XX 
YAWS AND SYPHILIS 
TypicaL secondary eruptions of yaws were commonly observed in children and 
adults, but especially in young children, in native villages in Liberia and in the 
Belgian Congo (Nos. 202-207). In many villages a large number of the in- 
habitants stated they had suffered from the disease in childhood, and individuals 
with yaws were seen in almost every village in which a survey was made, indicat- 
ing the wide prevalence of the disease. Chesterman' states that in the regions 
around Stanleyville ninety-five per cent of the people acquire yaws in infancy or 
at least before puberty. 
Of some interest were eight children showing extensive and typical sec- 
ondary yaws granulomata who lived in a village a little below Kibati (near 
the base of the voleano of Ninagongo). The altitude of Kibati is about 2000 
meters, and that of the village where the children were seen is not much lower. 
Photographs of two of these children are reproduced in Nos. 206-207. 
Sellards, Lopez, and Rizal * found that while yaws is widespread in the moun- 
tains of Northern Luzon, at an altitude of approximately 800 to 1200 meters, 
the yaws cases observed in the mountains showed a striking peculiarity in that 
the cutaneous lesions in ninety per cent of the patients were limited to mu- 
cocutaneous junctures of the mouth, nose, anus, and genitalia. They state that 
on hypothetical grounds one may consider that a special strain of yaws of low 
dermatotropic affinity has developed in these tribes which have been cut off for 
centuries from much connection with the outside world. They also point out 
that it has come to be a textbook statement * that the disease practically does 
not occur above an altitude of 800 feet, about 270 meters. 
Sellards * however, points out that several observers, — Ricono, Oho, Mett- 
let, and Gilks — had all observed cases in altitudes in the neighborhood of 
5000 feet. 
Ramsay ° in Assam, found that florid yaws is only common among the 
dwellers in the plains during the warm season. In the cold season these people, 
and the hill dwellers at all seasons, showed only condyloma-like lesions in the 
warm, moist regions of the axilla, between the nates, ete., while at the return of 
hot weather or if the hill dwellers came down to the hot plain, the disease again 
became florid. 
In contradistinction to the prevalence of yaws in Liberia was the small 
1 Chesterman: Brit. Jour. Venereal Dis. (1928), IV, 64. 
? Sellards, Lopez, and Rizal: Philippine Jour. Sci. (1926), XXX, 497. 
* Castellani and Chalmers: ‘Manual of Tropical Medicine’’ (1919), p. 1537. 
4 Sellards: Loc. cit. 
’ Ramsay: Jour. Trop. Med. and Hyg. (1925), XXVIII, 85. 
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