37 ‘ s 
I may admit that the primaries include several (say four) non 
venereal cases returned by myself. 
It is true that the primary lesion, even when venereal, is 
frequently a very trivial-looking thing to the patient, but many such 
sores are aggravated by the dirty habits and incontinence of the 
black patients, and must come to hospital for surgical treatment. 
In St. Kitts we operated very often on such cases. There are. 
therefore, probably not many chancres of the genitals, in St Vincent 
at any rate, which are not brought to the surgeon’s notice. 
This paucity of venereal chancres in the tropics is referred to by 
Numa Rat, whose experience extended to the W est Coast of Afnca 
as well as the West Indies. *' And I may add that it is very rarely 
" indeed that I have seen the initial lesion of syphilis in a black man 
“ in any country. Either the syphilitic chancre in the negro is a much 
" l ess serious affair than it is in a European, or the former considers 
" it too trifling, whatever its severity, to trouble the doctor about. 1: 
“ is reasonable to assume that in a place like St. Kitts, in which 
syphilis prevails so generally, the initial lesion of the affection would 
be modified by the presence of an inherited syphilitic taint. 1 
It may justly be contended that 31 venereal primaries in 1 - 99 1 
cases of syphilis is an inadequate proportion. And, again, in four 
years only 42 cases of primary have been admitted to hospital, 
seems certain that the venereal chancres do not account for the 
amount of syphilis in the Colony, and it will be my endeavour to 
suggest an explanation in the following pages, which I believe applies 
equally to all tropical countries. 
TERTIARY SYPHILIS IN EARLY LIFE 
While we were speaking of tertiary syphilis, the reader no doubt 
has had in his mind the syphilis of adults. But we have now to 
consider another phase of the question. A great deal, if not most, d 
t ic tertiary in the West Indies is seen or has begun early in the L 
of the patients, and much of the juvenile syphilis is of a very severe 
character. 
. T^ e ^ ar f? e infant m ortality indicates what has become of most^ 
'• Report on Anguilla. Colonial Reprints, No. 19. 
