212 TROPICAL MEDICINE AND HYGIENE 



Secondary symptoms are often overlooked. Macular 

 eruptions are not easily seen on dark skins, and as there 

 is no discomfort attention is not directed to them. 

 Papular eruptions can be seen more readily. The throat 

 conditions if severe will be recognized, but are not often 

 seen. 



There is a prevalent belief, especially among soldiers, 

 that syphilis contracted from natives is unusually severe. 

 This, however, is not borne out by Indian experience, 

 where the disease among Europeans, except in persons 

 debilitated by other causes, appears, if anything, milder 

 than at home. Among the native army in India the 

 known incidence of syphilis is much less than among the 

 British troops. 



Typical tertiary lesions are observed and include 

 those of bone and gummata of the brain and abdo- 

 minal viscera, which are fairly often seen in post- 

 mortem examinations. 



On the whole the disease is less severe in the Tropics 

 than it is amongst the poorer classes in England, where 

 the treatment has been neglected. The Chinese, of 

 course, have used mercury from time immemorial, but 

 other races, unless treated by Europeans, are practically 

 untreated. 



In tropical countries where yaws is uncommon there 

 is no tendency for the syphilitic eruptions to be fram- 

 bcesial, and in countries where yaws is common the 

 common manifestations of secondary and tertiary syphilis 

 also occur. 



Atheroma and lesions of the vessels are fairly common 

 in the Tropics, but less so amongst Indians than amongst 

 the negroes. The atheroma is frequently in patches and 

 often leads to aneurism. 



It must be remembered that a chronic irregular fever 

 occurs in some cases of secondary and tertiary syphilis 

 and may be mistaken for the similar fevers that occur in 

 tropical diseases such as kala-azar or malaria. A course 

 of antisyphilitic treatment may speedily cure a fever of 

 this kind. 



