280 REPORT OF THE HARVARD AFRICAN EXPEDITION 
sidered to be the tertiary manifestations of yaws and similar conditions which 
may be due to syphilis. He points out in his article published in 1926 that there 
has been no evidence of value in recent writings to show that the nervous system 
is ever affected in yaws. 
He, however, refers both in this and in a later report 1 to Harper’s observations 
and belief that both general paralysis and tabes may result from yaws, in the 
Fiji Islands where syphilis has not been observed to occur.? Harper also found 
optic atrophy and aortic aneurism among the Fijians and refers to all these 
lesions as paraframboesial diseases. Parham,*® working in Samoa, holds much 
the same view. He believes that the children in Samoa are invariably infected 
with yaws which renders them subsequently immune in adult life to syphilis, 
and that syphilis is practically unknown in Samoa. In this view he is upheld 
by Ritchie. Lambert * after emphasizing that syphilis is almost unknown in 
the Fiji Islands, says that in the insane asylum there have been 182 admissions 
of natives during the past twenty years of whom 42 have died of general paralysis 
of the insane, and that none of these natives had syphilis. Cases of paraplegia 
responding to treatment with iodides and arsenical compounds were not infre- 
quently met with. Parham not only thinks that tabes and general paralysis may 
result from yaws, but that yaws may be inherited. Hunt and Johnson § also 
believe that yaws infection may be hereditary. Choisser ’ states with reference 
to the condition of the nervous system in yaws, that the most common finding 
is spontaneous haemorrhage into the brain. In one case the haemorrhage oc- 
curred into the spinal cord. This was diagnosed clinically as tabes dorsalis, and 
aroused much interest inasmuch as up to date no case of tabes had been found. 
The autopsy finding, however, revealed to him the true nature of the condition 
to be a spontaneous haemorrhage into the central canal. In his present series of 
cases he found four spontaneous cerebral haemorrhages at autopsy. These all 
occurred in young adults with clinical histories and symptoms of yaws infection. 
They were not cases of hypertension, but on the contrary presented systolic 
pressures below what one might expect for their age. 
Parsons,® in a more recent publication, states that it has been held that lesions 
of the central nervous system do not exist in Haiti because the Haitian disease 
is yaws and not syphilis. He points out that the disease as found in the cities 
of Haiti does not differ in any way, except for the absence of tabes and paresis, 
from the syphilis of the United States, and that the accumulation of autopsy 
and clinical records there now shows that the rural, non-venereal form of the 
disease known as yaws is capable of producing in Haitians all the lesions that 
syphilis can produce. He believes that the most rational explanation of the non- 
appearance of tabes and paresis in Haiti, where syphilis is universal, lies in the 
1 Stannus: Brit. Jour. Ven. Dis. (1928), IV, 64. 
2 Harper: Kenya Med. Jour. (1925) II, 18. 
§ Parham: Amer. Jour. Trop. Med. (1922), II, 341. 
* Ritchie: Med. Jour. Australia (1927), Supp. No. 13, p. 401. 
> Lambert: Amer. Jour. Trop. Med. (1929), LX, 429. 
® Hunt and Johnson: U.S. Naval Med. Bull. (1923), XVIII, 599. 
7 Choisser: U.S. Naval Med. Bull. (1929), XX VII, 566. 
8 Parsons: U.S. Naval Med. Bull. (1928), XXVI, 916. 
