UPPER BURMA. 53 Feb., 1906.] YAWS IN The of these are riverine villages be- REPORT ON THE PREVALENCE OF YAWS majority tween which constant communication ?exists IN THE LOWER CHINDWIN DISTRICT, Inland villages in this township are less affected UPPER BURMA. and in farther inland ones some distance from each the disorder to a slight by p. a. other, prevails only ? McCarthy, extent. Mily. Asst.-Sdbgeon, Budalin township adjoining Kani has also 29 Civil Surgeon, Lower Chinchoin District. villages where the disease is found. The majo- was of are on I he existence of yaws in the district rity these villages the Chindwin river with first Mr. A. H. Nolan, late Civil in communication villages in the Kani recognised bj7 have also of Monywa, who had his attention township. Oases been seen in some Surgeon on the Mu drawn to cases of the disease in the small villages river near the Sliwebo previously district. Pakokku and Shwebo districts in 1899. After border of the the dis- In Alon township the disease is found in his appointment to Lower Chindwin were seen to those 6 in one villas trict, cases which similar only villages, Salingyi township is while Pale is found in Shwebo and Pakokku districts, led to affected ; entirely free from ft and ? an and study of the disorder found Character description of the disease. enquiry The observations have been made prevailing in this district. His observations following be- from a of 431 cases that have been were embodied in a paper which was read study treated m the from November fore the Indian Medical Congress in Calcutta district 1904. Mode communication.?The disease is a in 1894 and published in the British Medical of Journal of 2nd February 1895. definitely contagious, infectious, and chronic dis- atten- caused direct inoculation of the On my arrival in Monywa in 1901, my order, by speci- fic virus a breach of surface of the tion was drawn to the existence of the disorder through skin. This condition of broken surface is constant- and since then my observations have led to the the of conclusion that "Yaws" described by Manson, ly present in way abrasions, wounds, or various forms of skin in Sheube, and other authors is found prevailing ulcers, eruptions, the of inhabitants of a and the in the Lower Chindwin district, the various majority village, to infection and of the disease lesions of the disorder being similar to those liability spread in a with can be described these authors. locality affected yaws readily by understood. Local names of the disease.?The disease is names if] district In The themselves understand that the known by different the _ people can be communicated from one to the the lvaui township it is called Toung-noo-nah, disease the initial lesion in an i.e., I and noo-nah?leprosy?refer- other, beginning open oung-hill, either direct contact of the secretions ring to the raised exciescences in the disorder. surface, by a the contact of It is also known as kwe-nah??a crippling disease from yaws fungus, by clothino- or a house infected with the about this locality. mats in disease5 on from the dust in a village infested with the virus' In villages bordering the Shwebo,Sagaing, it is and the of flies and other and Pakokku distiicts, called Pwe-zone~ by communicability insects. nah. A translation of tins word f^ives an illus- a far as observa- trative idea of the eruption seen. Piue is Degree of contagion.?S0 my tions have tended to are of mole which throws up little mounds show, children the species sufferers, but no is and both of earth over its burrowing place. This mound greatest age exempt " no- sexes suffer alike. Very infants is known as "zone by the Burmans. This young appear to be less affected than children over 6 months menclature of the disease was graphically de- and in no case has an infant born of an infected scribed to me by a learned phoongyi in the dis- mother been heard of as been trict and clearly illustrates the form of eruption having born with the disease. The youngest child found suffering seen.311. from the disorder in the total number treated History and the distribution 0f tfie disease.? was three months old. No definite period of its introduction into this can be to ages 113 were between 1 and part of Upper Burma traced. According it has been known for 5, 10G between 5 and 10, 54 between 10 and 15 In some villages gene- the 21 between 15 and 20, 43 between 20 and rations, while in others, disorder is of recent 30,' 35 between 30 and 40, and 59 over 40 origin, having been introduced from some pre- years In in The disease is a viously affected village. large villages undoubtedly piace disorder, dis- but of slow When an inmate a Kani township, a tradition prevails that the progression. of house is attacked, other cases n:e to order was first introduced from Siam, trading certain in the course of time. boats in former days coming up along the Mer- follow The between the first case a coast to the Chindwin river. period in house gui to i? Extent Up to the present time has been known vary diff.ient localities of prevalence.district found from 2 months to i from the 65 villages in the have been years introduction affected with the disease. The centre of pre- or the disease. of incubation valence is in the Kani township in which 29 The period is uncertain From notes collected in cases where the villages are affected. primary 54 THE INDIAN MEDICAL GAZETTE. [Feb., 1906. lesion appeared in recent ulcers or wounds, a loins are invariablj' present; an itchy descrip- period of 3 weeks to 2 months was said to have tion of the skin is also described before the elapsed before the primary sore appealed. In appearance of the eruption. The skin at this G cases where inoculation unfortunately occurred stage becomes harsh and dry with raised patches in the sites of vaccination erosions, G weeks to of furfuraceous desquamation, either in small 2 months elapsed from the date of operation and areas or by coalescence involving large areas. In healing of the vaccine ulcers before the appear- these patches the granulomata appear as minute ance of the primary frambcesial sore. It is papules which sprout out and coalesce, the sum- noteworthy in this connection to remark, that mit of each papule having a yellow point. in each of the 6 cases successful vaccine vesicles With the growth of each papule and a coalition appeared in two of the sites of operation, the of several, the yaws is formed. A fully develop- single site of failure in each case resulting later ed individual tumour presents the following- in a primary frambcesial lesion, and each sub- characteristics. It is conical in shape, raised ject developed a moderately severe secondary about h to J of an inch from the surface of the eruption of yaws. This observation is interest- skin. The base is round or oval with a diame- ing in view of one author's conclusion?Keelam? ter from ^ to | inches. The summit is topped who states that vaccinated subjects develop with a yellow inspissated moist crust which is only a mild form of the disease and that vaccina- difficult to wipe off. If scraped, bleeding occurs, tion exercises a favourable influence on the and on wiping the blood pink papules are appa- course of the disorder. rent with interspaces which dip down between Symptoms and 'progress of the disease.?In a them. Rapid exudation of cheesy material recurs few instances only in adults were S3'mptoms and the 3'ellow moist crust again forms, which experienced of a prodomal nature prior to the later on becomes brown. appearance of the initial lesion. These were mild, Several of the tumours may coalesce and form consisting in slight feverishness, loss of appetite, irregularly raised patches. When exposed to the as and rheumatic pains about joints and pressure in the arm-pit and in the inner part muscles. The primary lesion if occurring in an of the thighs, and near mucous surfaces about apparently sound site or a slight breach of the corners of the mouth, nose, near the anus surface, appears as a hard papule itchy in and about the vulva, the eruption appears as character, which gradually enlarges and breaks flattened moist yellow condylomata. When dowu having on its summit a depressed yellow situated in the hands and feet, they resemble spot of inspissated secretion. This tends to hard fissured growths exuding a sero-purulent spread until the whole papule is absorbed by material which does not crust readily owing to ulceration. This ulcer heals in the course of a the thick epidermis which prevents the entire few days and leaves a slight scar which is notice- outgrowth of the papules. As a rule little pain able for some months later. Unless occurring is associated with the growth except on the on small surfaces of broken skin, the initial hands and feet, but itching is usually marked. lesion is difficult to recognize. Some patients The crop of the tubercles varies from a few described the onset of the disorder as an aggra- in number to a general invasion of the whole vation of irritation of existing ulcers where body, being most numerous on the face, back and inoculation was presumed to have occurred. chest. Hairy portions and mucous surfaces are In many cases no history of a primary lesion veiy rarely affected, but they are frequently could be obtained before the appearance of a found at the junction of mucous surfaces with general eruption.