the medals shall present on the obverse the bust of the ’

founder; on the reverse a design relating to the prevention and treat-ment of pulmonary tuberculosis, with the inscription (exergue),"Prevention and Cure of Tuberculosis," and that the name of therecipient and the date of the award be placed on the edge of the medal.

THE CHEMICAL AND BACTERIOLOGICALEXAMINATION OF DRINKING-WATERFROM THE STANDPOINT OF THEMEDICAL OFFICER OF HEALTH.

THAT there has within recent years been a decided changein the attitude of the medical officer of health towards thevalue to be attached to chemical analysis few will question,and it is perhaps a debatable point whether the reactionwhich has taken place in favour of the bacteriologist may nothave led to a somewhat exaggerated importance beingaccorded to the results of the bacteriological examination ofwater. In former days the dictum of the chemist in

regard to any given water was accepted as final andthe water stood condemned or absolved according to

the results which the sample submitted yielded. Atthe present time the chemist has to some extent beensuperseded by the bacteriologist, and the dictum ofthe latter is now by some considered to be as conclusiveas was that of the chemist in former days. Under thesecircumstances it is hardly to be wondered at that bacterio-logical methods should be subjected to some criticism at thehands of the chemist. To those who would seek to studythe question from the chemist’s standpoint we would com-mend an able article by Dr. Dupre, F.R S., which appearedrecently in the Analyst, and to those who, like ourselves, areapproaching the subject from the standpoint of the medicalofficer of health we cannot do better than advise the perusalof a paper which appeared also in the Analyst, and whichhas now, together with Dr. Dupre’s paper, been issued inpamphlet form. For the information of our readers we will,