1885 Journal of the American Medical Association  
prior to the year 1875, when he undoubtedly had syphilis ; and since some of the other members of the family have similar symptoms, it is reasonable to infer that a hereditary tendency existed as a predis¬ posing cause. This, together with his youthful vice, spermatorrhoea, and erratic temperament, may have been sufficient to induce the albuminuria and a con¬ sequent cachexia that served as a fruitful soil for the ravages of the specific disease. Dr. C. E. Webster stated that through the kind¬
more » ... through the kind¬ ness of Dr. Webb he had had an opportunity of ex¬ amining the patient, and was greatly interested in this report of a rare and obscure disease. He would like to inquire of the reader if in his study of this disease he had been able to distinctly separate it from the condition known as " fragilitas ossium." It seemed to him that cases of fragilitas ossium were sometimes diagnosticated as osteo-malacia. He also thought that there was a tendency, growing from the reticence on the part of patients to admit syphilis, to make that diagnosis in all obscure cases, not giving due credence to other possibilities. He would like to know if an examination of the liver was made at the autopsy ; and also whether it was an established fact that only a rare form of albumen was soluble in boiling nitric acid. Regarding supporting the chest, he thinks no splint could have been devised to pre¬ vent collapse of the thorax. Dr. J. J. M. Angear spoke of an affection of the trophic nerves as a possible starting point of this disease. Regarding onanism as a habit, everything following this practice is of course attributed to it, but he thinks that there is a disease of the trophic nerves that precedes this, or that there is a disease of the nerve centres that causes this depraved condition, and that it is governed by nerve influences. He therefore thinks that where a post-mortem examina¬ tion is made, the nerve centres should be examined in cases in which a patient is known to have practiced onanism, as well as in those having suffered from mol¬ lifies ossium. Dr. A. Leigh inquired if there were any changes in the small blood-vessels. Were they, in conjunc¬ tion with the portal vein and heart, cyanosed ? Dr. Liston H. Montgomery thought that if the patient had had syphilis several years previously, and the children were robust in appearance, when dur¬ ing a considerable portion of this time, tertiary symptoms manifested themselves in the father, he could not understand how it was that the children enjoyed good health now. Dr. Webb closed by stating that he could not answer satisfactorily the questions that had been asked. He though there was a close relation between some cases of mollities ossium and fragilitas ossium, rickets and specific disease. Regarding the nerve centres that control the process of nutrition, he thinks it is quite probable that they are first the seat of the disease, or that hydro-myelitis or osteo-myelitis may be complicated with it. He was sorry that he had not closely examined the liver in this case, and obtained slides for microscopical examinations.
doi:10.1001/jama.1885.02390860018011a fatcat:v4hohyhohbchzga5zrfupvodcm