Page:Tropical Diseases.djvu/705

From Wikisource
Jump to navigation Jump to search
This page has been proofread, but needs to be validated.
XXXVII]
SYMPTOMS
659

grey, viscid fluid which soon becomes inspissated, rapidly forming a fresh cap to the yaw. Pus, unless as a consequence of irritation, is not, as a rule, found under the crust.

Although the formation of the papules and yaws is attended with much itching, the yaw itself is not at all sensitive; the tumour may be touched, with acid even, without causing pain— a diagnostic point of some importance.

The yaw usually attains its maximum development in two weeks. For several weeks longer it remains stationary before beginning to shrink. The crust then thins, shrinks, darkens, separates at the periphery, and at last falls off, disclosing at the site of the former fungating mass a slightly thickened spot of fairly sound skin which, though pale at first, may subsequently become hyperpigmented.

Ulceration.— Such is the normal process of evolution and involution of a yaw. But it sometimes happens that the tumours, in place of becoming absorbed, break down and ulcerate, the ulceration, however, being confined to the yaw itself. In other instances ulceration goes deeper and extends circumferentially, giving rise to extensive sores with subsequent cicatricial contractions. Such ulcerations may or may not be encrusted. With the development of the deeper and wider forms of ulceration, the typical lesions of yaws may disappear for a time, or perhaps permanently. In the latter case the ulcers are said not to be infective, and do not communicate yaws; they are, therefore, to be regarded rather as complications or, it may be, sequelæ. Such ulcers may persist for years. Ulceration, according to Nicholls, occurs in about 8 per cent, of cases.

Onychia.— Yaws may occur around or under a nail and give rise to a troublesome form of onychia.

Foot yaws.— When a yaw develops on the sole of a foot, in consequence of being bound down by the dense and thick epidermis it causes much suffering. Spreading laterally under the thick, leathery, and unyielding epidermis, it may attain a large size. After a time the epidermis over the growth gives way,