Br J Vener Dis: first published as 10.1136/sti.41.3.155 on 1 September 1965. Downloaded from Brit. J. vener. Dis. (1965), 41, 155. YAWS SURVEY-JAMAICA, 1963* BY G. H. K. GENTLEt Plymouth, Montserrat, West Indies The Country as the Maroons. For the next 80 years, a guerilla Geography.-The island of Jamaica is situated in warfare was waged against the British settlers. Up to the Caribbean sea between 170 43' and 180 32' N. lat., the period of the emancipation, there was a large and 760 11' and 78° 21' W. long., 100 miles west of scale slavery trade with the West Coast of Africa to Haiti and 90 miles south of Cuba. obtain a labour force to manage the valuable sugar The greatest length is 146 miles and greatest width estates. 51 miles, with a total area of 4,500 square miles. The After the emancipation in 1838, Jamaica became island is divided into thirteen parishes. The surface a land of people free to work for whom they chose. of the island is extremely mountainous with There followed a massive exodus of liberated persons copyright. numerous ridges and spurs extending from east to from the estates, and to replace them, labourers were west. The highest, known as Blue Mountain Peak, brought in from India. Later in the 19th century attains an elevation of 7,500 feet. Chinese and Lebanese came in mainly as merchants. A great diversity of climate exists, from the By the second decade of the 20th century, Jamaica's tropical temperature of 80°-86° along the sea coast racial inheritance was completed from African, to between 400 and 50° at the highest elevations. The European, and Asian stock. Table I shows the mean annual rainfall varies from 62 55 in. in the population growth over 30 years, by age group: parish of St Ann to 140 46 in. in the parish of http://sti.bmj.com/ Portland. The 25-year mean of the thirteen parishes is TABLE I 76-64 in. Jamaica abounds with rivers and springs, POPULATION 1943-65 with most of the former running in a northerly or southerly direction. Census, 1943 Census, 1960 Estimated The wild life of Jamaica is made up mainly of Total Population 1965 birds and insects. The agouti is the only indigenous 1,237,063 1,613,148 1,757,200 wild animal, and he shares his domain with the feral 0-14 674,000 793,600 on September 24, 2021 by guest. Protected Age Group 15-49 724,300 703,200 hog. The mongoose is an immigrant and at one time (yrs) 50 and the crocodiles of the southern rivers were very Over 222,600 260,400 numerous. History.-For practical purposes, Jamaica's his- A History of Yaws in Jamaica tory begins in 1494 when Columbus landed there. Yaws was first identified in the West Indies early During the next century and a half, the Spaniards in the 17th century. Its introduction into Jamaica is annihilated the Arawaks, and imported African stated to have followed the importation of African slaves and cattle. At the time of the island's capture slaves during the 16th century. Several physicians by the British in 1655, there were only 1,500 inhabi- wrote about the disease in Jamaica, but one in par- tants, including slaves. The Spaniards released the ticular recorded the following observations concern- slaves who fled to the mountains and became known ing the methods by which yaws may be contracted: * Invited article received for publication March 31, 1965. (a) By sleeping in the same bed and the "ichor" from the t Medical Adviser, WHO/Pan-American Health Organization, P.O. Box 724, Georgetown, British Guiana. yaws getting in wounds or scratches of the infected. 155 Br J Vener Dis: first published as 10.1136/sti.41.3.155 on 1 September 1965. Downloaded from 156 BRITISH JOURNAL OF VENEREAL DISEASES (b) By handling the infected and allowing the virus to intimate contact between the infected and non- touch scratches or excoriations. infected. (c) By a sore considered not yaws, eventually turning out During 1932 field work was confined to districts in to be yaws. In the meantime the patient may have the parish of St Thomas, where special methods were washed his foot in the same bowl or basin as other tried for the discovery of cases and treatment of the persons, and thus passed on the disease. infected. In 1933 the activities of the Commission developed along three principal lines: (d) By small flies gorging themselves with the "ichor" of the infected alighting on the ulcers, etc., of those (a) The Research Unit worked on the following problems: who never had the disease. (1) A study of the central nervous sytem in yaws. It would appear that up to the time of the emanci- (2) Biopsy studies of representative yaws lesions. pation, the disease was kept under control by isola- (3) Cardiovascular involvement. tion of cases in "yaws huts". After the emancipation in 1834, a large number of liberated persons dis- (4) Transmission. persed throughout the island, and it is presumed that (5) Effects of drugs on the disease. the disease flourished among them. Freedom from (6) Follow-up of old treated cases. slavery, the lack of money to pay for medical atten- (7) Immunity reactions. tion, and their belief in "obeah" medicine, kept them (8) Comparative studies of yaws and syphilis. from seeing regular physicians. In 1852, a report by the Central Board of Health (b) Two Treatment Units were organized with a medical stated that "Yaws are distinctly an African disease. officer in charge of a survey team, and a treatment It is singular that previous to the emancipation, team. The former consisted of two specially- every estate had its 'yaws hut', which was filled, . trained sanitary inspectors. An assistant, two sani- In towns it is rarely or never seen." tary inspectors, and a clerk were assigned to the In the year 1854, labourers were imported into the latter. island from India. The Government was responsible The Yaws Commission found that bismuth injections copyright. for their medical treatment, and the prevalence of taken regularly gave just as good results as Salvarsan. yaws among this group which presumably had Follow-up of cases treated with each of these drugs over become infected after arrival, made the Government a period of 3 years showed that the number of cures were realize that this disease had become a major public the same. The action of bismuth was slower, but lasted health problem. In spite of organized treatment fol- longer. Salvarsan produced quicker healing, but like of Salvarsan in the bismuth needed at least six regular treatments to produce lowing the introduction 1911, a permanent cure. disease appeared to be just as prevalent in 1930 as before. (c) The Central Laboratory served as an adjunct to field http://sti.bmj.com/ Since 1920, the Government had expended from work, and provided opportunity for laboratory £2,000£-8,000 per annum for the treatment of this investigations. disease. The methods used benefited the patient, but failed to control the disease. In view of this, a Com- It is understood that the cooperation of the mission was organized to study the public health and Department of Education was solicited, and ques- epidemiological aspects of yaws. tionnaires were sent out to all schools in the island, to determine the incidence of yaws among school children. The treatment of yaws in Jamaica is on September 24, 2021 by guest. Protected I. The Jamaica Yaws Commission covered by Law 23 of 1910, which imposes on house- In 1932, the Yaws Commission was organized holders and school teachers the duty of reporting upon the invitation of the Government to the Rocke- cases of the disease to the District Medical Officer feller Foundation to cooperate in a study of this (DMO) in the district where the cases existed. disease. Much valuable ir.'ormation was published Treatment was to be arranged by the DMO, who on the epidemiological features, treatment, and con- also employed district constables to find cases, trol of yaws. Among the salient epidemiological report them, and bring them in for treatment. features brought to light, was that concerning its transmission by the Hippelates fly. It is recorded that Table II (opposite) gives data relating to yaws for these flies were liberal feeders on yaws ulcers, and it the period of the Commission's work from 1932-36 was believed that they played an important part in in certain areas in six eastern parishes. Figs 1 and 2 the transmission of infection. Undoubtedly, the most (opposite) show the areas surveyed and the percentage important single factor in the spread of infection was distribution of yaws recorded by the Commission. Br J Vener Dis: first published as 10.1136/sti.41.3.155 on 1 September 1965. Downloaded from YA WS SUR VE Y-JAMAICA, 1963 157 O AREAS SURVEYED PARISH BOUNDARIES FIG. 1.-Areas surveyed in Jamaica. copyright. FIG. 2.-Distribution of yaws in Jamaica. http://sti.bmj.com/ TABLE 1I Two additional units were established to supple- JAMAICA YAWS COMMISSION ment those employed with the Commission. The POPULATION IN AREAS WHERE YAWS CONTROL WAS scope of activities of these units was widened, and INSTITUTED they functioned as health units, to provide immuniza- tions against smallpox and typhoid, to carry out No. of Persons Year No. of Total Treated for de-worming, and to set up rural latrine sanitation. on September 24, 2021 by guest. Protected New Areas Population Yaws Eachunit was mobile, and comprised a medical officer, 1932 .