374 
tubercular troubles, 1 am inclined to believe that a great deal of the 
phthisis is really syphilitic. 1 have several times been agreeably 
surprised by the recovery of a phthisis case. Without actually 
diagnosing - syphilis, one gets such a belief m iodide, and uses it for 
such a wide range of complaints, that some of the lung cases have bad 
the good fortune to be accidentally cured in this way. It is a sate 
thing to treat all supposed phthisis with iodide if the tubercle bacillus 
cannot be found or if there is no opportunity to search for it But 
even after discounting for pure syphilis of the lung, there remains a 
number of tubercular cases quite out of proportion to the amount of 
tubercle of other tissues. 
With respect to the West Indies I can personally vouch for the 
prevalence of syphilis in the islands St. Croix (Danish West Indies;, 
St. Kitts, Nevis, Antigua, St. Lucia and St. Vincent. In Barbados 
I think there is not so much of grave syphilis, but the disease is 
widely spread nevertheless. Dr. W. J. Branch, after 25 years 
practice in St. Kitts, said in reply to a query, " nearly every black or 
" coloured person on St. Kitts has, or has had, syphilis in some shape 
“ or other, congenital, acquired or both." 1 1 had five years 
experience in district and hospital work in that island, and can assure 
the reader that though this estimate is true, the condition of the 
population of St. Vincent is worse. 1 lere I have seen a man in 
middle life with tertiary scars dating from childhood, a scar of an old 
penile chancre, and a new eruption of secondaries. That is to say, in 
St. Vincent people may be “ thrice dipped ” in syphilis. Second 
infections are the rule of life if an individual comes to mature years. 
I he combination of secondaries and tertiaries is very commonly seen. 
In my annual hospital report for 1902-03 I wrote:— 
" When to this moral state is added a profound and universal 
saturation with syphilis and depletion by ankylostoma, it may easily 
be understood that the present labouring population of St. Vincent 
1S leased and pauperized as any in the world. The effects of 
s yp ills depend on the nutrition of the patient ; so that where there 
a soil as suited for the exuberant manifestation of the disease a= 
° tams here ’ 1S not surprising to note the disablement and 
increasing pauperism due to syphilitic ulceration and necrosis. 
-?_>P iliti c pa ralysis, and degenerative neurosis. . • • 
'■ Nlcholls ’ Report, page 167. 
