276 REPORT OF THE HARVARD AFRICAN EXPEDITION 
ease. On the Gold Coast, in 1923 and 1924, there were observed for the whole 
colony 1,311 cases of syphilis and 5,312 of yaws, no cases of tertiary mani- 
festations of syphilis being mentioned, while the secondary cases were about 
twice as numerous as the primary. In Nigeria, in 1923, 1,405 cases of yaws and 
563 cases of primary syphilis and 1,128 of secondary syphilis were observed and 
treated. The statement, however, is made that yaws is relatively uncommon, 
while venereal disease is widespread. 
Nogue ! (1923-1924) reports that yaws is rare in Senegal and that he saw 
only four cases in four years at Dakar. Syphilis, on the other hand, was rampant. 
Of all the patients treated at the hospital, practically 100 per cent were syphilitic. 
Still births constituted 17 per cent, and 42 per cent of the children were said to die 
before the age of four years. 
In the French Congo in 1921 and 1923, Chapeyrou states that a third of those 
treated in hospitals were affected with syphilis. Clapier in 1921 saw 2000 cases 
in a population of 45,000 in Lower Ubangi and 20 per cent of the children showed 
framboesial eruptions. Portois (1924) and van Nitsen (1920 and 1924) and Van 
den Branden (1922 and 1924) have reported upon the presence of yaws in the 
Belgian Congo, and Mattlet (1924) and Miguens (1924) in Urundi, where the 
disease is especially common. They report secondary eruptions in children and 
tertiary yaws lesions in adults, with no mention of syphilis. In Tanganyika in 
1923, Davy reports 3,593 cases of yaws and 716 cases of primary, 1,638 cases of 
secondary and 253 cases of inherited syphilis treated in the Government hos- 
pitals. In Uganda in 1928, Keen gives the total cases of syphilis at 11,505 and 
of yaws, 3,376. 
In some of the localities where the two conditions are noted it should be em- 
phasized that the tertiary lesions have apparently been diagnosed generally as the 
result of syphilis, or in others as the result of yaws, the opinion sometimes vary- 
ing with the observer. 
Tertiary Yaws. N’gonde is the name used locally in parts of Central Africa, 
about Stanleyville for example, for tertiary yaws. Our observations of this 
condition were made particularly from the study of thirty-two cases. 
In its fully developed and typical form, as we saw it, n’gonde is characterized 
by searring and ulcerations which have a marked tendency toward bilateral 
symmetry. ‘The lesions are most commonly seen where bone lies close beneath 
the skin; e.g., on the forehead, face, joints of the shoulders, elbows, wrists, hands, 
lower legs, ankles and feet. 
The sears in n’gonde are often puckered, like those produced by severe scald- 
ing. Pigment in them may be increased or diminished. Vitiliginous patches are 
common, particularly in those upon the lower legs. Recent scars often have a 
pink color. That the disease is very chronic is shown by frequent coexistence of 
old scars and active ulcers. ‘The ulcers in the same case often show different 
stages of development. Healing by granulation tissue and overgrowth of skin 
may be going on beside an ulcer which is covered with slough and is extending. 
1 Nogue: Ann. d’Hyg. Publique, Industrielle et Sociale (1924), No. 4, p. 149. Trop. Dis. Bull. 
(1926), X-XIIT, 4. 
