IS YAWS SYPHILIS ? To the Editor of "The Indian Medical Gazette." Sir,?In your issue for October 1897 in Dr. Powell's excellent paper "Is Yaws Syphilis ?" there is one misapprehension which, with your permission, I should like to correct. .Dr. Powell seems to think that it has been stated that syphilis does not exist in Fiji. What I and others have stated is that syphilis is unknown amongst the Natives of Fiji. In East Indian immigrants and Europeans it is by no means uncommon and runs the usual course. Though only a side issue and not affecting any of the main points of Dr. Powell's paper, the point is of a little importance, as in considering lesions which may be forms of tertiary yaws we have not to exclude, as in other countries, the probability of these being tertiary sypliilides. The subjoined extract from a paper I wrote in 1895 I think shows that syphilis cannot be an important factor in the
Pathology. Fijian " Note.?That syphilis is unknown amongst the Fijian natives is the experience of every medical man in that group. " Opportunities for its observation if present are good. A
large proportion
of the adult male
population
pass
through
Nov. 1898.]
GAZETTE NOTIFICATIONS.
gaol, for in addition to many trivial offences against Native Laws, fornication and adultery are punished by imprisonment. In all the larger gaols, each prisoner is examined by a
Adult unmarried males when indentured on under medical care and are by no means averse to lie up for most trifling sickness and are examined then by the Medical Officer. " When a Medical Officer visits a village, it is usual for the headmen to show him all the sick including all not working. " As regards my own experience, though acquired in a district where not only the largest number of coolies were employed, but also including two of the largest native villages and most frequented in old times by Europeans, as is shown from the number of half castes, I never saw primary or secondary syphilis except in Europeans and East Indians, at least its rarity. proving " The experience of every medical man, including Dr. Corthe Chief Medical Officer, who has not only had long ney, experience, but a most intimate acquaintance with their diseases, language and customs, is to the same effect. "The native practitioners who see in their training in the Suva Hospital cases of syphilis amongst the East Indians also sxy they see nothing like it amongst the natives. " Stronger negative evidence would be difficult to obtain. "That the Fijians, though not a licentious race, have had both from Europeans and East Indians abundant opportunities of acquiring syphilis is certain, and as a speculation it was frequently suggested that the yaws were to some extent a protection, and in this connection it is especially noteworthy that in all the conclusive cases of persons being attacked with both syphilis and yaws, the syphilis preceded the yaws, though as the latter is usually acquired in childhood, we should expect to find yaws precede syphilis in the larger proportion of cases. medical man.
plantations
are
" C. W. D." I should like to add that the opportunities the natives have had of acquiring syphilis were rare till the last 30 or 40 years, and that in view of the positive evidence adduced by Dr. Powell and others of syphilis following yaws, the suggestion in the last paragraph must, of course, be abandoned. The only manifestation which I now think to be at all probable in a tertiary form of yaws is the lupoid ulceration of the posterior nares, and adjoining pharyngeal parts which was and is still considered to be a tertiary sequela in Fiji quite independently of any West Indian work. In proportion to the number of cases of yaws it is rare, speaking from recollection, well under 2 per cent. It occurs after puberty and in early adult life, as a rule, though I have seen one case aged 9 years, and others in later life. Yaws is in Fiji very rare in the first year of life, but it is commonly acquired towards the end of the second year, and in the third year less commonly, in the fourth and fifth and rarely later. It follows therefore that this ulceration if a tertiary sequela very rarely occurs in less than ten years after the original attack of yaws. If Dr. Powell is able to watch his cases for a few more years, the absence of any such ulceration will be most valuable evidence as to whether this is truly a sequela. At present the period of observation is too short to be of value as negative
evidence.
I am, &c., C. W. DANIELS, m.b., Colonial Medical Service, B. Guiana, late Fiji.
439
Pathology. Fijian " Note.?That syphilis is unknown amongst the Fijian natives is the experience of every medical man in that group. " Opportunities for its observation if present are good. A
large proportion
of the adult male
population
pass
through
Nov. 1898.]
GAZETTE NOTIFICATIONS.
gaol, for in addition to many trivial offences against Native Laws, fornication and adultery are punished by imprisonment. In all the larger gaols, each prisoner is examined by a
Adult unmarried males when indentured on under medical care and are by no means averse to lie up for most trifling sickness and are examined then by the Medical Officer. " When a Medical Officer visits a village, it is usual for the headmen to show him all the sick including all not working. " As regards my own experience, though acquired in a district where not only the largest number of coolies were employed, but also including two of the largest native villages and most frequented in old times by Europeans, as is shown from the number of half castes, I never saw primary or secondary syphilis except in Europeans and East Indians, at least its rarity. proving " The experience of every medical man, including Dr. Corthe Chief Medical Officer, who has not only had long ney, experience, but a most intimate acquaintance with their diseases, language and customs, is to the same effect. "The native practitioners who see in their training in the Suva Hospital cases of syphilis amongst the East Indians also sxy they see nothing like it amongst the natives. " Stronger negative evidence would be difficult to obtain. "That the Fijians, though not a licentious race, have had both from Europeans and East Indians abundant opportunities of acquiring syphilis is certain, and as a speculation it was frequently suggested that the yaws were to some extent a protection, and in this connection it is especially noteworthy that in all the conclusive cases of persons being attacked with both syphilis and yaws, the syphilis preceded the yaws, though as the latter is usually acquired in childhood, we should expect to find yaws precede syphilis in the larger proportion of cases. medical man.
plantations
are
" C. W. D." I should like to add that the opportunities the natives have had of acquiring syphilis were rare till the last 30 or 40 years, and that in view of the positive evidence adduced by Dr. Powell and others of syphilis following yaws, the suggestion in the last paragraph must, of course, be abandoned. The only manifestation which I now think to be at all probable in a tertiary form of yaws is the lupoid ulceration of the posterior nares, and adjoining pharyngeal parts which was and is still considered to be a tertiary sequela in Fiji quite independently of any West Indian work. In proportion to the number of cases of yaws it is rare, speaking from recollection, well under 2 per cent. It occurs after puberty and in early adult life, as a rule, though I have seen one case aged 9 years, and others in later life. Yaws is in Fiji very rare in the first year of life, but it is commonly acquired towards the end of the second year, and in the third year less commonly, in the fourth and fifth and rarely later. It follows therefore that this ulceration if a tertiary sequela very rarely occurs in less than ten years after the original attack of yaws. If Dr. Powell is able to watch his cases for a few more years, the absence of any such ulceration will be most valuable evidence as to whether this is truly a sequela. At present the period of observation is too short to be of value as negative
evidence.
I am, &c., C. W. DANIELS, m.b., Colonial Medical Service, B. Guiana, late Fiji.
439
