39i 
But anyone who cares to look for them will not have far to seek in 
almost any case of yaws. 
Consistently with the description of the secondaries of yaws, Rat 
goes further and describes the tertiaries. In this he is in accord with 
Daniels and Corney in Fiji. These symptoms need no description— 
periostitic nodes, multiple dactylitis, destructive rhinopharyngitis, 
lupoid ulcerations, &c. It is only to be remarked that one does not 
realise to what extent tertiary syphilis can go until he has seen the 
cases of untreated syphilis in a yaws district. 
It is evident that, in the experience of the writers just mentioned, 
there is not enough venereal syphilis to account for the extraordinary 
prevalence of tertiary, and so they were driven to ascribing the 
tertiary, quite correctly, to yaws. They have failed, no doubt, to see 
the non-venereal syphilis without frambesiae, which would have 
afforded an escape from the difficulty. 
Tertiaries identical with those of syphilis are recorded as being 
exceedingly prevalent, and are attributed to yaws by Daniels and 
others in Fiji, Kynsey in Ceylon, Rat in Dominica. Among ninety 
cases of tertiary syphilis of whom the history was ascertained in 
St. Vincent, sixty-nine were said to have had yaws and only five 
admitted genital syphilis. Some of the remainder had suffered, no 
doubt, from extra-genital chancre without frambesiae, and therefore 
did not recognise that they had yaws. On the other hand, not all 
that claim to have had yaws have had a frambesial eruption, for, as 
I pointed out before, the natives, and apparently also some medical 
® en > call cases yaws that have had no frambesiae. 
From the facts of the polymorphism of the eruptions and the 
occurrence of tertiaries, it is evident that the only difficulty in the way 
of the general abandonment of the yaws heresy is the frambesial 
e mption itself. As Jonathan Hutchinson has pointed out, the 
Profession did not originally hold yaws to be an independent disease, 
*0 that it is quite fair to speak of this belief that yaws is not syphilis as 
a heresy. The frambesial eruption is of such importance and, 
t0 my mind, such a formidable difficulty that I have reserved its 
consideration for another section. 
% contention is that syphilis is very common, in fact, almost 
universal, among the natives in the tropics; that in certain districts 
:t usually presents an eruption of papillomata, which has given rise to 
