.388 
the ordinary type, and some of my colleagues have adopted or 
confirmed my opinion. Such cases are seen more commonly in towns 
where yaws is never prevalent. I have seen a few such develop 
frambesial eruptions after having been diagnosed and treated as 
syphilis ; the frambesiae appearing along with the other syphilides. 
Nearly everyone familiar with yaws recognises what the natives 
all know, that there is a primary in yaws. No doubt this is often a 
fungating ulcer rather like a frambesia, but it may be identical with 
the foot chancre of ordinary type. Chancres on the penis not 
infrequently fungate in the same way, as Hutchinson points out. The 
foot chancre, out of which yaws also sometimes originates, is, in my 
experience, a small sore about 5 to 10 mm. wide, round, with 
indurated base and periphery and raised edges. It may be on one of 
the toes, the inner malleolus, the tubercle of the fifth metatarsal or 
back of the foot, but the commonest site is the outer malleolus. 
In the case of yaws, the natives in some instances do not recognise 
the primary, which may be inconspicuous, as is often the case in 
syphilis; and then a large group of frambesiae, especially a horse¬ 
shoe group, may be called the “ mother-yaw." On the other hand, a 
primary may really become the “ master-yaw ” or largest frambesia, 
by fungating and having a satellite eruption of papillomata 
around it. 
It is perhaps unnecessary to insist that there is aways a primary in 
yaws. Numa Rat has made this quite clear, and the universal opinion 
of the inhabitants of yaws districts themselves leaves no doubt on the 
su ject. Notwithstanding, it is urged (e.g. Manson, Tropical Diseases, 
F>- 530) as an argument against the syphilis theory that the primary is 
wanting in yaws.” 
The identity of non-venereal syphilis of the easily-recognised 
-r* aS ^ ^ rs *- referred to, and the whole group of symptoms 
, ed '^ WS ’ is 80 obvious that the peasants themselves bear witness 
, ** * n< d u de under this name other skin eruptions, besides 
e rambesiae, which they have observed to be associated with the 
CSe bave popular names — tubbo, corn-yaws, crab-yaws, 
pian-gratelle and dartres. The peasants speak familiarly of “yaws- 
pains. hey point to where a patient did “ ketch a yaws,” who has 
svn V kT? V 0P f frambesiae ’ but h *d rheumatoid pains and vesicular 
syphilides, and is afterwards seen with tertiary 
