39 2 
the idea of yaws as a distinct disease; but that the cases with 
papillomata present otherwise all the features of syphilis, just as do 
the non-venereal cases. To appreciate the relation of the various 
forms of eruptions to each other and to recognise their nature, as well 
as to understand many other disease problems, it is necessary to 
remember that syphilis is in the tropics not usually a venereal disease. 
Notwithstanding the vitality of long-rooted error. I feel sure that 
the profession would have more readily accepted the dictum of 
Jonathan Hutchinson had we realised the frequency of extra-genital 
chancre. It is the teaching of the schools and text-books that syphilis 
is a venereal disease, which has blinded us to the fact that in the 
tropics it has little to do with sexual intercourse ; that there is, in fact, 
far more non-venereal syphilis in the world than syphilis acquired on 
the genitals. 
Case 14.— D. k..; 6 years; Coloured. 
March 27th, 1906. Has had a sore of the toe and paronychia for several 
weeks. About two weeks ago began to get “ spots ” on the skin. Has now a 
few spots of psoriasis over the body and palms of the hands. Also on the knees 
and elbows. Is feverish at nights, has small hard glands in both groins and on 
elbows. 
Here is a very early case in which, I think, the diagnosis of syphilis 
is justified. 
Case 15. — J. W.; 13 years; Black. 
August 1 st, 1903. Has a small indolent dirty sore on the left outer malleolus, 
with raised edges and indurated base and periphery. This has been present for 
several weeks. There are tender glands in both groins. That on right larger 
and more tender. Small hard glands left side of neck, on both elbows and in both 
axillae. 1 wo weeks ago the first crop of eruptions appeared and they have 
continued to come out since. Has now a general papular eruption (licheni 
tending to vesicular heads. This is very closely set over the whole trunk, 
extending to the neck, upper arms, and thighs, where it thins away. A few 
papules on the lower part of the cheeks, none on the limbs. 
Also an early case, in which the diagnosis seems very evident. 
( ask 16.— K. B.j 10 years; Black. 
April 6th, 1903. Three months ago had a scratch on right outer malleolus 
W 10 ecame a sore. Her mother shows this as what she considered a mother 
vaw It is now a pigmented and indurated scar. There are many spots o> 
scaiy psoriasis over the body, face and limbs—rheumatoid pains in the right 
elbow, both knees and ankles. The mother complains that the child is getting 
azy and hard to rouse in the morning. Later she developed evening fever. 
September 1st, 1903. Noted that she had attended irregularly. Eruptions 
are worse. Has never had frambesiae. 
This illustrates the popular identification of syphilis with yaws 
