An imperial laboratory: the investigation and treatment of treponematoses in occupied Haiti, 1915-1934 / Um laboratório imperial: investigação e tratamento da treponematose no Haiti ocupado, 1915-1934

This article examines anti-treponematoses work as part of US occupation public health policy in Haiti, a unique event in the history of international health. Yaws was highly prevalent in Haiti, but occupation doctors initially ignored it because of its close association with syphilis and stigmas attached to sexually transmitted disease. This changed when C.S. Butler asserted that yaws was "innocent" and that the two diseases should therefore be considered as one. Treatment increased as an anti-treponematoses campaign was now believed to hold great benefits for the occupation's paternalist and strategic aims, even though it ultimately failed. This work reflected Haiti's status as a public health "laboratory" which affected Haitian medicine for years to come and significantly influenced future campaigns aimed at disease eradication.

Este artigo investiga o trabalho anti-treponêmico como parte da política norte-americana de saúde pública na ocupação do Haiti, evento inédito na história da saúde internacional. Era alta a incidência da bouba no Haiti, mas médicos da ocupação a ignoravam por ser parecida com a sífilis e pelos estigmas da doença sexualmente transmitida. A situação mudou quando C.S. Butler afirmou que a bouba era "inocente" e que as duas doenças deveriam ser consideradas uma. Surgiram mais tratamentos com uma campanha anti-treponêmica que trazia benefícios aos objetivos paternalistas e estratégicos da ocupação, apesar do seu fracasso final. Esse trabalho ilustra o Haiti como "laboratório" de saúde pública, o que afetou a medicina haitiana por anos e influenciou campanhas futuras para erradicar a doença.

An imperial laboratory: the investigation and treatment of treponematoses in occupied Haiti, 1915-1934.

This article examines anti-treponematoses work as part of US occupation public health policy in Haiti, a unique event in the history of international health. Yaws was highly prevalent in Haiti, but occupation doctors initially ignored it because of its close association with syphilis and stigmas attached to sexually transmitted disease. This changed when C.S. Butler asserted that yaws was "innocent" and that the two diseases should therefore be considered as one. Treatment increased as an anti-treponematoses campaign was now believed to hold great benefits for the occupation's paternalist and strategic aims, even though it ultimately failed. This work reflected Haiti's status as a public health "laboratory" which affected Haitian medicine for years to come and significantly influenced future campaigns aimed at disease eradication.

Efficacy of a targeted, oral penicillin-based yaws control program among children living in rural South America.

Yaws is endemic in rural Guyana. An observational study was conducted to determine the efficacy of oral penicillin V therapy in treating skin lesions of yaws in children. In 1999, inhabitants of 7 rural villages near Bartica, Guyana, were screened for skin lesions of yaws. Cases were confirmed by serological testing. A control program was implemented in 2000: children < or =14 years old were screened, and those with active lesions were treated with oral penicillin V for 7-10 days. In 2001, children were rescreened and active cases were treated. Prevalence of yaws skin lesions fell from 5.1% (52 of 1020 children screened in 2000) to 1.6% (8 of 516 in 2001), a 71% drop. Sixteen (94%) of 17 children treated in 2000 and reassessed in 2001 had complete resolution of lesions. A targeted, oral penicillin-based treatment regimen can successfully treat dermatologic yaws in individual children and can decrease the prevalence of skin yaws in a community in which it is endemic. This information may aid in the implementation of additional control efforts.

Yaws in Ecuador: impact of control measures on the disease in the Province of Esmeraldas.

OBJECTIVES: To determine the impact of a community-based programme of yaws control in Esmeraldas province in Ecuador. METHODS: Community health workers provided mass treatment and subsequent surveillance for the detection and treatment of new cases and their contacts over the period 1988 to 1993. Clinical and serological surveys were performed in the study area in 1988 and 1993. RESULTS: Over the 5 year observation period, the number of communities with active infections had decreased by 75%, from 20 communities in 1988 to 5 in 1993. In 1993, 4 communities were found free of clinical infections as well as latent infections. There was a corresponding decrease of 94.6% in the prevalence of dermal lesions (from 11.2% to 0.6%), and a reduction of 97.3% in latent infections (from 93.6% to 2.5%). CONCLUSIONS: The control of yaws using existing community-based health workers has proved very effective in Ecuador.

Nonvenereal treponematoses: yaws, endemic syphilis, and pinta

The nonvenereal treponematoses--yaws, endemic syphilis, and pinta--constitute a major health concern for many third world countries. These diseases are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Nonvenereal treponematoses differ significantly in their modes of transmission, epidemiology, and clinical presentation from venereal syphilis. Like venereal syphilis, they have a chronic relapsing course and have prominent cutaneous manifestations. Recently, several cases of imported yaws and endemic syphilis have been described in Europe. With the escalating U.S. military presence in many remote areas of the world and ever-increasing world-wide travel, the diagnosis of the nonvenereal treponematoses must be considered in appropriate clinical and historical situations.

Yaws in Colombia.

By the beginning of this century, yaws was a well-known endemic disease in Colombia. Colombian authorities estimated that by early 1930 there were 70,000 active cases of yaws, most of which were located in the Pacific coastal regions. With the advent of penicillin therapy, Colombia organized an anti-yaws campaign, which began in 1950. The campaign relied on the use of penicillin and house-to-house case finding. From 1950 to 1953 more than 111,000 persons with active cases of yaws and 125,000 of their contacts were treated with penicillin. The reported incidence of yaws declined dramatically, and by 1973 only 573 cases were reported in the endemic areas. By 1983 this number had fallen to 31. Because of the persistence of small foci of yaws activity, the anti-yaws campaign has been reorganized to provide a firm basis for the final eradication of the disease in Colombia.

Yaws control: report of a mass juvenile sweep in St. Lucia

In 1963 one pocket of high yaws remained on St. Lucia, 533 new cases being notified in that year from a total population of approximately 9,000 people. 77 percent of these cases occurred in children under the age of 15 years and consequently a mass juvenile sweep with treatment of all cases and contacts was made late in 1964. Because of differing environmental circumstances, the District was divided into urban, Dennery Village, and rural, Richfond Valley, sections. The findings during the sweep have been analysed separately for the two sections and different age distribution patterns were noted although the sex and lesion distributions were similar. In all, 3,422 children were examined and treated and 294 clinically evident cases were found. The prevalence rates were 131.7/1,000 children examined in the Valley and 35.1/1,000 in the Village. Serological testing of 157 children from both areas indicated a latency rate of 23 percent in children who were not exhibiting clinical evidence of active disease at the time of examination. Following this juvenile sweep, one case was notified from the District in 1965 and two cases were notified in 1966 (AU)

Early yaws

A girl aged 7 from St. Vincent in the West Indies developed a papular eruption and papillomata 3 months after her arrival in England. Dark-ground examination of serum obtained from one of the papillomata revealed treponemes, and serological tests for treponemal disease were positive. The lesions responded rapidly to treatment with parenteral penicillin (AU)

An outbreak of yaws in a suburban community in Jamaica

Four associated cases of yaws occurred in a suburban community in Jamaica in 1963-64. Intensive case-finding and adequate treatment brought the outbreak to an end (Summary)

Yaws survey: Jamaica

The introduction of yaws into Jamaica followed the importation of African slaves during the 16th century. The disease was kept under reasonable control by the isolation of cases by estate owners in "yaws huts". After the emacipation, liberated persons dispersed throughout the country, and their faith in "Obeah" medicine coupled with their inability to pay for medical care resulted in the disease becoming widespread; 30 years of control effort by medical officers resulted in little or no reduction. The Yaws Commission was organized in 1932 and functioned until 1937. Some very valuable work was published on the treatment, control, and epidemiology of this disease. In 1938, control reverted to the local medical services, and four health units were maintained to cover the entire country. In 1955, the plan prepared for an International Programme for the Eradication of Yaws and Control of Venereal Diseases was not undertaken for financial reasons. During the ensuing 4-year period, the health units succeeded in bringing about a marked reduction in cases. It was considered that, for all practical purposes, eradication had been achieved, and as a result, surveillance activities were relegated to the District Medical Services. In 1963, a Survey was organized by the Ministry of Health, with the assistance and advice of the WHO/PAHO VD/T consultant for this zone, to determine the extent and characteristics of the problem. Over a period of 3 months, all but one of thirteen parishes were covered by a series of clinics held at selected centres. The results of the Survey are summarized in Table V. Past experience with capaigns designed to control and eradicate yaws has shown that these objectives are attained only when proven methods are adopted (AU)

Non-specific factors in the epidemiology of yaws

Yaws is found in hot countries where the mean isotherm is in the region of 80§. It is found in humid areas which implies a heavy rainfall, a non-previous soil and luxurious vegetation. It is found in rural districts where the economic circumstances are poor, where socially the order is low and the standards of hygiene and sanitation are not high. The highest incidence of yaws infection and of active lesions, and of non-immunity, appears to be in the first two decades, after which there is a decrease within the community of the above three factors. It is probable that the main mode of infection is by contact, but flies may also have a considerable part to play in the transmission of the disease. There is a low incidence of infection in adult life, the cause of which appears to be quite distinct from a low incidence due to an acquired immunity from a previous child infection. The reason for this is not understood. However, if this assumption is correct, it would be logical to introduce some method of immunization into the mass treatment programmes. After many mass treatment the attack rates within the community are considerably reduced but there remains a small residue of relapsed, reinfected, and new cases. It has been suggested that the type of case which is responsible for the continued propagation of the disease is the latent case with relapsing ulcerative plantar framboesides. In view of the fact that yaws is infrequent or even abscent in those areas of the tropics where the economic and social status of the populace is relatively high, it is possible, that with further socio-economic progress in the so-called under developed areas, that yaws may eventually be eliminated. So may it be with many other disease (AU)

Framboesia (yaws) treated with aureomycin

Ten cases of framboesia, seven showing initial lesions and nine early framboesides were treated with Aureomycin; dosage was 25 milligrammes per kilogramme body weight per day for fourteen days. The results after a twelve month period from the commencement of treatment were as follows: (i) All cases showed complete clinical cure and there were no relapses (ii) In six cases there was a reversal of the Kahn serological test; in two there was a marked decrease of titre and the two cases which were originally seronegative remained so (AU)

The modern treatment of framboesia (yaws)

The objective of any anti-framboesial campain should be mass treatment combined with public health measures to eradicate the disease totally. For mass treatment of framboesia the "two-shot" treatment at a three to five day interval using repository penicillin is recommended (AU)

The control of yaws by an intensive treatment method

A description of the territory in Jamaica in which yaws has been under control for three years is followed by a brief account of preliminary studies. The intensive treatment method used in control is explained and results obtained are discussed. (Summary)