39 8 
I said before, that it is only the frambesial eruption which 
constitutes the difficulty in accepting yaws as syphilis. 
Manson says:—“I may mention the primary sore, the infection 
“ of the foetus, the adenitis, the exanthem, the alopecia, the absence 
“ of itching, the iritis, the affection of the permanent teeth, the bone 
“ and eye affections, the congenital lesions, the polymorphism of the 
“ eruptions, the nerve lesions, and the gummata of syphilis. All these 
“ are wanting in yaws." 1 
To take these in detail: - 
(i.) The primary sore. — There is, as we have seen above, no 
doubt at all about this. Numa Rat made this quije clear, and the 
experiments of Charlouis are convincing. In short, as Hutchinson 
says, Alford Nicholls is the only observer who disputes the fact that 
there is always a primary lesion in yaws. Careful examination and 
enquiry will elicit this quite as often as in cases of syphilis. 
(2.) The infection of the foetus.— It would be quite as logical to 
deny the inheritance of syphilis. It is so rare for a child to be bom 
with syphilitic eruptions that few of us have seen such a case. Many 
infants are seen with yaws at the age that they might have the 
secondaries of inherited disease. But when such cases occur, we are 
in the habit of inferring that the yaws is acquired. Inheritance has 
been demonstrated in at least two cases mentioned by Hutchinson. 
I have never myself seen an infant known to have hereditary syphilis 
develop a frambesial eruption ; but all the infants I have seen thus 
have been at once put on mercury, and kept at it as long as I 
continued to see them. They get better, or, more usually, I hear 
nothing of them for a long time until the parent applies for a death 
certificate. It cannot certainly be said that inherited syphilis is not 
sometimes frambesial, and it is known that a child may inherit the 
yawsy taint and develop the frambesia in due time. 2 
The adenitis. This is an almost invariable accompaniment of 
t e yaws infection. The experiments of Charlouis are conclusive, 
besides the experience of actual examination of yaws patients. 
(4.) The alopecia. In all my experience of many hundreds of 
cases of negro syphilis (non-frambesial) I have only once seen 
a opecia, and in that c ase the diagnosis was at first obscure, but 
'• Tropical Diseases, page 530. 
2 - Hutchinson Fasc., page 18. 
