serpiginous affections, are rare in congenital syphilis. Not only do we but seldom encounter disorders of the nervous system, but palmar psoriasis, chronic affections of the tongue, sarcocele, and gummata of the viscera, are alike rare. Excepting in the infantile period, congenital syphilis but rarely shortens life. It does not in any special manner predispose to anything.

Late one evening, not long ago, my servant announced that a shabbily dressed man wished to speak to me. My man would evidently have been pleased, had I obeyed my first inclination of declining to see him. I did not do so, and was rewarded for my selfdenial,as on many other occasions, by obtaining a valuable clinical fact. The man brought with him his photograph of more than twenty years ago, which I had had taken in the early days of our recognition of the syphilitic physiognomy and teeth. He was then a boy aged 9, and now a married man aged 32. His features were very much deformed, and his teeth typical. I had formerly treated him for a severe attack of double keratitis, and his mother, at the same time, for a tertiary ulcer on the leg. I had not seen either of them for more than twenty years. He told me that he had enjoyed excellent health ever since, and that he worked constantly in a paper staining business. A fear that his sight was failing him had now made him wish to see me. At first I thought it would prob ably be an example of progressive choroidoretinitis, but, on examination, it proved to be only aggravated myopia. Thus it appeared that all kind of activity in his taint had ceased with the attack of keratitis. I may add, in passing, that he told me that his mother also had remained perfectly well ever since her treatment. He was himself married, but had no children. It may be replied that isolated cases prove nothing, and that, after all, the lad's mother should be allowed to pair off against himself, showing that neither after acquired nor after inherited disease do remote sequelae always follow. I have, how ever, had many opportunities for similar ob servations of the immunity in those who suffered up to the age of puberty from all other forms of disease. In nearly all cases, the attack of keratitis is the last of the phe

nomena.

IDIOCY IN CONNECTION WITH INHERITED SYPHILIS.-Indiocy in connection with congenital syphilis, is certainly not common. I have seen a very great number of the subjects of inherited taint who had attained adult life, and whose intelligence was excellent. I have at the same time seen a few in whom, at

different periods of life, cerebral disorders were slow to develop, which were attended with mental derangement now and then mounting to imbecility. In one case, a lad whom I had long known as having suffered from interstitial keratitis, etc., became an inmate of Colney Hatch Asylum, and there died; but I do not know what precise form his insanity took. A girl aged about 10, who was brought over from New Zealand quite blind with white atrophy, and in whom the evidences of inherited taint were perfectly clear, was passionate and uncontrollable in an extreme degree, and, I believe, became ulti mately insane. In another case, a poor woman aged about 35, married, and the mother of a healthy child, but herself quite deaf and almost blind as the result of inher ited taint, became gradually sleepless, peevish, and restless, until her condition really amounted to that of lunacy. I once had an opportunity for making a necropsy in the case of a young man the subject of inherited syphilis, who had died after very slowly ag gressive symptoms of brain failure. We found the skull considerable thickened, but did not discover any other noticeable changes.

I have seen several times, in consultation with Dr. Langdon Down, a young lady who has been for long under his care as an imbecile. Under his treatment, some of her faculties have been much developed, but she is still in many respects quite childish. She has a well-marked syphilitic physiognomy, a pair of characteristic teeth, and she has passed through a very severe attack of interstitial keratitis. The state of her eyes when I last saw her was very peculiar. She is so nearly blind that she can only just see large objects, and cannot read the largest type. In both eyes there is a little haze of cornea re maining, and the ciliary regions are dusky. In both, the pupil dilates well with atropine, and the fundus can be inspected. The condi tions are, however, not alike in the two eyes. In the right, the optic disc is white and the central vessels very small, but I could find no disease in the choroid; in the left, the fundus is obscured by considerable opacity in the lens and by films in the vitreous humor. It can be made out beyond doubt, however, that, in addition to a white optic disc, there are signs of very extensive choroidal disease. These consist, not, as usual, in patches of absorption, or in changes resembling retinitis pigmentosa, but chiefly in dense round black dots and patches, which occur plentifully on all parts of the fundus without special arrangement and resemble spots of ink on a

sheet of blotting paper. I have noted just such appearances before, in cases of braindefect allied to idiocy. It is interesting to note that, in this case, there has never been any failure in hearing. There can be little doubt that she has been the subject of optic neuritis, but it is impossible to assign dates with exactness. She asserts that, a few years ago, she could see well enough to read, so that it is certain that there have been some aggressive changes of late years.

The precise date at which the brain began to suffer in Dr. Down's patient was not known, but it was certain that the idiocy was not congenital. It is at about the age of eight or nine that the brain begins to fail. Even in the early period the attack rarely proceeds to any high degree of intensity; acute outbreaks are very rare. This is in keep ing with what we observe in connection with choroiditis, which rarely destroys the sight, but produces, as a rule, changes only in the periphery of the fundus. Dr. Hughlings Jackson has drawn our attention to the probability that a pia-matritis may be in some sort. the analogue of choroiditis, and_may_occur under similar conditions; and Dr. Judson Bury has proved, from necropsies, that a state of secondary atrophy of the grey substance of the convolutions may be the result.

As a matter of clinical observation, I would suggest that it is not at all uncommon to note slight deficiency in vigor of intellect in the subjects of infantile syphilis, but that any thing amounting to dementia is certainly rare. These defects, whether very slight or more severe, are, I think, rarely aggressive, though I have known a few in which the symptoms implied slowly advancing changes. In one such many years ago, I obtained a post mortem examination, and found the skull. cap thickened and sclerosed, and the brain. atrophic.

It has been a matter of general remark amongst authorities on that subject, that wellmarked examples of inherited syphilis are not frequently seen in our idiot asylums. Many years ago, my friend, Dr. Daniel Hack Tuke, persuaded me to visit with him the Earlswood Asylum, with special reference to this point, with the result that, as I have already said, we found only a very few who could be reasonably suspected of being syph ilitic. Dr. Langdon Down subsequently, from more extended investigations, recorded a similar opinion; and only the other day, in conversation, this high authority told me that he had seen no reason to alter his opinion. In the British Medical Journal, of January 30,Dr. Shuttleworth,of the Lancaster Asylum,

in a lecture upon the causes of idiocy, upholds the same view, stating that he had not one patient under care in whom syphilis could be suspected, and adds that characteristic teeth are rare in idiot asylums. Dr. Judson Bury, in an excellent paper in Brain, of April, 1883, maintains a somewhat different opinion, and thinks it not improbable that there are more cases due to this cause than have been suspected. He urges the importance of taking a wider basis for diagnostic recognition, more especially the examination of the choroid. It is quite true, as I have indeed often urged, that we must not content ourselves with the inspection of the teeth. Probably only in a minority of the examples of inherited taint do the teeth show any peculiarities, and in many in whcih they are damaged they are yet far from being characteristic. If we would wish to be successful in our diagnosis, we must take into simultaneous consideration the whole group of phenomena which we now know are often connected with the taint. If this were done, Dr. Judson Bury thinks that we may probably find syphilis as a cause in not a few cases of juvenile dementia.

As might have been expected from the fact that syphilitic infants are generally born with all the appearances of perfect health, we do not find congenital idiocy, whether microcephalic or otherwise, in other than the very rarest connection with this taint. It is at the same period of life that we encounter disorders of the sense-capsules, choroiditis, keratitis, deafness, and the like, that we find the chief risk to the brain, and thus the failures of intellect are to be classed rather as the dementia of children than congenital idiocy.

CASE OF DEFECTIVE BRAIN, WITH ATROPHY OF OPTIC DISCS, IN ASSOCIATION WITH INHERITED SYPHILIS.-A young man, who was sent to me by Dr. Barnes, of Ewell, afforded an excellent example of the slighter form of the mental defect sometimes met with in connection with inherited syphilis. There could be little doubt that there had been in infancy a temporary condition of meningitis, attended by optic neuritis. The lad was brought to me on account of defective sight, and in the hope that he might be helped by spectacles. I found that his pupils were of unequal size, and not very active, and that he could see only 20. He was 17 years old,and engaged in a builder's office. He had a pair of typical teeth, and a physiognomy which was fairly characteristic. There was no history of any illness that he could remember, but he had been told that he was ill in infancy. He was the eldest of his family, one older than himself

having died young. His father had died after a four years' illness, of "softening of the brain." Long before his illness, he had suffered from "headaches, which made him eccentric and of unbearable temper." It may be conjectured that the so called softening was really due to slowly aggressive syphilitic changes. On using the ophthalmoscope, I found the optic disc in each eye very pale, and its margins indistinct. The central vessels were not in the least concealed, nor were they much diminished. Near to the disc were some groups of faintly marked minute pale dots in the choroid. None of these had any pigment at their edges. In the extreme periphery of both were ill-defined patches of similar dots, and after considerable search I found a few lines of black pigment in the retina. There were no large patches of absorption in the choroid, and the changes were altogether very inconspicuous. Still, there could be no doubt that he had experienced an attack of neuro-retinitis, and that slight changes were now in progress in the direction of retinitis pigmentosa. It should be stated that it had been observed that he could not see well by artificial light, and that his pupils dilated but little under the use of atropine. As yet, no attack of keratitis had been experienced, but probably it is tocome. Nor was there any deafness. As regards his brain condition, the lad was so nervous that I could scarcely get him to speak to me or to read the testtypes. A friend who came with him told me that he was decidedly defective in intellect, and much behind other boys of his age. It was believed that his sight was slowly becoming worse.

It is, I think, not uncommon for congenital syphilis to damage, in some slight degree the whole bodily development; its subjects are not unfrequently short in stature, and a shade below the average in general capacity. Sometimes there appears to be special defect in sexual development. In a few rare cases this general defect is very marked. I have seen two or three young women (adults), the subjects of inherited taint, who were dwarfed, and had no sexual characteristics. Their mammæ were not larger than those of boys, and little or no sexual hair was present. In one such, we had the opportunity of a post mortem examination, and found the uterus and its appendages of extremely small size. Thus, the extreme length of the uterus was less than an inch and a half. Lancereaux has related a somewhat similar case. I have seen young men also, under similar conditions, in whom the sexual development was exceedingly

slight. To what local lesion in infancy, or during intra-uterine life, we should assign such general arrests, I do not know; unless, indeed, we conjecture that they have to do with changes which have taken place on the surface of the hemispheres. In a few, very exceptional instances, indications of cerebral failure continue to advance with extreme slowness during life. These are probably analogous to the pseudo-retinitis pigmentosa which occurs in inherited syphilis.

CONCLUSION. Had time permitted, Mr. President, there are yet many questions which I should have muchliked to bring before you. For example, I should have liked to state the extremely difficult problem as to the true nature of pemphigus of infants. This affection, which attacks for the most part the hands and feet only, is a disease of the first week of life, and usually ends fatally before the infant is a fortnight old. It often carries off several infants in succession. Why should the inherited taint so deviate from rule? Why should it show its effects so soon after birth? and why should a local and not very severe skin-disease be so prone to end in death?

Another question of great interest is as to how it comes about that, whilst syphilitic in fants are generally quite healthy at birth, and remain so for three or four weeks at least, yet syphilis is so common a cause of abortion. Why, if it can kill the fetus so commonly, does it at the same time leave so many in perfect health, until the influence of open-air life has been brought to bear through a definite period? Why, if it can kill so many in utero, is it so infinitely rare for a child to be born showing either past or present evidences of taint? Is it the fact that, if the virus take on activity at all in the fetus in utero, it almost invariably kills it? Have we for certain a state of the virus in which it is absolutely inactive, and neither retards development nor evokes local inflammations? Without doubt, in the facts to which I have adverted, we have to face a very obscure problem.

Nor is it easier to explain why one sex should suffer more frequently from the results of inherited taint than the other. According to my statistics of heredito-syphilitic iritis, the proportion between the sexes is sixteen females to five males; whilst, although not so great, the disproportion is still very definite in the same direction in the case of interstitial keratitis. A re-examination of these facts, and the collection of evidence on a larger scale, might possible disclose some higher law, of which as yet we have no suspicion.

In referring to the re-examination of facts, I may perhaps be permitted to mention cer tain classes of facts which it is very desirable to collect. They are chiefly of a character which can be obtained only by those engaged in family practice. Our knowledge respecting some of the most important moot questions as to the natural history of inherited syphilis would be much helped, if all who came across cases belonging to any of the following categories would carefully record them.

Cases in which twins, one or other, or both, suffer from inherited syphilis. They should be followed up through as long a period as possible.

1873, Mr. Lee, and in 1874, Dr. Broadbent, dealt with subjects more or less identical with those which I have ventured to discuss. In apology for what I have felt to be almost presumption in attempting to supplement the work of such men, I must allege the boundless and perennial interest of the subject. Nor will this be the last time, I trust, by many that the study of syphilis will engage the mind of your lecturer. We are as yet but on the threshold of its investigation, and discoveries of great importance await, I doubt not, the industry of observers yet to come. If in any sinall degree their labors should be helped by hints thrown out in the short course of lectures which I now close, my task, which has already had its pleasure in your approval, will then have received also its abundant reward.

All exceptions, or apparent exceptions, to Colles's law (that a suckling child cannot infect the nipple of its own mother).

All instances of children born alive with indications of syphilis upon them. All cases of pemphigus infantum, or of other syphilitic eruptions, making their pearance during the first week of life.

ap

And now, Mr. President and gentlemen, in conclusion, I have to thank you all heartily for the kind attention with which you have listened to my lectures. I have also to express my sense of indebtedness to those, not a few in number, nor deficient in repute, who have added to the value of what I have said by the comments and new facts which they published in the journals during the last few weeks. For the most part, the letters to which I refer have given support, not unneeded and often valuable, to the opinions which I have expressed. In other cases, where the comment has been more or less critical, I desire to take this opportunity of saying that I am equally grateful and desirous of profiting, but that at the same time I shall ask to be excused from controversy. On the difficult subject of the relationship between the infecting and non-infecting sore, I observe with regret that I have failed to make my meaning clear to all. I am willing in this failure to take a share of the blame, but only a share, for really I did my best.

This is, I believe, the third or perhaps the fourth time, that your Lettsomian lecturer has taken for his topic some subject in connection with syphilis. In 1859, Mr. Victor de Méric, in

-We observe in the last issue of the "Medical

of Jefferson Medical College, recently cut down upon and removed a calculus from the kidney of a male patient. The journal expresses the intention of publishing the details of the case in full at an early date.

reading matter, as the operation is radical, and

This will unquestionably furnish interesting

the result will be looked forward to with consid

erable interest, but the publication will be stale, as it is only a day or two since the daily papers of St. Louis contained a minute and technical description of the whole affair, clipped from the daily press of Philadelphia of a few days before. The bones of the elder Gross must have been disturbed to see his successor thus flagrantly violating the "code," which was his own life-long guide.

The conduct of the present Professor of Surgery of Jefferson, coupled with the record made by the Dean before leaving his home among the hill-tops of Cincinnati, on the banks of the Ohio, may partly explain the fact that Jefferson's Faculty is "too busy" to travel long distances away from the "centers" in order to be present at the meetings of the A. M. A.

-It is a generally accepted belief, that, of all workers, either of brain or brawn, doctors are the least independent, being complete slaves to the whims and caprices of invalid men, women and children. However, history records the fact that at least five doctors were practical exponents of independent ideas, there being that number whose signatures were attached to the original draft of the Declaration of Independence, along with fifty others, strong, brave and true, from the various walks of life.

WEEKLY MEDICAL REVIEW,

EDITED BY

THE MEDICAL PRESS AND LIBRARY ASSOCIATION

Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves.

All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to

J. H. CHAMBERS,

914 LOCUST STREET, ST. LOUIS, MO.

SATURDAY, OCTOBER 30, 1886.

THE BALD HEADED MEN OF THE EAST.

Again the Western physician suffers. A little while ago a great man told us that we had malaria and might not attain to that high average of scientific lore that was reached by our more favored brethren of the East. Now comes Mr. Eaton, Medical Record, Oct. 2, and observes "that the per cent of baldness is in direct proportion to the amount of "education and cultivation." Furthermore, Mr. Eaton and Dr. W. A. Hammond tell us that "bald headed men are most plentiful in New York and Boston. After these come Philadelphia, Washington and the Western towns." A few weeks since, it was bad enough, but having tried to get rid of our malaria in our desire to grasp science, we now find we have too much hair. Is there no relief? We believe we were born bald-headed, but that does not count; it must be the result of education and cultivation." Some of us drank at the fountain of knowledge where the baldheaded philosophers of the East sold the waters and worked the pump handle. Others lived for long years in the East where the skies were blue, the wind blew, and a few of the savants blew and still are blowing, but it was in vain, our hair grew and here we are. We know that in Mexico there are dogs that are hairless. Does this show a simisimilarity between Mexico and New York? Are the Mexican dogs being "educated and cultivated" for New York society-or is New York going to the dogs?

We now know why the bald-headed man selects the front row at the theater-he is a scientist, a comparative anatomist perhaps, looking for fat calves. We now know why Wm. A. Hammond is bald. He is scientific, and Mr. Eaton, he too is bald, we suppose-at least he is bare-faced enough to be bald all

over.

Dermatologists tell us that many cases of alopecia in the East are due to syphilis. If, according to the immortal Billings, malaria is antagonistic to science in the West, we are led to believe that syphilis favors it in the East. Do we not know that syphilis some. times produces baldness in New York, and that baldness shines most where there is education, i. e., in New York and Boston accord ing to Dr. Hammond and Mr. Eaton.

We had thought that possibly Dr. Hammond left his hair, when for certain reasons he suddenly left the army some years ago; but we live and learn.

There is another cause of baldness, other than cultivation, education and syphilis, which we fear the learned investigators have not considered. Sometimes there is a contraction of brain matter and an evolution of gas in the cranium. Part of this gas escapes through different channels, and part being retained, not only produces an enlargement of the head-called by various names-but may permeate the calvarium and destroy the hair follicles.

This condition has, we believe, never been noticed west of the Alleghany mountains, the few cases of baldness in the Mississippi Valley being due, as Mr. Eaton has said, "to educa tion and cultivation."

RELIGIOUS NEWSPAPER ADVERTISING.

Several times during the past few months, we have called attention to the quack adver tisements and worse than quack advertise ments, found ments, found in religious newspapers. We mentioned one paper of our city because it is an exceedingly prominent paper, and one ad vertisement because it was exceedingly bad We find upon further examination, that this