3 86 
the present time for profuse eruptions, iritis, numerous suppurating 
glands in the neck, bone aches, periostitis. In fact, she has had 
nearly every early syphilitic symptom possible except nerve syphilis 
But she has never had either a venereal chancre or a frambesial 
eruption. 
It is most important that the profession, especially in the tropics, 
should realise the importance and frequency of extra-genital syphilis. 
We all know that surgeons and nurses get finger syphilis occasionally. 
In the island of St. Kitts, with at no time more than eight medical 
men in practice, and usually only six, there were in twenty-seven 
years five instances of finger syphilis in surgeons. These are well- 
authenticated cases. 
When we consider how readily syphilis is inoculated, and how the 
habits of the poor in the tropics afford opportunities for inoculation, 
we shall not wonder that extra-genital primary occurs. In the West 
Indies the labourers, especially children, go barefoot, and are, 
therefore, frequently receiving bruises and scratches on the feet and 
legs. 
The negroes never realise the fact of infection or contagion. This 
forces itself on our attention by the trouble they give when quarantine 
measures are to be carried out. They are too indolent or careless to 
make any effort to avoid or prevent infection, even when they 
acknowledge that a disease is catching. A child with yaws huddles 
ogether with the other children just as naturally as the adults will 
ep or co abit with lepers. In I ortola, while I was there, the only 
i a 6 ^ '° cou ^ be called a professional prostitute was an ulcerated 
eper. he syphilitic, the yawsy, the leprous and the healthy mix in 
pip h ai f- . mt “ nate contac t without a thought. Leprosy, like 
no^a^ iaS1 f may be the Subject °f reproach, but these diseases are 
dislrn aUSe aV °1 anCe ° f Physical COntact Yaws is hardly even a 
of a hen e T P ? C CyeS ° f schoolma sters and other coloured folk 
a better clas s than the labourers. 
can be nd evt CirCUmStances - * » ba rdly wonderful that yaws 
muaculousTr 7 “ * " ative community; and it would be 
almost ^universal D ' VCnereal Action did not occur where syphilis is 
J h ° 566 the Pe ° Ple ’ n0t ^ 
’ m y description of West Indian 
