286 The Philippine Journal of Science mz 



Yaws also amply fulfills the requirements of obnoxiousness, 

 particularly as regards the loathsome lesions that develop 

 around the mucocutaneous orifices. A single visit to a yaws 

 clinic would surprise the most disinterested observer. The 

 serious consequences of yaws are by no means limited to the 

 granulomatous stage, for the late and tertiary stages produce 

 marked pain and incapacitation. In the Loyalty Islands, Col- 

 lin (2) reports that yaws is a grave menace; that in some 

 villages of Lifou Island more than half of the children are 

 covered with granulomata. Collin attributes the high infantile 

 mortality of those islands to yaws and the other infections in- 

 duced by it; he considers that Lifou itself is in danger of 

 depopulation. 



Left untreated, the granulomatous stage heals of itself after 

 a few years ; the mutilating tertiary lesions have been described 

 from Africa by Howard. (3) The destructive lesions of the 

 nasopharynx, known in Guam as gangosa, are generally con- 

 sidered to be a direct sequel of yaws. In Santo Domingo, the 

 dread of yaws was particularly pronounced. Except for the 

 intentional exposure of infants, people infected with yaws were 

 studiously avoided. They were barred absolutely from the 

 villages, not by government regulations, but by native custom. 

 The first patient injected at our clinic there returned on 

 his second visit practically cured. His first question was 

 significant, being, "How soon may I enter the village?" 

 Within the home, a small outbuilding was erected where the 

 patient lived during the entire granulomatous stage, not being 

 permitted in any of the other buildings. This primitive quar- 

 antine was apparently of some value in checking the spread 

 of the disease within the family. These measures are certainly 

 not practiced in the Philippines. Nevertheless, yaws patients 

 do not mingle freely with the public. One may visit homes 

 in villages where yaws is abundant without seeing any cases 

 until inquiry or search is instituted, or until the opportunity 

 for treatment is offered. 



The requirement of cooperation could hardly be more readily 

 satisfied than in the case of yaws patients. Indeed, in the 

 early days of a clinic it is often oversatisfied. On commencing 

 the work at Las Pifias, near Manila, we left a request for four 

 patients to come to the Presidencia, only for examination and 

 not for treatment. Before the appointed time, eleven presented 

 themselves, and they brought a written list of seventeen others 

 who requested that they be allowed to come. On some occa- 



