— 37 syphilis. Concealment may be eliminated as all the tribe appreciate the benefit of injections and know they can have them free if a lesion of the genitalia can be produced. It can only be concluded that the majority of these syphilide-like lesions is due to some other condition or conditions one of which is yaws. Undisputable cases of yaws, however, are also comparatively few so I think we must look further afield still. Malaria as will be seen later in the report is a very com¬ mon disease of children and I think that it is conceivable that this disease may have certain sequelae of a syphilitic like nature.

Tertiary Syphilis and Yaws. The following analysis of cases of this type will show that more are attributable to yaws than to syphilis. There still remain, however, many which may arise from either condition.

Deformities of bones (sabre-shaped tibiae, etc.) . . 30 Clavus (?) all in old people .. .. .. .. 20 Gangosa (two in children) .. .. .. .. 8 Onychia .. .. .. .. .. . . 2 Emaciation with history of a rash .. .. .. 15 Ulceration of scrotum in adults .. .. . . 5 Nocturnal headache with history of rash . . . . 2 Bilateral synovitis .. .. .. .. . . 2 Osteo-myelitis . . . . . . . . . . 2 86 Congenital syphilis or yaws (?) Sixty cases of syphilide-like affections occur¬ red in children born of parents having either a history of some syphilis-like infection or actually showing one or other of the conditions enumerated above. The most common manifestations were sabre-shaped deformity of the tibiae, symmetrical skin lesions, and emaciation. These may have been congenital syphilis, but on the other hand they could quite as readily be diagnosed as late yaw lesions following on evanescent unnoticed primary affections.

Primary and secondary yaws. A fair number of cases were found; their chief characteristic being a lack of conformity to the typical text-book descriptions of this condition. The following is an analysis of the lesions found.

Ulceration of the fore-skin in boys mostly about five vears old .. . . .. . . .. 10 Ulceration of vulva in two girls both aged 4 years 2 Condylomata round anus of four young girls .. 4 Mucous plaques on the mucous membrane on the inner side of the lips . . . . . . . . 28 44 It is interesting to note that these lesions occurred usually without any other manifestation or history thereof.

In addition to these about forty cases of secondary yaws were included under skin infection making a grand total of 84.

The sites of the lesions enumerated would appear to suggest that the virus was contracted from the ground, and that the mucous membrane was more prone to infection than the skin. Also I failed to get in lesions of the mucous membrane any history of antecedent abrasions as appears to be necessary to ensure infection through the skin.

Juxta Articular Nodes. These are included here as they are considered by most authorities a tertiary yaw manifestation. In more than 50% of cases however. T failed to elicit any history of antecedent yaws or syphilis. They are