CO885-(16-18) — Page 685

PUBLIC RECORD OFFICE

חוּד

Reference :-

C.O.885

18 PUBLIC RECORD OFFICE, LONDON

16981

18

No. 30. CEYLON.

THE GOVERNOR to THE SECRETARY OF STATE.

(No. 226.)

(Received May 13, 1907.)

The Queen's Cottage, Nuwara Eliya, Ceylon,

April 24, 1907. [P/intel except the portions in the enclosure in [ ] as No. 3 in Appendix VII. to [Cd. 3992], March, 1908.

Enclosure 1 in No. 30. FRAMBOESIA TROPICA (YAWS).

By ALDO CASTELLANI, M.D., Director of the Clinic for Tropical Diseases, Colombo

*

*

(Ceylon),

*

***

*

*

In Venezuela and other South American countries the name Bubas is much used; [according to Breda and others, however, the disease known as Bubas differs from true Framboesia.]

SYMPTOMS.

Constitutional symptoms of severe nature are generally absent during the whole course of the eruption in ordinary cases; the physical examination of the internal organs does not reveal anything abnormal; a few superficial lymphatic glands may be enlarged, [but in my experience this is not a constant feature.] The analysis of urine does not reveal anything abnormal. The stools may contain ova of various worms, but this also is of frequent occurrence in normal natives.

*

[INOCULATION EXPERIMENTS Of Yaws in Man,

*

Paulet (1848) inoculated fourteen negroes with the secretion taken from yaws granulomata. All of them developed yaws, the incubation period varying from twelve to twenty days, when at the place of inoculation in ten cases the first nodule In two cases of yaws appeared, soon followed by a typical general eruption. apparently the eruption did not start from the seat of inoculation.

The investigation of Charlouis (1881) is most important. He first took four cases of yaws and inoculated them at various spots with the secretion of their own yaws in three cases at the place of inoculation typical yaws granulomata developed. Charlouis also inoculated thirty-two Chinese prisoners who had never suffered from the disease-with crusts and scrapings of a yaws case. In twenty-eight cases the disease developed, beginning always from the seat of inoculation.

Moreover, Charlouis inoculated a native suffering from typical yaws, with syphilis. The inoculation was quite successful, a primary syphilitic sore develop- ing, followed by all the usual types of secondary eruption.

That yaws patients are not immune against syphilis is proved also by Powell, who described two very interesting cases of syphilis supervening on yaws.

PERSONAL EXPERIMENTAL INVESTIGATIONS.

Inoculation of yaws in monkeys,

My first experiments made at the beginning of 1905, on a "purple-faced monkey" (Semnopithecus cephalopterus) were negative. In February and March of 1906 I made some more experiments of inoculation on three monkeys on the genus macacus, with positive results in one case. The monkey which was successfully inoculated with yaws, was later successfully inoculated with syphilis with positive results. In the meantime, Neisser, Baermann, and Halberstädter, published in the Munich Med. Woch. (No. 28, 1906), a report on their results on the inoculation of yaws in monkeys, coming to the conclusion that monkeys of a high, as well as of a low, type are susceptible to be infected with yaws; and that monkeys immunized for syphilis do not become immune for yaws.

19

I have continued the investigation on numerous monkeys of the genus macacus and semnopithecus. In both genera the positive results are fairly numerous pro- vided the scarifications on which the yaws material is inoculated are made as deep as possible. I quote two of the experiments which gave positive results.

On

Monkey No. 4 (Maccacus pileatus), 10th November, 1906. The scrapings taken from a non-ulcerated yaws papule is thoroughly rubbed into the scarified spots over the left eyebrow. The slight local inflammatory facts caused by the scarifica- tion subsided in three days. Nineteen days after the inoculation a very small flattened papule surrounded by an infiltrated zone, appeared at the seat of inoculation. The lesion soon became enlarged and moist, the secretion drying into a thick crust. removing this crust a granulating, raw surface was seen. Two months later the first element being still present, four more papules appeared, two on the lower part of the forehead close to the primary lesion, and two just over the upper lip. One of these elements disappeared after a few days; the others became moist and a yellowish crust formed on each of them. These papules remained always small and disappeared after three months, leaving tiny dark marks. The eruption was evidently very itching, as the monkey was continually scratching. It is possible that the papules observed two months after the first lesion appeared may represent acts of autoinoculation by scratching, rather than representing a true secondary eruption.

Monkey No. 17 (Semnopithecus priamus), 15th October, 1906. Scrapings taken from a non-ulcerated papule of a yaws patient is well rubbed into deep scarifica- tions over the left eyebrow. Forty-five days after, three slightly elevated spots appeared which soon fused together into an infiltrated mass, covered by a thick crust; the lesion increased to the size of a sixpenny piece. No other elements appeared. The lesion is still present and of the same size (31st January, 1907). It was examined for the Spirochete pertenuis on three different occasions with positive results twice. Altogether eight monkeys of the genus macacus and 11 of the genus semnopi thecus have been inoculated with scrapings taken from the eruptive elements of yaws patients: the inoculation was successful in five monkeys of the first genus and nine of the second. The incubation period has varied from a minimum of 16 days to a maximum of 92. The appearance of the lesion developing at the seat of inoculation was practically the same in all cases: viz., an infiltrated spot slowly increasing in size and soon becoming moist, the secretion drying into a thick crust. When the crust was removed a raw, granulating, red surface was seen. With the exception of three cases the eruption remained localized at the point of inoculation, and no other eruptive elements appeared. In the three cases in which eruptive elements developed some time after the primary lesion, in one, as I have already mentioned (Monkey No. 4), two small papules appeared on the lower part of the forehead in vicinity to the primary lesion, and two others above the upper lip. Of the other two monkeys, in one a rather large moist papule appeared on the lower lip three months after the primary sore had developed; in the other, three small papules, which soon broke and became covered with a crust, developed on the lower part of the forehead, close to the primary lesion, two and a half months after the first lesion had appeared.

INOCULATION OF MONKEYS WITH THE BLOOD of the GenerAL CIRCULATION FROM A YAWS PATIENT.

About 5cc of blood was withdrawn (18th September, 1906) with all aseptic precautions, from a vein at the bend of the elbow of a patient suffering from a typical yaws eruption on the legs, back and face, but not on the arms; the needle, therefore, could be inserted through a perfectly normal skin without touching any yaws element. One cc of the blood was well rubbed into deeply scarified spots on the right eyebrow of a macacus. Thirty-three days later a small deeply raised brownish papule appeared. Before the papule became moist a scraping was taken and stained with Leishman's method according to the directions given by me in the "British Medical Journal," November 26th, 1905. Numerous individuals of the Spirochete pertenuis were present. The papule slowly enlarged and became covered with a crust. The lesion disappeared after three months; no other elements developed.

This experiment shows that:

1. Monkeys can be successfully inoculated with the blood of a yaws patient. 2. The Spirochete pertenuis is, at least temporarily, present in the blood of the general circulation, though so far I have not been able to detect it microscopically.

28021

C 2

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

19

nvestigation on numerous monkeys of the genus macacus oth genera the positive results are fairly numerous pro- which the yaws material is inoculated are made as deep f the experiments which gave positive results.

us pileatus), 10th November, 1906. The scrapings taken is papule is thoroughly rubbed into the scarified spots e slight local inflammatory facts caused by the scarifica- Nineteen days after the inoculation a very small flattened niltrated zone, appeared at the seat of inoculation. The d and moist, the secretion drying into a thick crust. On nulating, raw surface was seen. Two months later the esent, four more papules appeared, two on the lower part e primary lesion, and two just over the upper lip. One ared after a few days; the others became moist and a 1 each of them. These papules remained always small ee months, leaving tiny dark marks. The eruption was the monkey was continually scratching. It is possible two months after the first lesion appeared may represent scratching, rather than representing a true secondary pithecus priamus), 15th October, 1906. Scrapings taken dle of a yaws patient is well rubbed into deep scarifica- w. Forty-five days after, three slightly elevated spots together into an infiltrated mass, covered by a thick crust; ize of a sixpenny piece. No other elements appeared. The of the same size (31st January, 1907). It was examined 's on three different occasions with positive results twice. <eys of the genus macacus and 11 of the genus semnopi- ed with scrapings taken from the eruptive elements of tion was successful in five monkeys of the first genus and ncubation period has varied from a minimum of 16 days The appearance of the lesion developing at the seat of y the same in all cases: viz., an infiltrated spot slowly becoming moist, the secretion drying into a thick crust. red a raw, granulating, red surface was seen. With the > eruption remained localized at the point of inoculation, ments appeared. In the three cases in which eruptive ime after the primary lesion, in one, as I have already

+

two small papules appeared on the lower part of the primary lesion, and two others above the upper lip. Of one a rather large moist papule appeared on the lower primary sore had developed; in the other, three small and became covered with a crust, developed on the lower to the primary lesion, two and a half months after the

WITH THE BLOOD OF THE GENERAL CIRCULATION FROM A

YAWS PATIENT.

as withdrawn (18th September, 1906) with all aseptic the bend of the elbow of a patient suffering from a typical back and face, but not on the arms; the needle, therefore,

a perfectly normal skin without touching any yaws od was well rubbed into deeply scarified spots on the right Thirty-three days later a small deeply raised brownish the papule became moist a scraping was taken and stained ccording to the directions given by me in the "British or 26th, 1905. Numerous individuals of the Spirochete The papule slowly enlarged and became covered with a ired after three months; no other elements developed. s that:

cessfully inoculated with the blood of a yaws patient. rtenuis is, at least temporarily, present in the blood of agh so far I have not been able to detect it microscopically.

€ 2

PUBLIC RECORD OFFICE

חוּ

Reference :-

C.O.885

18 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO