HEALTH SURVEY IN PACIFIC
U. 8S. ARMED FORCES MEDICAL JOURNAL
Table 9. Percentage distribution of examined
population with positive Kahn reactions by age
group
Percent positive
Age group (years)
Total
Saipan
district
Palau
district
Marshall
Islands
district
50.1
30. 4
65. 4
38.1
Under 5
5 to 14
37.6
42.9
41.0
18.3
61.3
65.0
18.9
25.9
15 to 24
49.5
33.7
66.4
37,4
25 to 44
53.8
36.7
66.3
43.0
45 and over
52.9
32.0
63.9
44.0
All ages
district had the lowest percentage of all, only 3.6 percent positive,
The next lowest was Saipan Island, with 22.8 percent. At the other
extreme was Elato Atoll in the Palau district, the only place where
every individual tested had a positive reaction. Other islands or
atolls where over 75 percent of the population had positive reactions © |
were Kayangel (95.4), Satawal (92.9), Woleai (89.1), Peleliu (87.0),
Lamotrek (84.2), and Faraulep (77.3), all in the Palau district.
Generally speaking, the proportion of positive reactions increased
with age up to the age group of 45 and over, where a slight decline
was noted. The same rate of increase from age group to age group,
however, was not observed in each district. In the Saipan district
a marked increase occurred betweenthe 5- to 14- and 15- to 24-year age
groups, with little change in the age groups thereafter. The con-
spicuously high rate for Saipan’s under-5-years-of-age population,
however, is based on only 39 tests. Very little variation is observed
between the age groups in the Palau district. On the other hand,
the Marshall Islands district exhibits definite increases with each age
group.
In this survey a positive Kahn test was considered likely evidence
of the presence of yaws infection. It is recognized that the Kahn
test is far from being an infallible index for the prevalence of yaws,
for a positive reaction to the test may result from many diseases and
conditions. Because malaria was not noted in this area and because
syphilis, leprosy, and infectious mononucleosis seldom occurred in
proportion to the number of positive Kahn tests, it would appear
to be a reliable guide in this instance.
Yawsis not, as commonly believed, a venereal disease, but is a contagious disease that may be transmitted from person to person by
1210
.
VOLUME 10, NO. 10 53
direct contact or carried by flies. The spirochete causing yaws,
Treponema pertenue, enters throughopenlesions such as scratches and
minor cuts, The primary lesions appear most frequently on the lower
extremities and may last from 3 months to 3 years, It is not unusual
‘for old healed-over lesions to break down. Tertiary-stage lesions
often cause severe scarring and, in the form of gangosa, sometimes
completely destroy the features.
Many inhabitants had multiple scars as evidence of a history of
“> yaws. Very few diagnoses of active yaws were established during
the course of the health survey. As shownin table 10, most of these
eases were found in the Marshall Islands district. Numerous cases
of active yaws were suspected, but dark-field examinations of the
Jesions were negative, possibly due to local treatment of ulcerative
~ Jesions with merthiolate and mercuric ointments bythe native health
aides.
Table 10. Results of survey for active yaws, Saipan,”
Palau, and Marshall Islands districts
District and island
Number
or ato.
Total
Palau
Babelthuap Island |
1
1
“
Ine Island
Ebon Atoll
or atoll
73
| Marshall Islands.
eer
Mejit Island
2
|
Majuro Atoll
|
i
Alluk Atoll
Elato Atoll
Marshall Islands
District and island
of cases
71
|
Aur Island
|
Wotle Atoll
|
—
Maloelap Atoll
12
i
11
{
|
Likiep Atoll
Kwajaiein Atoll
Namorik Island
Tabal Island
Utirik Atoll
Lib Island
Number
of cases
8
7
4
3
3
3
2
2
2
2
1
*No active cases of yaws reported for the Saipan district.
During the survey (table 11) urogenital examinations were made
only of the male population, as the women were reluctant to permit
- examination. Little or no acute urethritis from gonococcus was
noted but, although cases were not reported on the health record,
medical officers at. some of the hospitals stated that among the women
there were many cases of “salpingitis, gonococcic” and “cervicitis,
-, acute, due to gonococcus.” The presenting symptoms of the report~ edly widespread gonococcal infection among the men were those of
“a nongonococcic urethritis.
Syphilis was almost nonexistent, a con-
“dition found to parallel the prevalence of yaws. Very few cases of
primary chancre were found and secondary skin manifestations oc[OCTOBER 1959
1211