"A somewhat paradoxical title" might well be the
remark from the theoretical point of view. "t.hy; the
diseases are so contrasted as to admit of no comparison and their combination even is denied by some."
Granted; when you have, on the one hand, a truth_
ful intelligent European, with the presence or histor
of a Hunterian Chancre, _ Glands, _ Secondary rashes
or tertiary manifestations, and on the other, a native
of the Tropics with an Extragenital mother Yaw, and
the pathegnomonic or, (to employ an expressive
Scottish word) 'Kenspeckle' Eruption of Secondary
Yaws. "Ca saute aux Yeux ".
With these classical features of the two disease
I am not concerned, since they admit of no discussion
when so portrayed, but,let us plunge into Central
Africa among a people recently more primitive than
those of Old Testament narrative, and we can readily
understand if opinion is still divided as to the
identity of the widely differing diseases mentioned
in the Bible, what chance the /African native had in
the past of differentiating Yaws and Syphilis for
himself. Further, _ what chance has the skilled
observer even now of obtaining a satisfactory history
of one or other or perhaps of both diseases.
When he comes to examine the lesions he may be
even more at sea. He is at once 'up against' the
black skin; he finds the lesions perhaps obscured by
dirt or native medicines, and, if not superimposed
on tissues already attacked by other diseases, e.g.
Filarasis, Leprosy or Tubercle, he may find them so
profoundly altered by deficiency disease, tropical
anaemias, secondary infection, or all three that he
cannot even say with any certainty that they are
Spirochaetal in origin, let alone, differentiate the
particular species concerned. Little wonder then,
that many have considered them one and the same.
Such an observer is of necessity denied the
crucial tests of microscopical, histological and
serological diagnosis, and he must therefore fall
back on other and more unorthodox means; he must
familiarise himself with the combinations and one
might even say the permutations of his two diseases
with each other and with the other local conditions
already mentioned, and he must know something of the
history of the diseases he is treating and the people
he is working among.
It is then along these lines and with these
reservations that I wish to discuss the subject.
Fortunate it is that the mass diagnosis of these
diseases, so liable to be confused and so profoundly
altered by concomitant conditions, is merely of
statistical interest, and that the mass treatment of
both is only a matter of intensity,