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millennium B.C. It has already enveloped in myth an invasion of the 
Elamites, which occurred about 2300 B.C. But even that is a 
respectable antiquity, and if syphilis was known to the poet of this 
the oldest epic in existence, there has been ample time and 
opportunity for it to spread to Europe before the middle of the second 
millennium A.D. 
It is now known that endemic non-venereal syphilis may flourish 
even in Europe. Metchnikoff 1 points out that in rural districts 
in Russia the children are the chief sufferers and agents of 
the spread of syphilis, just as they are of yaws in the tropics. There 
is no reason for postponing the introduction of the disease into 
Europe to the 16th century, when it is far more probable that it 
has been present and spreading in a non-venereal manner as 
long as the human race has been in existence. 
I append a few cases of yaws, that is, cases that displayed the 
frambesial eruption alone or, as is more usual, accompanied by other 
syphilides. 
Case 26.—C. W.; 8 years; Black. 
January 23rd, 1906. Seen with an ulcer at the web of toes. 
February 10th, 1906. Complained of pains, fever, and malaise, given liq. 
hydrag. perch. 
March 24th, 1906. Onychia of nearly all the toes, whole body spotted with 
small round patches of scaly psoriasis. A large frambesia at the arms, which is 
said to have appeared a week before. Large glands in both groins. Ulcer on the 
plantar surface of web of toes is still in the same state as when first seen. Took 
six weekly injections of salalembroth. The frambesia disappeared rapidly, the 
skin cleared and the foot healed. 
Discharged from treatment with directions to return in a month. Has not 
been seen since. 
Case 27. — C. B.; 3 years; Black. 
March 1st, 1906. Has had yaws lately. One small frambesia still apparent 
at the angle of mouth. Had glands on elbows, in back of neck, axillae, below both 
angles of jaw, and in groins. I’rofuse eruption of small raw eroded surfaces, 
not raised but covered with moist yellow pellicles, in the left axilla. Few similar, 
drier and more crusted in the right axilla. Two such on the abdomen. Papules 
of similar character, some moist and some crusted, on and behind both auricles. 
Case 28. — M. P.; 8 years; Black. 
March -th, 1903. Had a sore on right ankle some months before. Large 
gland in right groin. Small hard glands on both elbows and many in the neck, 
omplains of pain in knees and ankles. Several marks of previous yaws on the 
egs. Several frambesiae with crusts 6n the right knee and the back. Papular 
eruption (lichen) between shoulder blades and round the axillae. 
1. Harben Lectures, 1906. 
