BY JOHN S. PARRY, M.D., Attending Accoucheur to the Philadelphia Hospital, etc. MARY JANE G-, æt. 10 years. Born in Philadelphia. Family History.-Her parents have been married twelve years, and have had three children, of whom Mary is the eldest. The second child died when seven weeks old, the mother states, of “water on the brain." The third is moderately healthy, is now three years old, and, though of good facial appearance, is disposed to cutaneous disorders; has soft, flabby muscles and a tumid abdomen. It presents no positive evidence of syphilis. The mother is perfectly healthy; has never had any disease of the skin, sore-throat, or alopecia. She positively asserts that she has never had primary syphilis or gonorrhea. Her hus- band is very dissipated, and they are not now living together. It cannot be positively asserted that he had primary syphilis; but his wife believes that he was so affected about one year after their marriage, and one before the patient's birth. The subject was at that time discussed between them, and was the cause of domestic difficulty. She never saw any evidences of secondary syphilis about him. From 1860 to 1865 he was in the army; and after his return home, and until the time of their separation, he complained of having “rheumatism.” This was not attended by any acute symptoms, and did not prevent his working, as the pain occurred only at night, though it was quite severe. Both parents 'have several brothers and sisters living, with large families, all of whom are very healthy. Previous History.—When born, our patient was a large, healthy child, and, except having the ordinary diseases of children, she continued well until early in 1863. In infancy she was not sub- ject to colds in the head, never had any disease of the skin, or other symptom of her present affection, so far as the mother is informed. The existing disease began in February, 1863, when she was two years and nine months old. She first complained of pain in the right leg, and, upon examination, a round, hard, tender swelling was discovered near the middle and upon the anterior surface of the right tibia. This was rapidly followed by similar swellings upon the same and the opposite bone. About two months later, nodes also occurred upon the bones of the forearms, where the cicatrices are shown in the photograph. She then suffered severely from nocturnal pains, her appetite was poor, and she grew rapidly weak. The nodes passed on to suppuration, leaving portions of the affected bones bare; parts of which exfoliated and were thrown off spontaneously, or were removed by the attending physician. During the next year she had nodes on the forehead, and there was destruction of the bones of the nose. In 1863 the soft palate became ulcerated, and in 1864 the disease involved the hard palate, producing the appearances to be presently described. In 1865 her hearing was destroyed. This was pre- ceded by soine, but not severe, otorrhea. She has never had any affection of the eyes. She was admitted to the Philadelphia Hospital in April, 1868. At that time the cicatrized surfaces were the seat of active dis- ease; dead bone projected at various points, and she was pro- foundly prostrated. She shortly afterward had nodes on the clavicles, and painful ulcerations upon various parts of the body, especially on the shoulders. In the latter part of April, 1870, she had a very severe attack of double pleuro-pneumonia. Present Condition, Nov. 1870. — Hair is thin, fine, and dry. - Forehead prominent, arched, and tender on pressure. There is a tender cicatrix over left frontal prominence. The bridge of nose is depressed, and on its surface is a white excavated cica- trix. The central incisors of the upper jaw have been destroyed. The remaining teeth are well developed, but irregular in posi- tion. In the roof of the mouth is an oval orifice an inch long and half as wide, extending backward nearly to the soft palate. The latter is perforated just anterior to the uvula. There are evidences of previous ulceration of the half arches and tonsils; but there is at present no active disease of any of these parts. The eyes are natural, except that there is a little opacity at the superior margin of each cornea. Skin is everywhere dry, harsh, and dingy. Upon the thorax the superficial veins are considerably enlarged. At the left sterno-clavicular articulation is a cicatrix. Upon each shoulder others are found, irregular in outline and about two inches in diameter. Both clavicles and the upper part of the sternum are very tender. The whole under surface of the right forearm presents a continuous scar, involving about one-third of the circumference of the limb. Portions of the muscles have been destroyed, and the skin is tightly adherent to the bone. The wrist is anchylosed with the arm,-semi-pronated. Her left forearm is almost precisely like the right, but the wrist is not anchylosed. The skin is tightly adherent to the ulna. Upon the anterior surface of the right leg is a series of scars, and the tibia is enlarged and irregular in its outline. Upon this side are two open ulcers,-one over the external malleolus, and the other two inches above. From both there is a thin, un- healthy, very offensive discharge, and both communicate with dead bone. Upon the left leg are two irregular and large cica- trices,-one on the upper anterior portion, and the other two inches above the inner malleolus. The liver and spleen are both slightly enlarged. Excepting on the right leg, the disease is nowhere in active progress. Her intelligence is good. TREATMENT. After her admission she took iodide of potassium and bichlo- ride of mercury, and later, the iodide with tonics, cod-liver oil, and a generous diet. REMARKS. a This case is interesting, not only on account of the severity of the lesions and the return to comparatively good health, but because the onset of the disease was delayed until she was nearly three years old, and made its appearance in the form of tertiary syphilis. I have repeatedly and carefully sifted the history, and always with the same result. Her mother, an intelligent woman, denies that the child ever had a skin disease in her life. I can- not learn either that she ever had any opportunity to acquire the affection after birth. The point to which I wish to direct particular attention is the fact that our patient probably derived the infection from her father. Prof. Boeck, of Christiania, in a paper published in The American Journal of Syphilography and Dermatology for Jan. 1870, page 16, says: “If the father has had constitutional syphilis, the child may inherit the disease; but this is rather the exception than the rule.” My attention had never been directed to this point before reading Prof. Boeck's article, but since that time I have had several oppor- tunities to verify his experience, and in every instance it has been confirmed. The cases, however, are not sufficiently numerous to warrant a positive opinion. In the history of this patient there is no evidence whatever that the mother has ever had primary syphilis, and she has cer- tainly never suffered from secondary or tertiary symptoms. On the other hand, it is almost certain that the father had chancres about one year before Mary's birth, and it is highly probable that he had osteocopic pains when he complained of rheuma- tism, after his return from the army.