382 
conclusive of the occurrence of youthful acquired syphilis, for if even 
possibly hereditary, they can only be rarely so. 
On the whole, therefore, while there is a great deal of congenital 
syphilis of infants, yet I am not satisfied that the amount of youthful 
tertiary which we see can be accounted for by inheritance. As before 
remarked, most of the congenital disease disappears by the death of 
the infants. \\ hat is left is presumably of a milder type, and would 
not produce such virulent and lasting tertiaries. When it can be 
shown, though this is anticipating my argument, that innocent 
syphilis is of frequent occurrence (apart from yaws), I feel I am 
justified in saying that the juvenile tertiary as seen is not the result 
of inherited taint. 
I have for some time been in the habit of jotting down short notes 
of syphilitic cases, though this has not been kept up regularly, and 
there are long and frequent hiatuses in my record. Yet out of the 
notes, such as they are, I can place before my readers enough cases 
to illustrate the several points to which I wish to call attention. 
I think it will be agreed that the cases following here read much 
n ° re exam ples of acquired than hereditary syphilis in spite of the 
youthfulness of the patients. I have been limited by selecting cases 
in which there was no history of yaws. 
l. 
T ' years > Jilack. ino note ot earlier history, 
lower enri°nf’ «■ 1 1 ^ I1 ’ eilted scars °n both legs. Deep adherent scar over th 
At present this • & lbu a ‘ lias had an ulcer of the right leg for some yean 
of the let. wha-t*- 311 en ° nnous sloughing ulcer involving half the circumferenc 
cicatrized V ! 1S a n ‘ UCh enlar S ed - The of the circumference of the leg i 
years standing US “P?*? 00 - This is clearly a case of tertiary of man 
the primary she ” aCqui / ed dlsease - Yet at the time when she must have ha 
primary she was rather too young for venereal infection. 
Cask 2.—VV. S. ; 13 years; Hindu. 
and adherent 1°"? T u°‘ h kneeS ‘ ° n the ri 8 ht ankle an '"u 
volcanic eruption! \ 1 ^ ^ thlS rnore than four years ago (dated by th 
This has been of ♦ A arg ® f ° U ‘ tertiar y ulcer covers the back of the right fooi 
nine years " ° ^ duratio "- The tertiary here dates from the age c 
« ask 3.-D. s . Io years; Riack 
superficial ukerTon the lefTw* 1 ° f “ blind ' boils ” ° n both le & s ; S *™ 
end of left fibula r 1 Ieg ‘ Swe,bn g of left ankle, and periostitis of lo 
H.rd g,a„d s on both g ' 0i " S ' lh ° 8e ^ 
circular. Thev arp r™ Sma11 ind °lent ulcers about 6 to 10 mm. wide, a 
begin as a pimple whic^hr 0 ^ “ ultipIe and symmetrical in arrangement. T 1 
eaks down and suppurates, leaving a shallow punch 
