YAWS AND SYPHILIS 281 
fact that malaria is also universal in that country. The idea that malaria may 
play a role in the prevention of the development of the later symptoms of yaws 
had also been advocated previously by Powell! and by Ramsay.” 
Schlossberger * has shown that, in the inoculation of mice with a strain of 
syphilis virus and with one of 7’. pertenue from Nichols, an infection of the brain 
may occur in both instances. A piece of the syphilitic lesion from an infected 
rabbit was buried in a skin pouch in the mouse’s back. It became absorbed in 
three weeks. The mice so treated showed no symptoms or signs of infection, 
but after ten months they were shown to possess a latent infection. Thus when 
they were killed and blood and portions of their organs, glands, spleen, and brain 
were injected into rabbits by the intra-testicular route, the gland and spleen 
gave positive evidence of the infection, and in the case of two syphilitic and two 
framboesial latent infections in the mice, their brain tissue inoculations into 
rabbits were followed by positive results. The inoculation of their blood into 
rabbits, on the other hand, gave negative results. In view of these experiments 
it seems possible that the brain in man may sometimes harbor the virus of yaws. 
Williams * reports the case of a native who developed, a week after the 
last of three intra-muscular injections of bismuth sodium tartrate for florid 
secondary yaws, cerebral symptoms with coma, and died twelve days later. 
An autopsy was performed and revealed lateral sinus thrombosis. No other 
lesions were found in the body and no thrombosis of the veins in the buttocks 
or abdomen was discovered. The brain was sent to the director of the patho- 
logical laboratory and a report was given that there were changes in the brain 
similar to those found in general paralysis of the insane. Stannus, however, 
in reviewing this report does not consider that a relationship was established 
between the pathological lesions found and the yaws for which the patient 
was treated. 
It has been remarked that typical tabes is extraordinarily rare among 
African natives. With reference to this point, we observed no typical cases 
of tabes or general paralysis in Africa, but we found numbers of cases of de- 
mentia in institutions in parts of Central Africa, confined with cases of sleeping 
sickness in which no trypanosomes had been found either in the blood or in 
the cerebrospinal fluid. As in these regions it is stated that the occurrence 
of yaws is almost universal in childhood, it may be that general paralysis will 
be subsequently regarded and reported as a manifestation of yaws in Africa, 
as it has in Fiji and Samoa. The cases that we saw of dementia and disturb- 
ances of the central nervous system in which no trypanosomes were found 
were being treated with anti-syphilitic remedies. Dr. Strada, at Coquilhatville, 
told us that the clinical picture of general paralysis is in his opinion accurately 
reproduced in some cases of trypanosomiasis. While Dr. Donadio at Stanley- 
ville considers that syphilis of the central nervous system is relatively rare in 
that region among blacks, he makes such a diagnosis in disturbances of the cen- 
1 Powell: Loc cit. 
2 Ramsay: Loc. cit. 
3 Schlossberger: Cent. f. Bakt. (1927), Orig., CIV, 1. 
4 Williams: Tanganyika Terr. Ann. Med. and San. Report for 1926, p. 105. 
