ON SYPHILIS AND GONORRHCEA 215 



mation must flow from their study in this light regarding 

 their prevention, amelioration, and cure. 



A clinical Lecture has just been delivered by Sir W. R. 

 Cowers at University College Hospital (vide Lancet, 

 Dec. i, 1905), entitled "A Metastatic Mystery," in his 

 usual most lucid style, and effectively illustrated. The 

 title of the lecture is transparently honest and brief, and 

 no doubt expresses the high-water mark of special know- 

 ledge on the subject ; yet the case, as viewed in the light 

 of our expressed views and personal knowledge of the 

 subject, resolves itself into one of belated manifestation 

 of tertiary syphilitic symptoms confined to the motor 

 cerebro-spinal nervature and part of the musculature of 

 the right side, and to the lateral aspect of the meninges 

 overlying the mid brain, all manifestly due to the localisa- 

 tion of the basal tumour described to the antero-lateral 

 aspect of the pons. We would assign as the place of 

 origin of this tumour, which we are satisfied is the fons 

 et origo of the attack, the locally involved sub-arachnoid 

 surface, where we may suppose a gummatous growth 

 originally evolved itself, and increased to the size men- 

 tioned, sustaining itself by a pseudo-encapsulation, and 

 succeeding in keeping itself stationary as to further growth 

 by the process of discharging from within or passing away 

 from its external aspect a continuous flow of epithelial 

 and other material due to its local presence and disturbing 

 influence, which found its way along the lines of least 

 resistance, which were the antero-lateral aspect of the spinal 

 cord, to the motor nerve roots, issuing at the points 

 indicated by the vertebrae affected, the trunks of the 

 nerves distributed to the muscles implicated, the periosteal 

 coverings of the bones, and the deeper osteal structures 

 where they were inserted. Likewise ensued the upward 

 cephalic progress from the scene of the tumour's irritation, 

 the tainted fluid causing, evidently, from the illustration 

 supplied, an opaque and thickened condition of the 

 meninges, and spreading laterally, to some extent, but 

 ultimately finding a means of exit for the tainted material 

 through one or more of the Pacchionian bodies and the 

 tables of the skull into and under the periosteum or 

 peri-cranium. Each of the abscesses and periosteal inflam- 



