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Foot yaws
461 TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL ~IEDICINE AND HYGIENE. Vol. XXXVIII. No. 6. July, 1945.
FOOT
YAWS. BY
A. D. CHARTERS, M.D. (CAMB.), D.T.M. & H. (LOND.), CAPT., E.A.A.M.C.e
I was very m u c h interested in Capt. FURNELL'S excellent article on foot lesions in Africans, which throws light upon certain skin diseases which are c o m m o n not only on the West Coast b u t also in East Africa. H e clarifies the aetiology of several conditions which have in the past been commonly diagnosed as foot yaws. I n his conclusion he makes the statement : " D o u b t is cast on the importance of yaws in the aetiology of foot lesions in Africans." At the time of his publication there was at No. 1 (E.A.) General Hospital a classical case of crab yaws. I therefore felt that it might be of interest to~ publish photographs of the case before and after treatment. T h e patient, a man of about 40, was a native of the M u h a tribe, Tanganyika Territory. H e was enlisted in January, 1943. H e was admitted to hospital in March, 1944, with a 6 months' history of scaling and fissuring of his palms and soles. H e complained of pain in his soles but not in his palms. H e stated that he had suffered f r o m a similar affection in 1932, which had recovered after two intravenous and two intramuscular injections. H e denied any history of syphilis.
Clinical Examination. T h e sites of election of the disease were the points most exposed to pressure. Hands. T h e r e was thickening and exfoliation of the skin of the centres of his palms, most marked over the third and fourth metacarpals. T h e skin over the proximal phalanges, particularly those of the middle and ring fingers, * I am indebted to Brig. R. P. COI1MACK,Director of Medical Services, G.H.Q., East Africa Command, for permitting me to publish this article. I wish to express my gratitude to Capt'. S. BUTT,who gave his authority and arranged for the pictures to be taken, and to Capt. F. G. HERMGESand Lieut. E. C. STANDOROUCHBY, who photographed the patient before and after treatment respectively.
4~2
FOOT YAWS
was also involved. The nails were hypertrophied and deformed. There was infiltration of the skin, both of the nail folds, and beneath the free ends of the nails, giving a club-shaped appearance to the fingers and thumb. Feet. There was a deep erosion of the plantar surface of the right heel. There were fissures beneath the heads of the third, fourth and fifth metatarsal bones, and over the plantar surfaces of the toes. There was slight cutaneous thickening of the outer parts of the soles, but the medial longitudinal arches were ahnost unaffected. There was a state of onychia and paronychia of the toes, resembling the corresponding condition of the fingers. The Kahn Test was + + + A general examination revealed no other sign of yaws. Nothing abnormal was found in heart, lungs or nervous system.
P~'ogres$, Recovery commenced within 4 days of the first injections, which were given on 12th March. After 8 days the pain had almost disappeared. Within 20 days all subjective symptoms had vanished and there was an obvious improvement in the appearance of the parts ; the skin was less thickened, the fissures were healing and the unhealthy cuticle was peeling off. The second series of photographs were taken on 27th April, after the administration of seven weekly injections of 0.45 gramme N.A.B. intravenously and 0.2 gramme bismuth intramuscularly. They reveal a marked improvement. Fig. 6 may at first sight give the imlSression that a fresh ulcer has broken out on the lateral aspect of the right heel. This depression is, however, the result, not of new disease, but of exfoliation of unhealthy epithelium which was present before the commencement of treatment, as can be seen by a study of Fig. 5. REFERENCE.
FURNELL, M. J. G.
(1943). Trans. R. Soc. trop. Med. Hyg., 87, 217.
BEFORE
TKEATMENT.
AFTER A
To fare &zge 462
CASE
OF
FOOT
YAWS
TREATMENT.
FOOT
YAWS. BY
A. D. CHARTERS, M.D. (CAMB.), D.T.M. & H. (LOND.), CAPT., E.A.A.M.C.e
I was very m u c h interested in Capt. FURNELL'S excellent article on foot lesions in Africans, which throws light upon certain skin diseases which are c o m m o n not only on the West Coast b u t also in East Africa. H e clarifies the aetiology of several conditions which have in the past been commonly diagnosed as foot yaws. I n his conclusion he makes the statement : " D o u b t is cast on the importance of yaws in the aetiology of foot lesions in Africans." At the time of his publication there was at No. 1 (E.A.) General Hospital a classical case of crab yaws. I therefore felt that it might be of interest to~ publish photographs of the case before and after treatment. T h e patient, a man of about 40, was a native of the M u h a tribe, Tanganyika Territory. H e was enlisted in January, 1943. H e was admitted to hospital in March, 1944, with a 6 months' history of scaling and fissuring of his palms and soles. H e complained of pain in his soles but not in his palms. H e stated that he had suffered f r o m a similar affection in 1932, which had recovered after two intravenous and two intramuscular injections. H e denied any history of syphilis.
Clinical Examination. T h e sites of election of the disease were the points most exposed to pressure. Hands. T h e r e was thickening and exfoliation of the skin of the centres of his palms, most marked over the third and fourth metacarpals. T h e skin over the proximal phalanges, particularly those of the middle and ring fingers, * I am indebted to Brig. R. P. COI1MACK,Director of Medical Services, G.H.Q., East Africa Command, for permitting me to publish this article. I wish to express my gratitude to Capt'. S. BUTT,who gave his authority and arranged for the pictures to be taken, and to Capt. F. G. HERMGESand Lieut. E. C. STANDOROUCHBY, who photographed the patient before and after treatment respectively.
4~2
FOOT YAWS
was also involved. The nails were hypertrophied and deformed. There was infiltration of the skin, both of the nail folds, and beneath the free ends of the nails, giving a club-shaped appearance to the fingers and thumb. Feet. There was a deep erosion of the plantar surface of the right heel. There were fissures beneath the heads of the third, fourth and fifth metatarsal bones, and over the plantar surfaces of the toes. There was slight cutaneous thickening of the outer parts of the soles, but the medial longitudinal arches were ahnost unaffected. There was a state of onychia and paronychia of the toes, resembling the corresponding condition of the fingers. The Kahn Test was + + + A general examination revealed no other sign of yaws. Nothing abnormal was found in heart, lungs or nervous system.
P~'ogres$, Recovery commenced within 4 days of the first injections, which were given on 12th March. After 8 days the pain had almost disappeared. Within 20 days all subjective symptoms had vanished and there was an obvious improvement in the appearance of the parts ; the skin was less thickened, the fissures were healing and the unhealthy cuticle was peeling off. The second series of photographs were taken on 27th April, after the administration of seven weekly injections of 0.45 gramme N.A.B. intravenously and 0.2 gramme bismuth intramuscularly. They reveal a marked improvement. Fig. 6 may at first sight give the imlSression that a fresh ulcer has broken out on the lateral aspect of the right heel. This depression is, however, the result, not of new disease, but of exfoliation of unhealthy epithelium which was present before the commencement of treatment, as can be seen by a study of Fig. 5. REFERENCE.
FURNELL, M. J. G.
(1943). Trans. R. Soc. trop. Med. Hyg., 87, 217.
BEFORE
TKEATMENT.
AFTER A
To fare &zge 462
CASE
OF
FOOT
YAWS
TREATMENT.