EDITORIAL
BEJEL—YAWS
The more accurate knowledge of syphilis dates from 1530.
Since that date, no single sign or symptom of this disease is more
important, or indeed more essential, to the diagnosis of acquired
syphilis than the initial lesion. World-wide study of syphilis
for 406 years has enabled physicians to make certain dogmatic
statements in regard to it because these centuries have shown
that its symptomatology follows certain rules which, laboriously
worked out, have earned respect as laws.
We know, for example, that the number of cases of human
acquired syphilis which begin without an initial lesion is so small
as to be negligible, indeed this is so exceptional as to make us
wonder if it ever occurs. The ability to think and observe on the
part of the infected gauges the correctness of the history of initial
lesions. With "primitives" this is utterly useless. With the
better class civilized human being it is of greatest value.
Let us take a few examples. Suppose a nervous young man of
22 should consult his physician in some such manner as this:
"Doctor, I am afraid I have syphilis." "What makes you think
so?" "Well, I've never transgressed but once in my life and now
I've an eruption on me." "How long since this transgression?"
"3 months next Tuesday night at 10.45." "When did you first
notice a genital sore?" "I have not had a genital sore!"
Inspection shows no trace of a genital lesion, and you, the physician, then look at the eruption, confident that whatever it is,
it is not syphilis—erythema multiforme, pityriasis versicolor,
sycosis barbae, psoryasis, acne vulgaris or what have you? But
not syphilis.
Or, a girl of 19 with pretty face and engaging manner is brought
*Bejel: nonvenereal syphilis. E. H. Hudson, Arch. Dermat. & Syph., 33,
994-1011, June, 1936.
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EDITORIAL
to your office by her mother who is worried about a sore on her
daughter's lip which will not heal. "How long have you had
that?" "It has been there about a month, Doctor."
Inspection shows that the lesion is sclerotic, not painful and
that a lymph gland draining the area is enlarged.
"Mary, have you kissed any young man about three weeks
before you first noticed that sore?" "Yes, Doctor I allowed
Willie Van Meter to kiss me at Sarah Bernhard's party which
was (after calculation) two months ago next Friday." We
take a specimen of Mary's serum and look up Willie Van Meter,
being rather certain the serum will be positive and that Willie
will still have a mucous patch or so which will enable us to discover the source of Mary's tragedy.
The diagnoses here are as follows: To the lad of 22 who had
only sinned once in his life and who remembered the time to the
hour and minute, the lad who had gone through all those years
of hell in the two months of thinking about the future, you could
confidently say, "John, you have no syphilis. What you have,
we doctors call syphilophobia. Go and sin no more!"
But what are we to say to poor Mary who responded to that
urge as old as life itself to love and be loved? The woman's
specialty is rearing a family. If she is a proper woman, this is
the breath of life to her, the great adventure for which she lives,
moves and has her being. The diagnosis in Mary's case is innocently acquired syphilis. Willie Van Meter has done her a
great injustice. But she may be completely cured and may live
to be loved and honored by a family of healthy sons and daughters. In both the above cases the chancre (initial lesion) was
the sine qua non of diagnosis.
Now let us consider the cases of human syphilis which come
without evident initial lesion.
(1) Colles' Law. A child that is affected with congenital
syphilis, its mother showing no signs of the disease, will not infect
its mother (1837).
(2) Profeta's Law. A non-syphilitic child born of syphilitic
parents is immune.
Now the "Colles mother" may have syphilis, though we may
not be able to demonstrate it by any tests known to medicine.
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So also the "Profeta child" may be a syphilitic, even though we
may find all tests negative. These are the only types of human
syphilis in which it is difficult or impossible to demonstrate
initial lesions. The "Colles Mother" and the "Profeta child"
may later show symptomatic syphilis. The whole symptomatic
spectrum of acquired syphilis may be shown by a chancre-less
congenital syphilitic—early (1 month) or late (10 years) eruptions, gangosa, tabes, and general paralysis. Such congenital
taint may remain latent through a long life and the offspring may
be healthy. The presence or absence of a chancre is therefore of
paramount importance in the diagnosis of the type of syphilis.
On this basis there are three types of syphilis.
A. Venereally acquired syphilis with the chancre always situated upon the genitals. (We do not consider acquired syphilis
as seen in sexual perverts as within the scope of these remarks.)
B. Innocently acquired syphilis in which the chancre is extragenital.
C. Congenital (Profeta) or "Colles" (mother) syphilis in
which there is no demonstrable chancre. If we can prove the
initial lesion was absent, and the patient a child we have prima
facie evidence the syphilis is congenital. It cannot be otherwise.
Now it makes no difference up to 10 or 12 years what time the
chancreless eruption comes on, it is none the less congenital,
whatever the mother may show as to serology or symptoms.
CONCLUSIONS
1. Any people incapable of acquiring genital (venereal) syphilis already have acquired or congenital syphilis. Yaws may
thus be proven to be syphilis in the human being.
2. Bejel is congenital syphilis for this reason: initial lesions
do not occur. It is inconceivable that the initial lesion could
escape years of search for it.
3. Yaws and Bejel are identical etiologically although they
may differ slightly because of the climatic differences (chiefly
humidity) under which each develops.
4. Yaws, bejel and syphilis are synonymous terms.
C. S. BUTLER.