278 REPORT OF THE HARVARD AFRICAN EXPEDITION 
soles of the feet, with moderate tenderness and swelling, were also observed 
particularly in negro porters in Liberia and in the Belgian Congo. 
Before considering further some of the changes of n’gonde observed by us in 
Africa, reference may be made to the report of Hudson! upon a form of treponae- 
matosis observed among the Bedouin Arabs under the name of bejel. Hudson 
states that the natives distinguish bejel from faranghi, the foreign disease, or 
syphilis, with a primary sore acquired in adult life by sexual contact. Bejel is 
not considered a venereal disease. There is no history of primary sore and every- 
one admits having had the disease in childhood, but no one expects to get it a 
second time. It is said that inoculation of the children is sometimes practiced. 
There are nasal catarrhal discharges, affections of the throat, and skin eruptions. 
Stannus, in reviewing this report, says that the description of the disease is that 
of syphilis and that yaws does not enter into the problem. The question, how- 
ever, will remain in the minds of some, is bejel a form of syphilis contracted by 
children in the identical manner as yaws. 
The occurrence of tertiary lesions in yaws. In earlier years some of the lesions 
that are today reported as tertiary manifestations of yaws were frequently re- 
ferred to as syphilis. Some observers did not accept the ulcerative tertiary lesions 
as late manifestations of yaws. Powell,? writing in 1923 of his careful studies 
and observations made in Assam, says that no tertiary lesions were seen by him 
during the ten and one-half years his yaws cases were under observation. In 
three cases of syphilis, however, in two of which yaws was contracted, tertiary 
lesions occurred. A cracked and pitted form of plantar hyperkeratosis described 
by Castellani as a sequel of yaws he says is common in Assam and not rare else- 
where in India, but Powell disassociates it from yaws. 
Sellards and Goodpasture * say that they are convinced that in many cases 
yaws terminates spontaneously with the secondary stage while in other cases it 
lies latent or proceeds to tertiary manifestations. 
Ramsay 4 found chronic dermatitis and a worm-eaten appearance on the soles 
of the feet common among his 1000 cases, but tertiary lesions uncommon. How- 
ever, arthritis occurred in three per cent, chiefly of the phalanges. Araujo,° also 
with a wide experience with the disease, says that gummatous ulcerations have 
never been observed in yaws patients and in six cases of goundou there was no evi- 
dence of yaws. Many other observers, however, find tertiary lesions in yaws very 
common, especially in Africa. Thus Callanan,® through whose hands some 12,000 
cases of yaws passed in twenty-seven months, found that the tertiary lesions noted 
included gummata, periostitis and osteitis, which arecommon. Rarer lesions were 
pseudomycetoma, juxta-articular nodules and goundou, while gangosa was very 
common. The tertiary lesions were noted in seventy per cent of the adult males 
and females. Spittel’ says that the quiescent period of yaws usually lasts from 
1 Hudson: U.S. Naval Med. Bull. (1928), X XVI, 817. 
2 Powell: Proc. Royal Soc. Med. (Sec. on Trop. Dis.), (1923), XVI, 15. 
’ Sellards and Goodpasture: Philippine Jour. Sci. (1923), XXII, 219. 
4 Ramsay: Trop. Dis. Bull. (1925), XXII, 546. 
5 Araujo: Bull. Soc. Path. Exot. (1928), X- XI, 387. 6 Callanan: N. B. Thesis W. (1925). 
7 Spittel: Jour. Ceylon Branch Brit. Med. Asso. (1922), XIX, 1. 
