380 
a patient of sixteen years could easib have had time to reach this 
stage of tertiary from a venereal infection And in my own experience 
in St. Vincent most of the few females I have seen with venereal 
primary were about or under this age lint I have seen rhinopharyn¬ 
gitis in patients as young as nine or ten years. Both these writers 
ignore the possibility of non-venereal infection in childhood, and 
neither even raise the question of inheritance. 
The rhinopharyngitis as described by Leys and accepted by Rat 
is identical with that we have in St. Vincent. It is such a 
characteristic tertiary that it would he diagnosed as such without a 
moment’s hesitation if seen in a single individual. But it is very 
common in some places, e g. certain parts of the West Indies, Guam, 
Fiji, while in other places where there i just as much syphilis it is 
only occasionally seen. It is this peculiarity of distribution which 
makes the difficulty. I have pointed out that the damp, ho., 
wooded ravines of volcanic islands in the tropics are infested alike by 
yaws and rhinopharyngitis. The same climatic conditions determine 
the occurrence or favour the development of both. I he point to wli.ch 
attention has not been sufficiently directed is that syphilis is modifie 
by circumstances of climate, race, personal habits and constitution, o , 
so as to manifest itself in various forms. In St. Vincent, for exampe. 
lupoid destruction of the face is the rule on the Windward side o ^ 
island, and necrosis of the palate and turbinated bones on the Lee ^ 
It is incorrect to judge of syphilis of dark races in a tropica ^ 
house by the standard of syphilis in Europe. So certain 
rhinopharyngitis mutilans is a tertiary that its presence in ^ 
he conclusive that the supposed freedom of that group fr onl 
was a delusion, if such proof was ever seriously required. ^ 
The condition is this ; there is ulceration of tonsils, fauces, 
palate or nose, progressing to destruction and accompanie ^ ^ 
by necrosis of the hard palate, the turbinated bones and 
or all of these parts may he involved. The nose at len?t " 'on f 
in, but the ulceration does not usually reach the skin of the ^ ^ 
may seethe buccal, nasal, and pharyngeal cavities tkr0 '' n j jjned 
space, lying between the tongue and the base of the skull, ^ of 
by a vast green-gray ulcer relieved bv blackened re £ or the 
nea ^g ^ne. The condition does no t appear to 
»• Jour. Trop. Med. MaT 15th, 1906. 
