22,3 Sellards and Goodpasture: The Control of Yaws 287 



sions when no neosalvarsan was available, a few patients were 

 requested to return later for examination only, and it was 

 definitely announced to the other patients present that abso- 

 lutely no treatments would be given and that they must not 

 come to the next clinic. Nevertheless, they came in numbers, 

 quietly and uncomplainingly, on the chance that some injections 

 might be given. 



In Santo Domingo we expected that the extremely supersti- 

 tious people in the district where we worked, unaccustomed to 

 medical attention, would be instinctively opposed to intravenous 

 procedures. On the contrary, they referred to it as magic. 

 Their confidence in the treatment was easily obtained. Patients 

 accepted at the clinic for treatment were divided into two 

 groups ; namely, those who had just received their injections, and 

 those who were awaiting their turn. The former at once des- 

 ignated themselves as the "cured cases." Occasionally a pa- 

 tient would present himself with nothing more than a malarial 

 infection. Such patients, on being freely reassured and given 

 quinine to take by mouth, often went home extremely disap- 

 pointed at being denied an intravenous injection. 



The acumen of the wholly untrained natives in the accurate 

 recognition of the granulomatous stages of yaws facilitates field 

 operations to a remarkable degree. They seldom overlook a 

 case, and they do not tend to confuse it with other conditions. 

 Nevertheless, it is urged that the equipment and personnel of 

 a dispensary should not, as a general rule, be reduced to the 

 barest working minimum. By the simple addition of a Was- 

 sermann outfit, contributions of value can be made to our 

 knowledge of yaws and related diseases. It is well to be pre- 

 pared to study some of the obscure conditions that exist in 

 the isolated districts into which the treatment of yaws leads 

 medical workers. 



In the eradication of a disease, a distinct advantage is 

 offered in those infections which are of the acute self-limited 

 type and which produce a substantial immunity. This is illus- 

 trated very well by two diseases transmitted by mosquitoes; 

 namely, yellow fever and malaria. The former has been elimi- 

 nated in many regions and is even tending to die out spontane- 

 ously in some of its endemic zones. In the same geographical 

 areas, the expenditure of considerable effort has brought ma- 

 laria only under imperfect control. The lack of immunity re- 

 sults in the production of many chronic cases, and these serve 

 as reservoirs of the infecting agent. However, chronicity of 



