YAWS AND SYPHILIS 283 
nasal mucous membrane and more rarely in the larynx. Esler quotes the case 
of a child, aged two years, with florid secondary yaws, who developed laryngeal 
obstruction necessitating tracheotomy, and Callanan has seen a single case 
among many thousands showing a lesion on the tongue. Hunt and Johnson, 
among 2000 cases in Samoa, found less than five per mille with any lesions on 
the mucosa and in those cases the nasal mucous membrane was alone affected. 
Stannus, in citing such cases, says there is a strong suspicion that it is the muco- 
cutaneous junction area which is involved, and not the mucosa. Acheson * 
has also found a number of cases of yaws in which the mucous membranes of 
the lips were involved. In eleven cases, three adults and eight children, the 
lesions were completely on the mucous membrane of the lip. In twenty-two 
cases the nostrils were blocked, but here the lesions sprang from the mucocu- 
taneous junction. 
Ayuyao” has reported upon tertiary manifestations of yaws in the nose 
and throat in the Philippine Islands. He also believes that the initial lesion 
occurs in the nose, rather than in the pharynx, though the pharynx and larynx 
may be primarily involved. MHallenberger?’ also illustrates and mentions a 
ease with chronic granulomatous tissue about the mucous membranes of the 
mouth. 
Miyao?* has also reported and illustrated two cases with lesions of yaws 
on the external genitals. In the first case there were in addition to extensive 
granulomata on the skin, lesions on the lip, anus, and glans penis. The last 
are well illustrated. The disease was directly transmitted from this patient 
to his wife who developed initial yaws lesions upon the mucous membrane of 
the vulva. 
It also has usually been stated that the viscera are never affected in yaws, 
but, as Stannus points out, 7. pertenue has been recovered in earlier cases 
from glands, spleen, and bone marrow. 
Some few visceral lesions have been ascribed to yaws in Fijians and have 
been called paraframboesial lesions. The optic atrophy and aortic aneurysm 
observed by Harper have already been referred to. 
Choisser,® who has performed 526 autopsies at the Haitian General Hos- 
pital, has not been able to differentiate the visceral lesions of yaws and syphilis, 
and regards the lesions found at autopsy as those of yaws, from the clinical 
history. He says, however, that the histories in many cases had to be disre- 
garded concerning the exact type of infection, inasmuch as conflicting state- 
ments were not uncommonly given by the patients during their stay in the 
hospital. Regardless of this, he says that he has observed a series of ten dif- 
ferent cases of yaws pure and simple with a negative history of syphilitic in- 
fection and no evidence of scars on the genitalia. In eight of these cases there 
1 Acheson: Northern Rhodesia Med. Report Health and Sanit. 1925 and 1926; Appendix, p. 125. 
2 Ayuyao: Jour. Philippine Med. Assoc. (1928), VII, 411. 
’ Hallenberger: Beihefte, Arch. f. Schiffs u. Tropen-Hyg. (1916), XX, 5. 
4 Miyao: Philippine Jour. Science (1930), XLI, 13. 
® Choisser: Stitt’s ‘‘Diagnostics and Treatment of Tropical Diseases’’ (1929), p. 156; Choisser: 
U.S. Naval Med. Bull. (1929), XX VII, 564. 
