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Yaws (also Frambesia tropica, thymosis, polypapilloma tropicum or pian) is a tropical infection of the skin, bones and joints caused by the spirochete bacterium Treponema pertenue. Other treponematosis diseases are bejel (Treponema endemicum), pinta (Treponema carateum), and syphilis (Treponema pallidum). more...

Yellow fever
Yellow nail syndrome
Yersinia pestis
Yolk sac tumor

The disease is transmitted by skin contact with infected individuals, the spirochete entering through an existing cut or similar damage. Within ninety days (but usually less than a month) of infection a painless but distinctive 'mother yaw' ulcerous papule appears on the skin at the point of entry, it is often described as raspberry-like and is 10-50 mm in size. This lesion will persist for up to nine months and other secondary growths will appear on the body as the original one heals, there may also be inflammation of the fingers (dactylitis).

If untreated a secondary stage occurs after up to four months of latency, it is marked by more 'raspberry' growths but smaller and ulcerous - exuding a thin, highly infective fluid which attracts flies. These growths may also merge together into thick fissured plaques, which can occur on the feet and induce a distinctive gait. These secondary growths are irreversible but there can be relapsing lesions and asymptomatic periods.

In 10-20% of cases the disease can progress over a decade or more to a tertiary stage with destructive lesions of the skin and bones. Large subcutaneous nodules develop and grow before abscessing and ulcerating, these can become infected and may merge together forming serpiginous tracts. These tracts heal with keloid formation which can cause deformities, disabilities and limb contractures. The bone lesions caused are periostitis, osteitis, and osteomyelitis, damage to the tibia can lead to a condition known as sabre shins. In a very few cases a condition known as goundou is caused where growths on the nasal maxillae can result in extensive and severe damage to the nose and palate.

The largest group afflicted by Yaws are children aged 6 to 10 years in the Caribbean Islands, Latin America, West Africa, India, Oceania or Southeast Asia. There were World Health Organization funded campaigns against yaws from 1954 to 1963 which greatly reduced the incidence of the disease, although more recently numbers have risen again.

The disease is identified from blood tests or by a lesion sample through a darkfield examination under a microscope. Treatment is by a single dose of penicillin, erythromycin or tetracycline, recurrence or relapse is uncommon.

Examination of ancient remains has led to the suggestion that yaws has affected hominids for the last 1.5 million years. The current name is believed to be of Carib origin, "yaya" meaning sore; frambesia is a Modern Latin word inspired by the French word framboise ("raspberry").


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Is there a doctor-president in the house? The unhappy history of physicians as national leaders
From National Review, 3/8/04 by Theodore Dalrymple

THE practice of medicine requires the exercise of a dispassionate compassion. Doctors are sympathetic yet objective, concerned yet detached, involved yet observant, feeling yet unsentimental; in other words, they have precisely those qualities that one would wish to see in a political leader. Myself a physician, I have had ample opportunity to observe the medical profession from within, and I think I may safely say that, taken all in all, and viewed objectively, it is the finest body of men and women of which humanity can boast. No matter where a doctor may come from, therefore, I immediately feel an affinity for him: for there is between us a freemasonry of the soul.

But would I really want to be ruled by a doctor? In other words, if I were an American, would I have wanted Howard Dean--from whom the United States now seems to be safe--for president? When I read that Dr. Dean had once said that he considered political and social problems simply as a doctor, that he made first an examination, then a diagnosis, and finally proposed a treatment, I experienced a slight frisson of terror. Could it be that social problems in a Dean administration would have been cleansed, debrided, excised, transplanted, or amputated? I doubt I am alone in fearing this transposition to the political of the clinical.

My first encounter with a doctor-president was in Malawi, during the salad days of His Excellency the Life President Ngwazi Dr. H. Kamuzu Banda. As I booked into my hotel in Blantyre, I was handed a cyclostyled piece of paper headed "Information for Tourists." It read something like this: "The people of Malawi so love their Kamuzu that if any visitor has come to Malawi with the intention of overthrowing His Excellency the Life President Ngwazi Dr. H. Kamuzu Banda, they will cut him into pieces and throw him to the crocodiles."

As tourist information, this struck me as distinctly odd (though it is true that when my mother first traveled to the United States in 1948, she was asked whether she had come to assassinate the president, and even now when I arrive I am asked to declare whether or not I am a genocidal murderer). Then I hired a car. One of the clauses of the contract obliged the hirer, in the not unlikely event that he came across the presidential motorcade, to drive off the road, switch off the engine, get out of the car, and stand to attention until the motorcade had passed. When he practiced medicine in England, incidentally, Dr. Banda required that his patients stand as he passed through the waiting room.

I am all in favor of respect for doctors, of course, but this seemed to be taking things a little far. Nevertheless, I conceived a sneaking admiration for His Excellency the Life President. An elder of the Church of Scotland, he always appeared in immaculate, dark three-piece suits, which couldn't have been easy in the tropics. In these suits, he would watch troupes of young women, dressed in cotton shifts printed with his portrait, performing semi-erotic dances in his praise. He was scholarly as well, having taught himself Latin, Greek, Hebrew, and German, in order to read the great books in their original tongues. He was probably the only bibliophile in Central Africa, possessing such treasures as a first edition of Robert Burton's Anatomy of Melancholy (1621), which he bought in New York for $6 in the 1920s, and would now fetch up to $50,000. He founded the Kamuzu Academy, an elite establishment sometimes called the Eton of Africa, around the tree under which he learnt to read, where the brightest Malawian children were given a classical education to prepare them for leadership of the country under His Excellency's firm overall guidance. The Kamuzu Academy consumed almost all of the country's entire educational budget, but it was genuinely meritocratic. I have met only one alumnus of this great school, in the prison in which I work. He was in for fraud, of course.

Unfortunately, despite his intellectual interests and accomplishments (or is it because of them?), Dr. Banda left Malawi in a parlous condition, with at least two of the four horsemen on the loose.

The most famous doctor-president of the last century was not Banda, however: it was Francois Duvalier, Papa Doc, another president a vie, who, unlike Banda, actually died in power. Before he became dictator, or spiritual leader of the nation (to quote one of his titles), he was a modest doctor employed in the Rockefeller Institute's campaign to eradicate yaws in Haiti, a disease upon which he wrote several papers. Whereas Banda did his undergraduate medical training in the United States (later re-training at Edinburgh), Duvalier did only his postgraduate medical training there.

No doubt the campaign against yaws, which aimed at total eradication of the germ, indistinguishable from that which causes syphilis, suggested to him methods of dealing with his political opponents. At any rate, Duvalierist propaganda suggested that his ascendancy to the presidency was only a natural progression of his medical work: that the hard-working doctor merely transferred his humane concerns to the national scale.

Africa has had two other doctor-presidents, whose experience of human nature while they practiced medicine led them to mistrust elections as a means of allowing the people to choose them as leaders. Felix Houphouet-Boigny was president of the Ivory Coast from 1960 until his death in 1993 (much longer than he practiced medicine, but then being a president is much more fun than seeing patients day in, day out). He was one of those presidents who so love their country, in the words of the American minister to Paraguay during the presidency of Carlos Antonio Lopez, they own half of it. He fully partook of the African presidential tradition of elevating his birthplace into a site of cosmic significance, and had the largest Christian basilica in the world built there. By the standards of post-independence African dictators he was only moderately bizarre, however, and for a time his country was the greatest success in West Africa (not very difficult to be). Whether the fact that his country has fallen apart since his death is a tribute to his peaceful rule, or a direct consequence of it, is a difficult question. His political philosophy was simple: "There is no number two, three, or four ... There is only a number one, that's me, and I do not share my decisions." Doctor-knows-best became official government policy.

The other African doctor-president was not only a doctor, but a Marxist and a poet (his rival, Jonas Savimbi, felt obliged to enter the poetic field also, with execrable results), so it goes without saying that his country was destined for catastrophe. Despite his poetic streak, Agostinho Neto was fluent in Marxist langue de bois, as the following extract demonstrates:

You don't have to know much about Communism in the 20th century to know what this meant.

Across the South Atlantic, another Marxist doctor-president, Salvador Allende, held power for three years. Personally charming, and an aficionado of the good things of material life, he so loved humanity (as a result of his medical experience) that he espoused ideals that had by then been responsible for the deaths of some scores of millions of people.

No survey of doctor-presidents would be complete without mention of two others. The first, Bashar Al-Assad, is the current president of Syria, who qualified as a doctor in Damascus in 1988 and studied ophthalmology in Britain for two years. No man can be blamed for being his father's son, of course, though Doctor-President Assad has not so far condemned his father's slaughter of many thousands of his countrymen in Hama, near which Assad Jr. spent some years in the military academy. He deserves some sympathy, however, because his choice of career path has been severely limited: the presidency or being hanged from the nearest lamppost by a mob. So far, he has chosen the former, as most men would do, but it is not unlikely that his career will in the end encompass both.

Radovan Karadzic was president of the Bosnian Serb Republic and is still on the run from justice. A psychiatrist, he studied at the Tavistock Clinic in London, the foremost institute of psychotherapy in the country, and evidently discovered there the healing power of mass violence. Perhaps his researches deep into the psyche of human beings also convinced him that people are hateful, worthless, or at least of no account. Certainly his contact with suffering humanity did not induce warm feelings in him.

All in all, then, doctor-presidents are probably best avoided. Whether they use the yaws-eradication model of the Rockefeller Institute or the family-therapy model of the Tavistock Clinic, the fact is that doctors have not generally shown themselves at their best when they have reached supreme political power. Americans might like to reflect on what they have been spared, thanks, in part, to a ferocious scream in the Iowa night.

Mr. Dalrymple is a physician and psychiatrist who works in a British prison. He is also a contributing editor of City Journal, and the author of Life at the Bottom: The Worldview That Makes the Underclass.

COPYRIGHT 2004 National Review, Inc.
COPYRIGHT 2005 Gale Group

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