the name, the second the occupation and age, the third the condition of the eyes when known, the fourth the distance in feet and feet and inches at which the black square first became visible, the fifth the distance at which the black square could be defined, the sixth and seventh give the same particlars as to the white square, and the eighth gives the distance at which the line first became visible.

A large number of other tests were made with another set of cards, but unfortunately one of the students lost them before they had

been measured, so that the results are not included in the table. There are, however, in the accompanying table, a sufficient number of observations to show pretty nearly the av erage limit of normal vision and to demonstrate the gross inaccuracy of the above quotation from Dr. Tidy's work. Some interesting and obvious deductions are readily made from the accompanying table, but lack of space and time will prevent their being presented in this article.

CASE IN WHICH THE FIRST-BORN CHILD OF A MOTHER WHO HAD SUFFERED FROM SYPHI LIS ESCAPED ANY EVIDENCE OF TAINT IN INFANCY, WHILST THE SECOND SUFFERED SE VERELY.-Some years ago I saw, with Mr. Cooper, of Bow, a very interesting case of heredito-syphilis. Our patient was a male infant, aged three months, born quite healthy. looking, but now covered with a syphilitic rash, and much emaciated. Both parents ap peared healthy. They had been married nearly three years. Before marriage the mother had contracted a sore on her lip from kissing a brother who had syphilis. This sore was recognized by her medical attendants as a chancre; it was followed by a rash, and she was treated for syphilis by mercury. The gentleman, now her husband, was

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gaged to her. He was made acquainted with the facts, and declined to allow the occurrence to affect their relations. About a year after the syphilis they were married, the young lady having then for six months been apparently in perfect health. A year after marriage the first child, a girl, was born. She re mained quite free from symptoms, and seemingly in excellent health, until at six months she was carried off by a short attack of whooping cough. Mr. Cooper confirmed to me the parents statement that this child never showed any indication of syphilitic taint. During the whole of her married life the

mother had remained free from symptoms, and she appeared to be quite well at the time that I was consulted about her second child. The father had never had syphilis, either before marriage or afterwards.

We seem to have here a case in proof that a mother, in whom the taint has been wholly latent for three years, may bear a child destined to suffer severely in the usual manner, and at the usual age. It is also proved that a first born child may escape (so far as infancy is concerned) the effects of a maternal taint, from which a younger one may yet suffer severely.

It is a matter for interesting speculation whether the sex of the infant has any influence on its liability to suffer. The one which apparently escaped was a girl, the one who suffered was a boy; the taint was a maternal one only. I call attention to this fact, but without suggesting that it has any importance. I have in vain attempted to find any law or rule in reference to difference of se verity of incidence of inherited syphilis in the two sexes. That a majority of those who suffer from iritis in infancy, and from keratitis when adolescent, are girls, seems, so far as present statistics go, to be established.

INHERITED SYPHILIS IN Two SISTERS, THE YOUNGER SUFFERING THE MOST SEVERELY.In 1861, a man brought to Moorfields two girls, his daughters, both of whom suffered from interstitial keratitis. In both the inflammation of the cornea was just beginning, yet the elder was three years (12) older than her sister (9). The younger, in whom it was beginning earlier, appeared to suffer more se verely throughout. Her physiognomy and teeth were characteristic, whilst her elder sister showed very slight peculiarities of physiognomy, and had perfect teeth.

I cite this as a very important item of evidence in proof of the unequal severity of inherited syphilis, quite independently of the period which has elapsed since the disease in the parents. It was unquestionable that both had suffered, yet the elder one had apparently almost escaped the symptoms common in the infantile period. The case is also of interest as showing how almost wholly latent the taint may be up to the time of the outbreak of keratitis. Had the sisters been in reversed positions, that is, had the younger one suffered as slightly as did the elder, the case would have seemed very strong in support of the creed that the taint is minimised by time.

THE SUPPOSED CONNECTION BETWEEN RICKETS AND SYPHILIS.-The dependence or otherwise of the bone affections usually known as rickets upon an inherited taint of

syphilis, is one which has been much discussed during the last ten years. The late M. Parrot ventured on the bold heresy that all rickets is due to syphilis, and in the course of his investigations he made known to us some very important matters of pathological fact. He had been to a large extent preceded by Wegner, of Berlin, and by Taylor, of New York, and he has since been admirably sup plemented amongst ourselves by the investigations of Dr. Barlow and Dr. David Lees. I can not now venture on more than a very brief summary of the facts which have been elicited. It is now quite certain that, during the secondary stage of syphilis in infants, that is, from the first to the sixth month, or longer, bone affections are very apt to occur, and that they are attended by extensive deposits of new porous bone, constituting what have been called bosses, on the skull. The long bones also suffer, but more rarely, and they are affected chiefly near their epiphyses. Suppuration may, in rare cases occur. These nodes are at this stage always multiple, and usually symmetrical. They disappear under specific treatment, and do not usually recur until some years later. As childhood advances, for example, from the age of five to ten years or more, bone-affections of another class are common. The shafts of the long bones now chiefly suffer, and the skull but seldom. Suppuration is very uncommon, and sclerosis, or the production of large osseous nodes, is common. Sometimes the nodes are laage enough to simulate new growths. Now, at both stages, syphilitic bone affections may be and often are mistaken for rickets. Many years ago I called attention to the fact that children with chronic periostitis, producing alterations in the form of the tibia and overgrowth, found their way to the orthopedic hospitals, and were liberally treated by splints. These cases are, however, far less common than those in which, in early infancy, it is dif ficult to tell whether the child has syphilis, or rickets, or both. The simultaneous occurrence of the two is very common, and hence the difficulties which investigators have found in coming to clear opinions as to the relationship between them. We may, however, I think, believe with confidence that there is a pure rickets dependent upon dietetic causes, which has nothing whatever to do with syphilis. It may easily be the fact that the existence of the rachitic state in an infant who has also an inherited taint of syphilis may give a decided tendency to bone-disease, and more especially to affections near the epiphyses. The local pathological product may also be a mixed one, and partake of the com

bined influence of the two causes. There is no reason why the two causes should not mix. ULCERS OF THE PALATE AND PHARYNX.— The question as to whether deep ulcerations of the palate and pharynx, when met with in young persons, are usually due to syphilis or to scrofula is one of great interest. I long ago ventured to record, as the result of some observation, my conclusion that it was rare in these cases to meet with syphilitic teeth; and I felt obliged, in not a few cases of this kind, to leave the diagnosis uncertain. As the result of further observations, I may now say that, year by year, the balance of evidence has more and more inclined towards the creed that such lesions are almost always syphilitic.

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We admitted into the London Hospital a lad who had a perforating ulcer of the soft palate, almost phagedænic. He was cured by cauterization of the ulcer. The most careful examination of the lad himself and of his family history failed to elicit a single fact supporting the suspicion of inherited taint His teeth were of good form; his physiognomy was good; he had not suffered from either choroiditis or keratitis. So the case stood. A year later, this same patient came to me at Moorfields for his eyes, and passed through a characteristic keratitis. Of late years, I have seen no case of deep ulceration of the throat in a young person without being able to make the diagnosis of inherited syphilis probable. Some years ago Dr. Wilks was enough to lend me, from his private library, a most interesting religious tract, which bears upon this subject. It was an autobiography, printed before I was born, which contained an excellent portrait of the heredito-syphilitic physiognomy, It is entitled, "The Conver sion and subsequent History of Benjamin Lawson, an Afflicted Youth, deprived of his Speech by Scrofula; on account of which he was for nine weeks an indoor patient in King's Ward, St. Thomas's Hospital, in the year 1815." The portrait prefixed showed the bridge of the nose sunk level with the cheeks, and the forehead large, with prominent frontal eminences. The subject of the autobiography records that he was born in 1798, in Coppergate, York. "of poor but honest parents." At the age of 12, he began to suffer from a bad sore-throat, and subsequently had a discharge from his nose; at the age of sixteen a loose piece of bone came out of his nose, at this time, he was very feeble, but still worked as a fly-boy in a printing office.

After this, bone continued occasionally to come away, and he was Mr. Cline's patient at St. Thomas's Hospital in 1815.

He recovered from a condition which ap. pears to have been thought almost hopeless, and lived ten years longer. The precise cause of his death is not recorded; he mentions, however, a fact which corroborates the diagnosis of syphilis. Whilst he was in the hospital, his father had a bad throat; it had been bad three months, and still kept getting worse, so that he could scarcely eat.

"A kind female friend, Mrs. G., who called to see me, got my father visited by the Methodist Society for relieving and communicating religious knowledge to the poor. The kind friend who came last to visit my father was a medical gentleman, who, on looking at my father's throat, told him, if he did not get into some hospital, he might soon be a dead man; he might be cured then, but he was dying for the use of means." He "got a letter for Middlesex Hospital;" and, when "he had been there but a week, he appeared much better. I was afraid to take anything solid, for fear it should stick in the hole in my palate and choke me: which, by the long progress of the disease, was as large as a shilling, directly over the throat; and by the frequent loss of pieces of bone, occasioned such a vacancy that, if anything lodged, there it nearly caused suffocation, and almost choked me till I got it away. I got so hungry, I was afraid I should be starved to death, for, though the thick milk was very nourishing, yet I always felt hungry after it."

This narrative is, I think, valuable as evidence in favor of the syphilitic nature of disease of the bones of the palate and nose, such as are frequently called strumous..

Permit me to mention one or two other cases illustrating the same point. A young man from S., aged 19, presented a good in stance of destruction of the palate and nasal bones by congenital syphilis. His nasal chambers were one cavity, every trace of the vomer and turbinated bones having disappeared. The uvula and adjacent parts of the soft palate had been destroyed. His nose had fallen down considerably, and the right ala had been in part destroyed. In 1885, six years after the beginning, all the parts were soundly healed, and there appeared no fear of a relapse. His teeth were good, and his physiognomy showed but little peculiarity. No projections on the frontal eminences were recognizable by the eye, but to the finger they were distinctly so. There was a considerable osseous node on one tibia.

It will be seen that in this case, although the destruction within the nose was so extensive, there was but little else by which to recognize the diathesis. It might easily have been a case

in which all hereditary taint might have been deemed to be absent. The node of the tibia alone revealed the taint, and it by no means decided the question as to whether we had to deal with inherited or with acquired disease. When I add that the boy was the youngest son of his family, and that all his brothers and sisters were quite healthy, it will be seen yet more clearly how near we might have been to a mistaken conclusion. The final evidence was given by the family surgeon, who was cognizant of the fact that his parents had both had syphilis shortly before his birth, and that his mother still suffered. Such a case ought, I think, to be allowed very considerable weight whenever, in the absence of history or of corroborative lesions, we may be tempted to say that destruction of the nasal bones or ulceration of the palate is of strumous origin.

A year or two after I saw this patient, his mother consulted me. She was the subject of locomotor ataxy, and had suffered, twenty years ago, severely from syphilis. Since ataxy is of comparative rarity in women, it is of interest to note this fact as to antecedent history.

MALFORMATION OF JOINTS CONSEQUENT UPON SYPHILITIC PERIOSTITIS IN INFANCY.Singular and very deceptive malformations of joints are sometimes produced by the irregular overgrowth of long bones in congenital syphilis. They are sometimes helped by alterations in the epiphyseal extremities due to the same cause. Many years ago, I had under my care, in the London Hospital, a girl aged about 6, who had large nodes on both her femora, and was unquestionably the subject of inherited syphilis. The forms of her elbows were altered in such a way that the end of the radius was displaced upwards in the external condyle, and simulated a partial dislocation. We were doubtful whether or not it was a congenital condition, but I was more inclined to refer it to influences mentioned, and to think that the radius was overgrown. overgrown. Some facts subsequently supplied to me by Mr. W. E. Hacon; of Upper Holloway, gave support to this opinion. Mr. Hacon's patient was a girl aged 14, the subject of specific disease, who had formerly suffered from keratitis and multiple nodes. One elbow looked exactly as if the radius were dislocated forwards, "but, on more careful examination, it was certain there was no dislocation, and that the deformity was owing to flattening of the external condyle." There was such alteration in form of the lower epiphysis that, in measuring across the back of the joint, from one condyle to the other,