Lecture on the Use of the Clinical Thermometer

The question that arises with regard to the present case (that of the child) is, whetlher it is a case of tubercular meningitis, the tubercular cachexia arisilng out of the malnutrition resulting from the syphilitic taiint, or wAhether it is possibly a syphilitic deposit in the brain, setting up the inflammiiationi in the eye an(d the other symptoms. Mr. Power said, with reference to the patch on the retina of the left eye, that it was more like onie arising from syphilis than tubercle; whereas Dr. West and D)r. Dickinson said( that they ha(l never known true syphilitic deposit in the brain in so young a chil(l. If it were ordinary tubercular meningitis, the chil(l ouglht to have died in a few weeks, instead of which, by a persistenit course of treatment, eminently antisyphilitic, the progress of the case has been favourable as far as general healtlh is concerned, thou,gh with the result of clamage to the eye. I have only to add to these comments by Dr. Heywood Smith, that they have mlly enitire concurrence. The precedinlg case shows that meningitis may be set ul) in clhildreni by old-standing syphilitic disease of the braini, anid removes the oIbjection which prevented Drs. West and Dickinson from accepting this view wlhen advanced by Dr. Smith. As Mr. Power states, imioreover, the r-etino-choroiditis observed is suggestive of syphilis, and is not the kind of optic change to be expected as a result of tubercular meninigitis, namely, optic isch&emia or neturitis. CASE III. A child, aged IO years, was brought to me in MIarch I873. She had the (depressecl nose and square head of congenital syphilis, andl ha(l nio cenitr;al inicisors in the upper jaw. She wvas the first child by a seconid husbanid of a womiian w%Nho had had eleveni children by her first husbanid, not one of wA-hicll ha(l reachedI the age of three months, anld -mllost of themii hadl been born (lead or died soon after birth. The mother ha(l never been well, but had had nio distinct syphilitic symptoms. This child wsas suffering from slight hemiplegia, most evident in the arm. It w,vas the third attack, and ha(l come on suddenly with agitation of the armi, as ha(l the two previous attacks ; and, as in them, recovery was slowly takinlg place. I have not seen the case since.