subsequently to marriage. His wife and three children escaped the contagion. The first attack under which he suffered was one of small sores; the second a gonorrhoea, with bubo. He took mercury for these attacks, but it purged him, and was immediately given up. The last attack, to which I refer his present constitutional symptoms, occurred ten years back; he then suffered under a gonorrhoea and several small sores, which got well in the course of a few days, with the aid of a lotion. He took no pills, and believes that he had no mercury; his mouth was not affected.

Shortly before the outbreak of the present eruption he had sore-throat, and was hoarse, and for the space of three years suffered occasionally in the same manner. Four years since, he experienced pains in the shin-bones, the pains recurred occasionally, but were at no time severe, and for some years past he has not had them at all. They were unaccompanied by redness of the skin or swelling of the periosteum. He has had no enlargement of the lymphatic glands, and no loss of hair; and has no sensation of soreness of the throat. However, on looking into the throat, I found the fauces in a state of congestion.

Another case, in which there was ulceration of the tubercles, I may also refer to in this place, as showing another feature of the tubercles, and also the great length of time during which the syphilitic poison may remain latent in the system, and yet retain all its destructive energy.

CASE 69.-A gentleman, about forty years of age, had a tubercular eruption, which was situated on the forehead, on one side of the face near the ear, and across the lower part of the loins. The eruption consisted of large, indolent, dull-red tubercles, having the density of

the surrounding integument, and scattered irregularly over a patch of altered skin of small extent, the chief tubercles being situated at the margin of the patch. There were six or eight of these tubercles grouped together on the middle of the forehead, forming a patch about an inch and a half square. On the side of the face, the tubercles, three or four in number, were isolated; while on the loins there was an oblong patch, which extended completely across the upper part of the buttock. The patch was of a brownish-red hue, and there were along its margin, and here and there within the included area, between fifty and sixty tubercles. Some few were isolated, but the greater number were in round or linear groups of from six to twelve each. The general size of the tubercles was a quarter of an inch in diameter. The patch looked as if the eruption had crept over its entire surface; it had the appearance of being collapsed and shrunken, and was thrown into numerous wrinkles; while in several places there were cicatrized pits, resulting from the ulceration of some of the tubercles.

This gentleman informed me that he had had a venereal sore in the year 1825. The sore gave him little inconvenience, and got well in about six weeks. He took mercury for its cure until his mouth became affected. After the sore had healed, he remembers that he was very subject to sore-throat, but he never had any eruption on the skin. In the course of years, the disposition to sore-throat wore off, and he has not been troubled with anything of the kind of late. He has had no venereal sore since that above mentioned, but has suffered twice or three times from gonorrhoea. The existing eruption made its appearance about seven years since, and has continued without much change until the present time. When it first broke out on the back, the lumps became sore, as he conceives, from pressure

or friction, and formed small ulcers, which gradually healed. But as the ulcers got well, or the tubercles subsided, others continued to make their appearance. During the last two or three years he has had no ulcers. He does not remember to have suffered from any pains in the joints or in the limbs.

I have before me the notes of another case of local tubercular eruption, situated on the lips and chin of a woman of about thirty-five years of age.

CASE 70.-The eruption consisted of a cluster of evenly-rounded tubercles, measuring two lines in diameter, and having an elevation of about half a line. The cluster formed an oblong patch of about an inch and a half square, and occupied the side of the chin. There were, besides, a very small patch, and about six isolated tubercles, all of a similar kind, the smaller patch being upon the upper lip, and the isolated tubercles upon the margins, of the lips and upon the prolabium. The tubercles were perfectly smooth on the surface at their first appearance, and for some time; they then desquamated slowly, throwing off a thin lamina of dried cuticle every now and then. Their color was a dull-red, sometimes inclined to purple, at other times to a coppery hue; and they appeared stationary, having been in existence, without any change, for several months, at the time of her visit to me.

There was not a spot of any kind upon the rest of her body; she was a married woman, and having had no primary symptoms of syphilis, I inferred that the present eruption was occasioned by a secondary poison.

CASE 71.-While the preceding case was under treatment, a young lady of good family was brought to me, with an incomplete ring of tubercle situated on the

cheek, near the lower eyelid. The line of tubercles curved upwards towards the temple, where they were met by a wheal-like tubercle nearly an inch in length. The color of the elevations was a dusky red, approaching to purple; they were perfectly smooth on the surface, and had occupied their present position for nearly two years. She had been treated with lotions and ointments of all kinds, and nitric acid had been proposed to her. The fear of a scar resulting from the use of the caustic, and the recent appearance of a similar tubercle on the nose, was the occasion of her visit to me. had no other spot of any kind about her.

She

The position in life of this young lady, the care with which she had been educated, and her age (nineteen), were such, that I felt the utter impossibility of her having been placed within the reach of the syphilitic poison; and yet the similarity of the eruption to that in cases 68 and 70 filled me with perplexity. The tubercles were not lupus; she had never evinced a symptom of scrofula; and I felt that if she had appeared among my poorer patients, I should not have hesitated to pronounce them to be syphilitic. As it was, and after mature reflection, I came to the conclusion that the disease was a germ of the syphilitic poison derived from her parents, and now, for the first time, manifesting itself on her skin; in fact, that it was hereditary syphilis.

I treated this young lady with the bichloride of mercury and sarsaparilla, and she gradually lost all trace of the eruption. It was not one of those cases of disorganization of the skin above referred to, and therefore there was no cicatrix, not even a stain left behind.

I have remarked upon the resemblance which these locally developed, isolated clusters of tubercles bear to lupus. Lupus itself consists of a cluster of locally developed tubercles, occurring for the most part on the

nose or on the face. The tubercles are identical in point of size, color, configuration, even in their mode of termination, with those of syphilis; and we take an interest in inquiring in what they differ. They differ in very little; they are more permanent; but we have seen a syphilitic eruption continue for many years (cases 68, 69); they are more destructive, but can anything be more destructive than the corroding and phagedenic ulcer of syphilis; they attack the nose, and so does syphilis. In making this comparison, I have taken the most marked examples of lupus; but between these and undoubted syphilitic tubercles the incline is so gentle and the difference so slight, that the penalty of pursuing their investigation is the belief in their identity. Is LUPUS NOT SYPHILIS? But lupus is generally regarded as owing its origin to scrofula-the obscure is called forth to illustrate the obscure. We are as much in the dark with regard to the cause of scrofula as we are with regard to that of lupus. Lupus is scrofula; and what, we might ask, is scrofula? IS SCROFULA SYPHILIS?

By a careful observation of the phenomena of syphilis, I have been led to the conclusion that many, if not all, of those cases of affection of the skin which have been denominated scrofula and lupus, take their origin in the syphilitic poison; and in the same category I feel inclined to place the squamous diseases, lepra and psoriasis. The subject, however, is too large and too comprehensive for precipitate judgment. I have expressed my belief; and I leave it to future years of observation and thought to mature my decision.

It is unnecessary to discuss here the characters of lepra and psoriasis; they resemble syphilitic tubercles in many respects, indeed, the annulate form of syphilitic tubercle has heretofore been called syphilitic lepra and syphilitic psoriasis; they resemble lupus, and lupus, as