395 
This may almost be given as a case of yaws, except that the 
eruption was not perfectly frambesial. The patient lived in town ; 
had he lived in a country village he would, no doubt, have had yaws. 
These few cases, I think, illustrate the various aspects in which 
non-venereal syphilis may be presented to the physician : primary 
syphilis not followed by frambesia contracted from yaws ; secondaries 
in children with and without an evident primary ; secondary in an adult 
due to extra-genital infection. Two show the difficulty there may be 
in differentiating yaws. I selected five which w'ere seen within five 
weeks at a. time when my notes were being regularly kept. This 
number indicates how common such cases really are. (Cases 16, 17, 
18, 19 and 25.) 
ATTITUDE OF THE MEDICAL PROFESSION 
TOWARDS YAWS 
In consideration of the symptoms of yaws, as referred to above, 
there would certainly never have been a doubt as to its identity with 
syphilis had it not been for the frambesial eruption. This is so 
unusual in European syphilis, and such a distinct and characteristic 
manifestation in yaws, that it was natural it should overshadow the 
other symptoms. Most physicians, who have not looked carefully 
into the matter, have a picture of yaws as consisting only of the 
frambesial eruption ; they think this is a harmless, though unpleasant, 
disease, which usually runs its course and disappears spontaneously, 
without permanent injury to the health. But at first yaws was 
included with syphilis, and even since its separation as a disease 
Sl{ i generis, the doubt that it was correctly separated has existed. 
In view of the enormous prevalence of yaws in the tropical world, 
l his doubt gives an importance to the disease which, I think, has not 
been appreciated ; for it is a most serious matter if syphilis, the most 
destructive and far-reaching in its effects of all diseases, is being 
allowed to ravage whole communities untreated and almost unnoticed. 
When in recent years the syphilist, who for forty years has been 
the authority to the English-speaking profession, pronounces his 
unqualified opinion that syphilis is yaws, it is time that the world took 
U P the matter seriously. In his preface to Numa Rat’s work on yaws, 
Jonathan Hutchinson expressed this view, based, it appears, largely 
