[This tape was duplicated from a 16mm film by Erickson Archival for the National Library of Medicine, September 2004. NLM call number HF1770]
[This film will not be shown to the general public without permission of the War Department]
[War Department Official Film. Misc. 1269. MCMXLVI]
[Yaws]
In peace, as in war, the fight against disease continues.
Many new obstacles must be surmounted and new objectives realized.
An insidious enemy which persists in many parts of the tropical zone is known as the treponema pertenue.
This spirochete causes a wide-spread infectious disease known as Yaws or framboesia.
The disease is characterized by an initial cutaneous papillary lesion.
The secondary lesion is, as a rule, a multiple reduplication of the primary stage.
In a small percentage of the cases, the disease goes on to a third stage which involves especially the skin and bones.
Yaws is essentially a disease of the inhabitants of countries in the tropical zone.
The disease is non-venereal and is usually contracted before puberty.
The effects of the treponema pertenue are known all over the tropical world where the disease makes its appearance under various colloquial names.
In Samoa it is called "Lupani" or "Tono".
In Fiji it is called "Coco".
In New Caledonia it is called "Tonga".
In Java it is called "Potek".
In the Malay Federate States it is called "Paru".
In Ceylon it is called "Parangi".
In Angola it is called "Momba".
In the Gold Coast it is called "Buba".
In Brazil it's called "Boubas".
In Haiti it is called "Pian".
Research and studies of Yaws have been conducted on this island for some time.
Much of the heroic history of Haiti has been commemorated by beautiful statues and buildings.
And the cities, in many instances, are quite picturesque and modern.
But in the country, there is much to be desired in the way of sanitation and hygiene and nearly 85 percent of the rural population is infected by Yaws.
Poverty with its accompanying filth, poor diet, and exhaustion from over-work predisposes to the spread of Yaws.
Haiti is densely populated and large families crowd into tiny huts at night.
It is the custom of the whole family to sleep together on mats.
This direct contact favors the transfer of the disease.
Infection is carried from an open sore to a break in the skin of a well person.
Because the children go without clothes the first few years of their life, they are subject to open wounds from trauma.
Mucocutaneous lesions are very frequent.
The common practice using the same utensils -- everyone eating, drinking,
and in general sharing the few possessions of the family -- helps to spread the disease.
It is also aided by the ability of treponema to survive for a considerable time under moist conditions.
Some believe that the minute fly, hippelates pallipes, which feeds on open Yaws lesions in swarms, can carry the disease.
The treponema of Yaws, treponema pertenue, discovered by Castellani in 1905,
is morphologically indistinguishable from the treponema pallidum of syphilis.
The serology in Yaws is similar to that of syphilis.
The organism is found in the epidermis of the Yaws granuloma and has been demonstrated in the lymphatic glands and spleen.
The organisms have not been demonstrated in the blood, but the disease has been transferred by transfusion.
Under low power magnification, there can be observed a striking feature of the Yaws lesion--
the great thickening of the epidermis and the degeneration which occurs in the epithelial cells.
Much of the thickening of the epidermis is due to serous exudate and leukocytic infiltration.
The leukocytes are often massed in the epidermis to form abscesses.
The papillae are elongated and vascular.
Under higher magnification, in addition to leukocytes, can be seen plasma cells
which are very numerous and constitute the majority of infiltrating cells.
Though lymphocytes and a moderate increase of fibroblasts are usually observed.
In contrast to syphilis, there is usually absent the perivascular cellular infiltration which is seen in the corium in that disease.
The spirochetes are seen in this epidermal abscess.
A common late Yaws lesion consists of gummatous alteration of the skin and subcutaneous tissue.
Following infection there is an incubation period of 3 to 4 weeks.
The primary lesion begins as a papule which soon becomes eroded and moist,
exuding a yellowish secretion which dries into a crust.
Upon removing the crust, granulation tissue, which bleeds easily, can be noted.
This is an early framboesia form, or raspberry like lesion.
About six weeks to three months after the primary lesion, the secondary eruption appears.
Lesions varying from drop to silver-dollar size are scattered over the body.
In the areas where the skin is in apposition, the lesions are moist and condylomatous.
In the late secondary stages, papillomatous lesions form on the palms of the hands and soles of the feet.
They occur underneath the thick epidermis and are painful and disabling.
This condition is known as "crab Yaws".
Because of the painful lesions, locomotion is difficult and becomes similar to that of a crab.
There are two forms of crab Yaws: wet and dry.
The wet lesion teems with spirochetes and is an active source of infection.
This disease sometimes takes the form of gangosa, a process which may destroy the nose and palate.
In this case there is a perforation of the hard palate.
Sometimes the destruction of the nose is so complete that the sinuses are visible.
The upper lip is completely destroyed leaving the teeth exposed.
When large areas of the extremities are involved, the ulceration and scar tissue which forms frequently cut off the circulation of the member.
The skin ulcers often become secondarily infected with bacteria with resulting destruction of the deeper layers of the skin.
Occasionally, the secondary lesions continue after the development of tertiary lesions.
If the returned circulation is blocked by scar tissue, the extremity is frequently enlarged and has the appearance of elephantiasis.
When there is marked destruction of the tissues and secondary infection involving the hands and feet, the fingers and toes are often lost.
The resulting scar tissue formed with the healing of the cutaneous ulcers often contracts and immobilizes the joints.
With the cooperation of the Office of Inter-American Affairs, a coordinated campaign against Yaws has been carried out in Haiti.
Permanent clinics for treatment of Yaws scattered all over the island of Haiti are very popular.
And people frequently come 40 or 50 miles for their injections of arsenicals and bismuths.
During the five days intensive treatment, which otherwise would take weeks, many camp in the clinic yard where they sleep and prepare their food.
After the patients arrive at the clinic, one of the doctors gives them a talk on the prevention and cure of Yaws.
A record is made for each patient which includes physical examination and treatment.
The doctor examines the patient for evidences of the disease.
Neo-arsphenamine and bismuth salicylate are used in the routine treatment of Yaws.
In cooperation with the Surgeon General's Office of the Army,
300 hundred cases were treated with 1,200,000 units of penicillin calcium in oil and beeswax.
600,000 units were given twice a day to adults; children in proportion to their size.
The injection was given intramuscularly.
The following cases show the results achieved by the use of penicillin.
Before treatment with penicillin, this patient shows scatter lesions over the body, including the face and penis.
Ten days later the lesions were entirely cleared.
Secondary Yaws lesions, frequently occuring on the mucocutaneous borders, were present in this case.
The use of penicillin reduced the contagious stage of the disease to a matter of a few days, rather than of months and years.
This factor is important from a public health point of view.
This boy's moist condylomatous lesions were highly infectious.
However, injections of 2,400,000 units of penicillin rendered them sterile.
The typical condyloma dried up and healed very rapidly under penicillin treatment.
A typical group of condylomata on a young girl also healed rapidly.
The Haitian government and the Office of Inter-American Affairs are working together to eradicate this widespread disease
by setting up model clinics for treatment, by instituting modern public health programs,
and most important of all, by teaching the natives basic hygiene and simple precautionary measures such as the use of soap and water.
The need for this work may be effectively symbolized by this baby who like 85 percent of the rural population has been a Yaws victim.
Now as more penicillin is being released more infected natives are receiving the treatment which effects such dramatic recoveries.
[The End. MISC. 1269. MCMXLVI]
[This film will not be shown to the general public without permission of the War Department]