Analysis of the names of students from London medical schools taking their final examinations in ... more Analysis of the names of students from London medical schools taking their final examinations in June 1982, 1983 and 1984 has revealed that racial and sexual discrimination operate when students are selected for medical education. On the basis of name the ratios of European to African, Asian or Arabic students vary significantly between the two extreme schools (P less than 0.01), and for any school the proportion tends to be consistent from year to year. Differences also occur between the proportion of females at each school. Furthermore, the pattern of racial and sexual discrimination at each school shows a highly significant rank correlation (r = 0.77). The admission policies at the different London medical schools need to be reviewed.
International Journal of Social Psychiatry, Dec 1, 1982
A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britai... more A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britain and were successfully traced in Jamaica show that most had suffered from recurrent episodes of schizophrenia but that few were predisposed develop this illness. After an average period of 42 months follow-up it was found that there had been an excessive mortality and that others were living in the Bush. The most important finding of the study is that the chronic symptoms of illness which have been previously described as characteristic of the repatriate syndrome, had taken place in a half of the sample. Nevertheless there was evidence of a good outcome in a third of those who were living and interviewed during the field survey. These findings have been discussed. It has been concluded that repatriation may be of therapeutic benefit but only following more careful selection of cases.
Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychi... more Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychiatric practice among black populations in Britain. Data from Third World countries suggest that prevailing social conditions may contribute to a high prevalence of physical and mental disorders. In one psychiatric sample, epilepsy was common, syphilis and its consequences significant, infections including tuberculosis notable, and hypertension was frequently associated with depression. Poverty-stricken conditions are prevalent in such settings and in ghetto conditions in the West. As a result, effective treatment may not be available. In Britain, there is a considerable literature on the association of health with inequalities of socioeconomic status, poverty, and unemployment. Townsend and colleagues have confirmed previous findings from the Black Report in a sophisticated analysis of conditions in the North of England. Three key dimensions—namely, premature mortality, chronic sickness and disablement, and delayed development, were incorporated in an Overall Health Index that correlated highly with an Overall Deprivation Index. In the latter, factors highly associated with being black and of minority ethnic status included percentages of unemployed households with more persons than rooms, no car, not owner occupied, and heads of household a manual worker.
An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cau... more An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cause of mental illness (Ireland, 1892). More recently a decreasing incidence of neurosyphilis was noted among racially similar persons in Uganda by Billington (1966), who attributed to penicillin the remarkable fall over the 20-year period reviewed. The low incidence in developed countries probably has a similar cause (Dewhurst, 1969; Dawson-Butterworth and Heathcote, 1970). That the diagnosis of neurosyphilis has become difficult was stressed by Heathfield (1968). Joffe, Black, and Floyd, (1968), in reviewing seven cases, pointed out that the modified picture noted might have been due to courses of penicillin given previously to all their patients for other reasons. Hume (1964) suggested that subcurative therapy masks syphilitic disease, but he believed this to be eventually helpful to the community. In Jamaica the predominantly Negro and rural population of almost two million has been exposed to two treponemal diseases. Thus, up to 1956, areas of high and low incidence of yaws were identified by Grant (1956), but by 1963 the yaws prevalence rate for the island was estimated to have been reduced to 16 per 10,000 population (Gentle, 1965) although certain rural areas still showed higher rates. A later study pointed out the difficulties presented to venereologists by the occurrence of the two diseases (Ashcroft, Miall, Standard, and Urquhart, 1967). In addition, the possibility of marked cross-immunity among the treponemal organisms was raised by Cannefax, Norins, and Gillespie (1967). With the widespread use of penicillin since its introduction in this area, it seems likely that modified neurological syndromes might be present. However, unusual pictures have been identified since the 19th century, as pointed out by Cruickshank (1956) and Montgomery, Cruickshank, Robertson, and Mc-Menemey(1964). These workers described the features
International Journal of Social Psychiatry, Jun 1, 1980
Social and psychiatric findings among boys at an approved school in Jamaica are described. Parent... more Social and psychiatric findings among boys at an approved school in Jamaica are described. Parental deviance and other evidence of family disorganization are less prevalent than elsewhere. A third of the boys are admitted for personal aggression and give a history of a previous offence. These factors are associated with a benign non-psychiatric (50 per cent) or malignant psychopathic (20 per cent) personality disorder and characterised by pre-morbid data of head injury, conduct disorder and intellectual deficit. Psychoneurosis (30 per cent) is associated with late separation experiences. It is of interest that paternal deprivation and other factors are similarly distributed among personality disordered and neurotic delinquents in Jamaica. Socio-cultural aspects of delinquency are discussed.
ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in L... more ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in London. Mortality in the general population is used as a basis of comparing an increased mortality in the psychiatric population. Two age groups are identified by the finding at 15 to 54 and a much lower one after this. In the second part of the study factors associated with suicide rather than other causes of death are investigated in two equal samples of the younger age group. The results point to the importance of personal and social factors which lead to admission but not to psychiatric indices.
International Journal of Social Psychiatry, Mar 1, 1984
The background to the present study was the emotional environmentcreated by a series of events wh... more The background to the present study was the emotional environmentcreated by a series of events which may have been temporally related to the New Cross fire in January 1981. The media had. become involved in an analysis of the factors which may have contributed to this fire in which 13 youngsters, all of West Indian origin, had died. The debate became somewhat intensified after a march which created a small disturbance in its route from Deptford, the scene of the fire, to Hyde Park Corner. This received full publicity and was to be followed by the first series of riots in April only a few days before the inquest into the fire. By the summer, rioting had spread to include wide areas of South London of which Deptford is a part, other parts of London and other urban areas in the country. The intensity of feeling in the work environment of the hospital and medical school may have been similar to that in the general society. However, there were factors which suggested that feeling may have been greater among certain sectors of the staff Thus the main hospital of this group provides services for multi-ethnic populations in inner city areas. Rooming houses are numerous and during this period of social change it was believed that social unrest had increased throughout the area. An inevitable feature of a situation which may have had racial overtones might be that staff may have become rather withdrawn and ineffective in their management of patients from other ethnic groups. A further factor may be an increase in inter-staff tension based on ethnic differ-
ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in L... more ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in London. Mortality in the general population is used as a basis of comparing an increased mortality in the psychiatric population. Two age groups are identified by the finding at 15 to 54 and a much lower one after this. In the second part of the study factors associated with suicide rather than other causes of death are investigated in two equal samples of the younger age group. The results point to the importance of personal and social factors which lead to admission but not to psychiatric indices.
Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychi... more Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychiatric practice among black populations in Britain. Data from Third World countries suggest that prevailing social conditions may contribute to a high prevalence of physical and mental disorders. In one psychiatric sample, epilepsy was common, syphilis and its consequences significant, infections including tuberculosis notable, and hypertension was frequently associated with depression. Poverty-stricken conditions are prevalent in such settings and in ghetto conditions in the West. As a result, effective treatment may not be available. In Britain, there is a considerable literature on the association of health with inequalities of socioeconomic status, poverty, and unemployment. Townsend and colleagues have confirmed previous findings from the Black Report in a sophisticated analysis of conditions in the North of England. Three key dimensions—namely, premature mortality, chronic sickness and disablement, and delayed development, were incorporated in an Overall Health Index that correlated highly with an Overall Deprivation Index. In the latter, factors highly associated with being black and of minority ethnic status included percentages of unemployed households with more persons than rooms, no car, not owner occupied, and heads of household a manual worker.
An official invitation was sent to the chairman of the Transcultural Psychiatry Society of the Un... more An official invitation was sent to the chairman of the Transcultural Psychiatry Society of the United Kingdom by Professor Kalle Achte as local chairman of the organising committee of the World Psychiatric Association Regional Symposium and by Dr. Antti Hemmi, Secretary General of this organisation asking me to organise a symposium on transcultural psychiatry.
A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britai... more A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britain and were successfully traced in Jamaica show that most had suffered from recurrent episodes of schizophrenia but that few were predisposed develop this illness. After an average period of 42 months follow-up it was found that there had been an excessive mortality and that others were living in the Bush. The most important finding of the study is that the chronic symptoms of illness which have been previously described as characteristic of the repatriate syndrome, had taken place in a half of the sample. Nevertheless there was evidence of a good outcome in a third of those who were living and interviewed during the field survey. These findings have been discussed. It has been concluded that repatriation may be of therapeutic benefit but only following more careful selection of cases.
Social and psychiatric findings among boys at an approved school in Jamaica are described. Parent... more Social and psychiatric findings among boys at an approved school in Jamaica are described. Parental deviance and other evidence of family disorganization are less prevalent than elsewhere. A third of the boys are admitted for personal aggression and give a history of a previous offence. These factors are associated with a benign non-psychiatric (50 per cent) or malignant psychopathic (20 per cent) personality disorder and characterised by pre-morbid data of head injury, conduct disorder and intellectual deficit. Psychoneurosis (30 per cent) is associated with late separation experiences. It is of interest that paternal deprivation and other factors are similarly distributed among personality disordered and neurotic delinquents in Jamaica. Socio-cultural aspects of delinquency are discussed.
RACE, CULTURE AND MENTAL DISORDER", by Philip Rack. Dr. Rack is an experienced psychiatrist who h... more RACE, CULTURE AND MENTAL DISORDER", by Philip Rack. Dr. Rack is an experienced psychiatrist who has been Head of the Transcultural Psychiatry Unit, Bradford, during the past decade. His book is a highly personalized but interesting account of his attitudes and how he has applied these to his work and some of the conclusions which he has reached as a result. The text makes every attempt to cover the wide area of psychiatry among persons who are now living in Britain but who are not indigenous. The book makes easy reading. However, there is
A sample of young West Indian females were interviewed whilst being on remand for petty offences.... more A sample of young West Indian females were interviewed whilst being on remand for petty offences. Most were suffering from adjustment reactions of adolescence, a half had previously been convicted and a third gave a history of parasuicide. On investigation, it was found that there had been a characteristic pattern of multiple separation experiences, which had been closely related to the onset of early symptoms of maladjustment, with subsequent delinquency. As this pattern of separation experiences is not found among delinquents in the West Indies, this should indicate that such pathogenic experiences may be related to residence in the new environment in Britain. Early pregnancy may constitute a further separation experience, which may also be stressful in vulnerable individuals.
An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cau... more An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cause of mental illness (Ireland, 1892). More recently a decreasing incidence of neurosyphilis was noted among racially similar persons in Uganda by Billington (1966), who attributed to penicillin the remarkable fall over the 20-year period reviewed. The low incidence in developed countries probably has a similar cause (Dewhurst, 1969; Dawson-Butterworth and Heathcote, 1970). That the diagnosis of neurosyphilis has become difficult was stressed by Heathfield (1968). Joffe, Black, and Floyd, (1968), in reviewing seven cases, pointed out that the modified picture noted might have been due to courses of penicillin given previously to all their patients for other reasons. Hume (1964) suggested that subcurative therapy masks syphilitic disease, but he believed this to be eventually helpful to the community. In Jamaica the predominantly Negro and rural population of almost two million has been exposed to two treponemal diseases. Thus, up to 1956, areas of high and low incidence of yaws were identified by Grant (1956), but by 1963 the yaws prevalence rate for the island was estimated to have been reduced to 16 per 10,000 population (Gentle, 1965) although certain rural areas still showed higher rates. A later study pointed out the difficulties presented to venereologists by the occurrence of the two diseases (Ashcroft, Miall, Standard, and Urquhart, 1967). In addition, the possibility of marked cross-immunity among the treponemal organisms was raised by Cannefax, Norins, and Gillespie (1967). With the widespread use of penicillin since its introduction in this area, it seems likely that modified neurological syndromes might be present. However, unusual pictures have been identified since the 19th century, as pointed out by Cruickshank (1956) and Montgomery, Cruickshank, Robertson, and Mc-Menemey(1964). These workers described the features
Analysis of the names of students from London medical schools taking their final examinations in ... more Analysis of the names of students from London medical schools taking their final examinations in June 1982, 1983 and 1984 has revealed that racial and sexual discrimination operate when students are selected for medical education. On the basis of name the ratios of European to African, Asian or Arabic students vary significantly between the two extreme schools (P less than 0.01), and for any school the proportion tends to be consistent from year to year. Differences also occur between the proportion of females at each school. Furthermore, the pattern of racial and sexual discrimination at each school shows a highly significant rank correlation (r = 0.77). The admission policies at the different London medical schools need to be reviewed.
International Journal of Social Psychiatry, Dec 1, 1982
A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britai... more A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britain and were successfully traced in Jamaica show that most had suffered from recurrent episodes of schizophrenia but that few were predisposed develop this illness. After an average period of 42 months follow-up it was found that there had been an excessive mortality and that others were living in the Bush. The most important finding of the study is that the chronic symptoms of illness which have been previously described as characteristic of the repatriate syndrome, had taken place in a half of the sample. Nevertheless there was evidence of a good outcome in a third of those who were living and interviewed during the field survey. These findings have been discussed. It has been concluded that repatriation may be of therapeutic benefit but only following more careful selection of cases.
Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychi... more Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychiatric practice among black populations in Britain. Data from Third World countries suggest that prevailing social conditions may contribute to a high prevalence of physical and mental disorders. In one psychiatric sample, epilepsy was common, syphilis and its consequences significant, infections including tuberculosis notable, and hypertension was frequently associated with depression. Poverty-stricken conditions are prevalent in such settings and in ghetto conditions in the West. As a result, effective treatment may not be available. In Britain, there is a considerable literature on the association of health with inequalities of socioeconomic status, poverty, and unemployment. Townsend and colleagues have confirmed previous findings from the Black Report in a sophisticated analysis of conditions in the North of England. Three key dimensions—namely, premature mortality, chronic sickness and disablement, and delayed development, were incorporated in an Overall Health Index that correlated highly with an Overall Deprivation Index. In the latter, factors highly associated with being black and of minority ethnic status included percentages of unemployed households with more persons than rooms, no car, not owner occupied, and heads of household a manual worker.
An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cau... more An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cause of mental illness (Ireland, 1892). More recently a decreasing incidence of neurosyphilis was noted among racially similar persons in Uganda by Billington (1966), who attributed to penicillin the remarkable fall over the 20-year period reviewed. The low incidence in developed countries probably has a similar cause (Dewhurst, 1969; Dawson-Butterworth and Heathcote, 1970). That the diagnosis of neurosyphilis has become difficult was stressed by Heathfield (1968). Joffe, Black, and Floyd, (1968), in reviewing seven cases, pointed out that the modified picture noted might have been due to courses of penicillin given previously to all their patients for other reasons. Hume (1964) suggested that subcurative therapy masks syphilitic disease, but he believed this to be eventually helpful to the community. In Jamaica the predominantly Negro and rural population of almost two million has been exposed to two treponemal diseases. Thus, up to 1956, areas of high and low incidence of yaws were identified by Grant (1956), but by 1963 the yaws prevalence rate for the island was estimated to have been reduced to 16 per 10,000 population (Gentle, 1965) although certain rural areas still showed higher rates. A later study pointed out the difficulties presented to venereologists by the occurrence of the two diseases (Ashcroft, Miall, Standard, and Urquhart, 1967). In addition, the possibility of marked cross-immunity among the treponemal organisms was raised by Cannefax, Norins, and Gillespie (1967). With the widespread use of penicillin since its introduction in this area, it seems likely that modified neurological syndromes might be present. However, unusual pictures have been identified since the 19th century, as pointed out by Cruickshank (1956) and Montgomery, Cruickshank, Robertson, and Mc-Menemey(1964). These workers described the features
International Journal of Social Psychiatry, Jun 1, 1980
Social and psychiatric findings among boys at an approved school in Jamaica are described. Parent... more Social and psychiatric findings among boys at an approved school in Jamaica are described. Parental deviance and other evidence of family disorganization are less prevalent than elsewhere. A third of the boys are admitted for personal aggression and give a history of a previous offence. These factors are associated with a benign non-psychiatric (50 per cent) or malignant psychopathic (20 per cent) personality disorder and characterised by pre-morbid data of head injury, conduct disorder and intellectual deficit. Psychoneurosis (30 per cent) is associated with late separation experiences. It is of interest that paternal deprivation and other factors are similarly distributed among personality disordered and neurotic delinquents in Jamaica. Socio-cultural aspects of delinquency are discussed.
ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in L... more ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in London. Mortality in the general population is used as a basis of comparing an increased mortality in the psychiatric population. Two age groups are identified by the finding at 15 to 54 and a much lower one after this. In the second part of the study factors associated with suicide rather than other causes of death are investigated in two equal samples of the younger age group. The results point to the importance of personal and social factors which lead to admission but not to psychiatric indices.
International Journal of Social Psychiatry, Mar 1, 1984
The background to the present study was the emotional environmentcreated by a series of events wh... more The background to the present study was the emotional environmentcreated by a series of events which may have been temporally related to the New Cross fire in January 1981. The media had. become involved in an analysis of the factors which may have contributed to this fire in which 13 youngsters, all of West Indian origin, had died. The debate became somewhat intensified after a march which created a small disturbance in its route from Deptford, the scene of the fire, to Hyde Park Corner. This received full publicity and was to be followed by the first series of riots in April only a few days before the inquest into the fire. By the summer, rioting had spread to include wide areas of South London of which Deptford is a part, other parts of London and other urban areas in the country. The intensity of feeling in the work environment of the hospital and medical school may have been similar to that in the general society. However, there were factors which suggested that feeling may have been greater among certain sectors of the staff Thus the main hospital of this group provides services for multi-ethnic populations in inner city areas. Rooming houses are numerous and during this period of social change it was believed that social unrest had increased throughout the area. An inevitable feature of a situation which may have had racial overtones might be that staff may have become rather withdrawn and ineffective in their management of patients from other ethnic groups. A further factor may be an increase in inter-staff tension based on ethnic differ-
ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in L... more ABSTRACT The study describes a 100-month follow-up of psychiatric admissions to a small unit in London. Mortality in the general population is used as a basis of comparing an increased mortality in the psychiatric population. Two age groups are identified by the finding at 15 to 54 and a much lower one after this. In the second part of the study factors associated with suicide rather than other causes of death are investigated in two equal samples of the younger age group. The results point to the importance of personal and social factors which lead to admission but not to psychiatric indices.
Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychi... more Publisher Summary This chapter focuses on the the ethnic dimension and the significance of psychiatric practice among black populations in Britain. Data from Third World countries suggest that prevailing social conditions may contribute to a high prevalence of physical and mental disorders. In one psychiatric sample, epilepsy was common, syphilis and its consequences significant, infections including tuberculosis notable, and hypertension was frequently associated with depression. Poverty-stricken conditions are prevalent in such settings and in ghetto conditions in the West. As a result, effective treatment may not be available. In Britain, there is a considerable literature on the association of health with inequalities of socioeconomic status, poverty, and unemployment. Townsend and colleagues have confirmed previous findings from the Black Report in a sophisticated analysis of conditions in the North of England. Three key dimensions—namely, premature mortality, chronic sickness and disablement, and delayed development, were incorporated in an Overall Health Index that correlated highly with an Overall Deprivation Index. In the latter, factors highly associated with being black and of minority ethnic status included percentages of unemployed households with more persons than rooms, no car, not owner occupied, and heads of household a manual worker.
An official invitation was sent to the chairman of the Transcultural Psychiatry Society of the Un... more An official invitation was sent to the chairman of the Transcultural Psychiatry Society of the United Kingdom by Professor Kalle Achte as local chairman of the organising committee of the World Psychiatric Association Regional Symposium and by Dr. Antti Hemmi, Secretary General of this organisation asking me to organise a symposium on transcultural psychiatry.
A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britai... more A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britain and were successfully traced in Jamaica show that most had suffered from recurrent episodes of schizophrenia but that few were predisposed develop this illness. After an average period of 42 months follow-up it was found that there had been an excessive mortality and that others were living in the Bush. The most important finding of the study is that the chronic symptoms of illness which have been previously described as characteristic of the repatriate syndrome, had taken place in a half of the sample. Nevertheless there was evidence of a good outcome in a third of those who were living and interviewed during the field survey. These findings have been discussed. It has been concluded that repatriation may be of therapeutic benefit but only following more careful selection of cases.
Social and psychiatric findings among boys at an approved school in Jamaica are described. Parent... more Social and psychiatric findings among boys at an approved school in Jamaica are described. Parental deviance and other evidence of family disorganization are less prevalent than elsewhere. A third of the boys are admitted for personal aggression and give a history of a previous offence. These factors are associated with a benign non-psychiatric (50 per cent) or malignant psychopathic (20 per cent) personality disorder and characterised by pre-morbid data of head injury, conduct disorder and intellectual deficit. Psychoneurosis (30 per cent) is associated with late separation experiences. It is of interest that paternal deprivation and other factors are similarly distributed among personality disordered and neurotic delinquents in Jamaica. Socio-cultural aspects of delinquency are discussed.
RACE, CULTURE AND MENTAL DISORDER", by Philip Rack. Dr. Rack is an experienced psychiatrist who h... more RACE, CULTURE AND MENTAL DISORDER", by Philip Rack. Dr. Rack is an experienced psychiatrist who has been Head of the Transcultural Psychiatry Unit, Bradford, during the past decade. His book is a highly personalized but interesting account of his attitudes and how he has applied these to his work and some of the conclusions which he has reached as a result. The text makes every attempt to cover the wide area of psychiatry among persons who are now living in Britain but who are not indigenous. The book makes easy reading. However, there is
A sample of young West Indian females were interviewed whilst being on remand for petty offences.... more A sample of young West Indian females were interviewed whilst being on remand for petty offences. Most were suffering from adjustment reactions of adolescence, a half had previously been convicted and a third gave a history of parasuicide. On investigation, it was found that there had been a characteristic pattern of multiple separation experiences, which had been closely related to the onset of early symptoms of maladjustment, with subsequent delinquency. As this pattern of separation experiences is not found among delinquents in the West Indies, this should indicate that such pathogenic experiences may be related to residence in the new environment in Britain. Early pregnancy may constitute a further separation experience, which may also be stressful in vulnerable individuals.
An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cau... more An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cause of mental illness (Ireland, 1892). More recently a decreasing incidence of neurosyphilis was noted among racially similar persons in Uganda by Billington (1966), who attributed to penicillin the remarkable fall over the 20-year period reviewed. The low incidence in developed countries probably has a similar cause (Dewhurst, 1969; Dawson-Butterworth and Heathcote, 1970). That the diagnosis of neurosyphilis has become difficult was stressed by Heathfield (1968). Joffe, Black, and Floyd, (1968), in reviewing seven cases, pointed out that the modified picture noted might have been due to courses of penicillin given previously to all their patients for other reasons. Hume (1964) suggested that subcurative therapy masks syphilitic disease, but he believed this to be eventually helpful to the community. In Jamaica the predominantly Negro and rural population of almost two million has been exposed to two treponemal diseases. Thus, up to 1956, areas of high and low incidence of yaws were identified by Grant (1956), but by 1963 the yaws prevalence rate for the island was estimated to have been reduced to 16 per 10,000 population (Gentle, 1965) although certain rural areas still showed higher rates. A later study pointed out the difficulties presented to venereologists by the occurrence of the two diseases (Ashcroft, Miall, Standard, and Urquhart, 1967). In addition, the possibility of marked cross-immunity among the treponemal organisms was raised by Cannefax, Norins, and Gillespie (1967). With the widespread use of penicillin since its introduction in this area, it seems likely that modified neurological syndromes might be present. However, unusual pictures have been identified since the 19th century, as pointed out by Cruickshank (1956) and Montgomery, Cruickshank, Robertson, and Mc-Menemey(1964). These workers described the features
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