osseous system in inherited syphilis are of great clinical interest. The due appreciation of their frequency and importance may fairly be claimed for modern observers. As date, indeed, as 1858 Diday writes that " the annals of science oNer at most five or six well authenticated instances of 1them." These words of Diday and the reticence on the -subject by the authorities of his day would seem inexplicable in the face of our present experience did it not appear by their writings that almost the

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... ole affection of the osseous -system Diday's contemporaries regarded as syphilitic was the presence of suppurating nodes on the long bones. Now, anodes on the long bones, whether leading to suppuration or -mot, are rarities in infants with inherited syphilis, and the .non-discovery of them no doubt led to the erroneous impressions of Diday and others. Mr. Hutchinson states that he -met with a few instances of nodes on the long bores in -infants early in his career and, I gather, does not regard them as so very uncommon. Other writers, too, describe ,them as not infrequent, but that, being evanescent, they are .often overlooked. This is as it may be, but careful and prolonged search has not enabled me to come across an instance of them in a child younger than eighteen months. In older children they are occasionally found in association -with Hutchinsonian teeth and interstitial keratitis. Thev usually occupy the same situations as the nodes of the adult .acquired form, but have seemed to me less tractable to the .influence of iodide than these last. If nodes are rare on the shafts of the long bones they are jar from being so on the bones of the skull, for the researches .of Parrot have clearly established the periosteal origin of the well-known cranial bosses occurring in inherited syphilis. 'These may appear in many places on the skull, but are -certainly more frequent on the frontal and parietal bones, close to the margins of the anterior fontanelle. With regard ,to the contention as to what really constitutes a syphilitic type of skull in infants, I would state my conviction that the natiform skull of Parrot, with the four bosses closely surrounding the anterior fontanelle, is undoubtedly syphilitic, and in this I am happy in being confirmed by Dr. Eustace .Smith. The subsequent changes in the skull brought about by rickets being superadded to syphilis have led, I believe, -to a confusion amongst observers. But the cranial bosses in ;rickets are confined to accentuations of the frontal and parietal eminences. Mr. Macnamara has, moreover, in his 'interesting work on the bones and joints, shown that in 'extensive syphilitic disease of the bones of the ,kull tLe frontal and patietal eminences are the only parts that escape. Jn early cases, then, we have the means of òi"tir,guishing the syphilitic from the rachitic type of kull. nut rickets i-i so frequent a complication of inherited syphilis that after the age of six months we are apt to get a mixed type of skull, with corresponding difficulties as to the part played by -the different factors in its causation. If I ventured to criticise the classical description by Mr. Hutuhinson of the -later stages of inherited syphilis, it would be that the type of skull he associated with this complaint is re,illy due to .rickets following upon it. The cranial bosses in i-yphilis do not often last beyond the first year of life and leave no traces of their former presence, and, moreover, do not affect .the situations of the frontal and parietal eminences. As with the type of skull, the connexion between inherited syphilis and rickets has been one of discussion. 1 Lectures I. and II. were published in THE LANCET of April 11th and 18th, 1896, respectively. 1'he explanation of the tiequent association of the two complaints would seem to me a natural and simple one. Rickets is a disease of mal-nutrition which may own many causes for its production. Amongst these, possibly, no factor is more powerful in this way than syphilis, and thus the vast majority of syphilitic infants incur a greater or less degree of subsequent rickets. The contention of Parrot, that every case of rickets has a foundation in syphilis, is to me, as with most others, inexplicable and utterly untenable. In only one case have I seen suppuration ensue upon a node on the skull. Here a tender swelling over the frontal bone occurred in a syphilitic infant about six months old, with redness and infiltration of the overlying skin. The skin gave way in a short time, and the bone bemath rapidly necrosed away, opening up the cerebral membranes ; mercury, iodide, and the cautery alike failed to arrest the progress and the child died from abscess of the adjacent brain. Dr. Barlow lately mentioned that he had seen two cases of a like formidable character, but I am not aware whether he has published them or not. By far the most important and frequent osseous affection in inherited syphilis is the inflammatory one occurring in the epiphyses and in the junctions between them and the rest of the bones. First described by Wegner in 1870, his researches have been confirmed and extended by Taylor of New York, Dr. Barlow, Dr. Lees, and many others. According to Wegner, there is found in the bones of new-born syphilitic infants and young children a morbid process taking place at the print of junction of the cartilage of the epiphysis with the diaphysis. This consists of a proliferation of the cells of the cartilage along with a retardation of ossification in its already calcified structure. At the same time this proliferation of the cartilage cells interferes with the existing bloodvessels, and the formation of new ones takes place imperfectly or is altogether arrested. As a consequence of this interference with the bloodvessels the cartilage cells themselves suffpr in their nutrition and undergo atrophy or fatty change. The result of this morbid process is seen on section as a narrow, somewhat jagged line of yellowish or orange colour running along the line of the epiphyseal cartilage. This appearance, according to Wegner, is due to necrotic tissue separating the diaphysis from the epiphysis, and a . further suppurative complication may lead to a complete detachment of the latter from the shaft of the bone.