HISTORY OF PEDIATRICS 509 



dition of the mastoid process and of the floor of the external canal and 

 the frequency of primary bone tuberculosis, are best appreciated by 

 the practitioner, general or special, who deals with their abscesses. 



Whether deaf-mutism is the result of consanguineous marriage 

 cannot be definitely asserted. It is not often hereditary, quite often 

 it appears to be the result of family alcoholism; it sometimes depends 

 on arrest of development and fetal inflammation, but is more fre- 

 quently an acquired condition. Not rarely children are affected after 

 they have been able to speak. The majority of cases are caused by 

 cerebral or cerebro-spinal inflammation. According to Biedert, 55% 

 are of that class, 28 % are caused by infectious diseases (cerebro- 

 spinal meningitis, scarlatina, typhoid fever, diphtheria, also variola 

 and measles), 3.3 % by injuries, and only 2.5 % are original ear affec- 

 tions. Thus many of the congenital cases, and most of the acquired, 

 are preventable. More and more will our deaf-mute institutions 

 avail themselves of this knowledge, and will learn how to teach their 

 children not only how to read and write, but also how to hear. 



Not to the same, but to a great extent, pediatrics and ophthal- 

 mology join hands. Infectious diseases, such as diphtheria, affect the 

 conjunctiva and sometimes the cornea. Syphilis of the cornea, with 

 or without chronic iritis, is the form of parenchymatous or diffuse 

 keratitis. A frequent tumor in the eye of the young is glioma, and 

 frequent symptomatic anomalies are strabismus and nystagmus - 

 both of them the results of a great many and various external or 

 internal causes, with sometimes difficult diagnoses. 



The connection of pedology with dermatology is more than skin 

 deep; some of the most interesting problems of the latter must be 

 studied on antenatal and postnatal lines. The congenital absence of 

 small or large parts of the surface is probably due to amniotic adhe- 

 sions; seborrhea and the mild form of lichen, also the furunculosis of 

 infant cachexia and atheroma, to the rapid development, in the 

 second half of intra-uterine life, of the sebaceous follicles; ichthyo- 

 sis, to the same and to a hypertrophy of the epidermis and the 

 papilla? of the corium, sometimes with dilatation of their blood- 

 vessels and with sclerosis of the connective tissue. Congenital anoma- 

 lies, such as lipoma, sarcoma, naevus pigmentosus, open all the ques- 

 tions of the embryonal origin of neoplasms; and the eruptions on the 

 infant surface unclose to the specialist the subject of infectious dis- 

 eases. We recognize in the pemphigus of the palms and soles syphi- 

 lis; in herpes, gangrene, and in what I have described as chronic 

 neurotic pemphigus, the irritable nervous system; in eczema, consti- 

 tutional disturbances of the nutrition; in erythema, local irritation 

 or intestinal auto-infection; in isolated or multiple forms ranging 

 between hyperemia and exudation, the effect of local irritation or the 

 acute or chronic influence of drugs. A dermatologist who knows no 



