Frambœsia: History of its Introduction into India; with Personal Observations of over 200 Initial Lesions

Abstract

Dr. Powell writes: -" The history of yaws in India taken alone seems to me sufficient to prove that syphilis and yaws are two distinct diseases. " Syphilis has existed in India for centuries and is specially prevalent among the coolies recruited from distant parts of India to the tea estates of Assam. In the estates under my care from 7 to 10 per cent. of the population were syphilitic. " Although prevalent in the Dutch Indies, Malaya and Ceylon, no case of yaws had been observed among the three hundred million inhabitants of British India till in December, 1899 [? 1889], after a residence of one and a half years in Assam, I met my first two cases. From these two the disease spread by direct contact till in ten years I personally observed and treated in a narrow strip of land 22 miles long, by 4 wide, 653 cases in a population of about 6, 000. " In 1887 a coolie woman came from Ceylon with three daughters, the youngest being infected with yaws. The other two girls in turn became infected, and were constant visitors to the lines in which cases were first seen by me. These four women called the disease ' faranghi ' while all the other coolies called it ' The New Disease. " Afterwards the author lived in Bombay for 19 years. He travelled much, had a large venereal practice, in his capacity of Inspector of Lepers examined many skin conditions, but he saw only one case of yaws, in a pilgrim from Sumatra. He gives details of the spread of the disease in Assam between 1889 and 1900, and later, with a map. Being in charge of indentured coolies and their children he was able to observe his patients at the very appearance of the primary lesion. When the coolies were paraded at roll-call, if a case of yaws had appeared, the native doctor was instructed to register any ulcer, wound, leech-bite or other breach of surface on uninfected men, and these were observed from day to day. The author has notes of the initial lesion in 205 cases. He has never seen a primary lesion that remotely resembled the ulcers described in the textbooks of BYAM and ARCHIBALD, MANSON-BAHR, and CASTELLANI and CHALMERS. In 43 cases the first sign of the disease was a general eruption in 35-121 days; in seven of these " though no lesion could be seen at the site of presumed inoculation, an ordinary fungating granuloma appeared at a short distance proximal to it; others still more proximal followed in a centrifugal direction till finally a general eruption developed "; three such cases are described. In 162 cases a raised fungating button, identical in all respects with those of the secondary eruption, appeared at the site of the presumed inoculation after 17-68 days. It is carefully described with references to figures. Failing trauma or caustic applications the yaw heals without scar. Ten cases are described illustrating these and other points. Another series illustrates the satellite type, a ring of lesser yaws round the primary. To show the rapidity with which the disease can spread the history is given of a family of seven, six of whom were attacked within three and a half months; vaccination, a leech-bite and scabies provided the points of entry of the virus. A general enlargement of glands was not observed in uncomplicated cases. In 11 cases the author took secretion from a granuloma and " vaccinated " the donor; the result was always negative. Though he has looked carefully for it he has never seen a " prodromal furfuraceous eruption." Children have little fever or joint-ache, adults less than the textbooks seem to indicate. With the exception of three cases, in two of which yaws was contracted by syphilitic patients, he has never seen any tertiary signs that could possibly be attributed to yaws, but he notes that no patient was under his observation more than 101/2 years after inoculation. Details are given of six cases in which syphilis was inoculated in patients suffering from yaws, and three in which this sequence was reversed. A cracked and pitted form of plantar hyperkeratosis described by CASTELLANI as a sequel of yaws is common in Assam and not rare elsewhere in India: POWELL dissociates it from yaws. Powell has seen no case of hereditary transmission; on the other hand seventeen babies born of parents who had yaws during pregnancy were healthy and remained so. He refers with much scepticism to the belief that there is no syphilis in Fiji, and notes that 25 years ago there were in that group 10, 000 Assamese cpolies who, he is unable to believe, were free from' syphilis, and inter-racial intercourse is free. [See HARPER, this Bulletin, Vol. 10, pp. 265-6.] The paper is illustrated pictorially and with a wealth of clinical detail. A. G. B.