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peasant life not unfamiliar, and if a look-out is kept, I am sure others 
will verify the existence of non-venereal syphilis for themselves. In 
places where yaws, under its various names, is prevalent, it will be 
found that frambesial eruptions and non-venereal syphilis of ordinary 
type are running together. In the drier and less-wooded localities 
the latter will probably be found the more common form. 
It must be remembered that in inherited syphilis secondaries do 
not occur after the second year, and are usually over in the first year 
of life. Tertiaries are the only lesions by which inherited taint can be 
manifested in children of, say, three years and upwards. Jonathan 
Hutchinson lays down : — 
“ If secondary symptoms of the kind described are to occur at all, 
“they will show themselves in infancy, and in the vast majority of 
“cases within the first three months of life. This is a very important 
"fact. If a syphilitic infant survive the first outbreak, in the course 
“of from six months to a year the symptoms common to this stage 
"(the rash, snuffles, mucous patches, &c.) will wholly disappear, and 
" there will follow a period of some years during which no active 
‘ symptoms will occur.’’ 1 
When, therefore, undoubted secondary eruptions and swollen 
glands are seen in children over the age of two years, they are almost 
certainly due to acquired disease, and this certainly rapidly increases 
with the age. Such children should be examined for the primary, 
which in the bare-footed is usually on the foot, most commonly on the 
outer malleolus. The indurated pigmented scar may be seen some 
time after the sore has healed, but these sores are often of long 
duration, and may be still unhealed months after they were infected 
with syphilis. They are often already indolent ulcers before the 
infection. I have diagnosed such primaries before the general 
symptoms were manifest, and the later eruptions have justified my 
diagnosis. More usually, however, one passes the sore by until the 
patient is complaining of rheumatoid pains or fever, for sore feet in 
children are so common that we cannot treat them all as potentially 
syphilitic. 
For several years I have been impressed with the frequency of 
these extra-genital chancres in children, followed by secondaries of 
’■ Syphilis, Ed. 1901, p. 75. 
