or two exceptions, has not been questioned. Simon says of it: "In scrofulosis of the osseous tissue, or rachitis, the urine varies very much in its composition from the normal type. These deviations principally consist in the diminution of urea and uric acid, and in the increase of the salts. The colour of the urine is generally either pale, or else it differs but little from the normal appearance; the free acid sometimes increases to an extraordinary degree, and some maintain that it is free phosphoric acid. This extraordinary and morbidly-increased capacity of the kidneys for the removal from the blood of those salts which are so essential for the structure of the osseous tissue, and the consequent tendency to the formation of calculi in rachitic children, is regarded by Walther as a vicarious act of the kidneys in connexion with the formation of bone."1 The identity, however, of rachitis and scrofulosis (including tuberculosis as a high degree of scrofula), as is inferred in the preceding quotation, is very questionable. Dr. Merei, in his work on Developmental Disorders and Rickets, states that of more than five hundred post mortem inspections of children, practised under his own eye in the Children's Hospital of Pesth, comprising a considerable proportion of rachitic subjects, not one instance of tubercular consumption occurred in a child having a high degree of rachitic spine or chest. He says that scrofulosis and tuberculosis may co-exist with rachitis; but that a high degree of rachitic compression of the chest-necessarily connected with over-carbonization of the blood -is a condition adverse to the development of pul monary tubercles. The assertions, therefore, of Rokitansky on this subject seem to be correct. Dr. Merei's conclusion is, "that rachitism is a disease which may be associated with, but is distinct in its nature from, scrofulosis and tuberculosis." 1 Intimately connected with this state of the system, as well as with that next to be noticed, the gouty diathesis,-between which two it seems to form a connecting link, is that which predisposes to the formation of urinary calculi. The blood is generally found to contain an abundance of fibrin, and considerable increase of the saline constituents. That this condition is liable to be transmitted hereditarily cannot be doubted; it is found to prevail in those even who have been removed from the influences under which the disease was originally generated. The gouty diathesis is undoubtedly hereditary in predisposition. It has not been hitherto known, I believe, that gout has ever manifested itself in infancy; but instances are on record wherein it has appeared in a decided form at an age when the usual exciting causes could have had no share whatever in its development. I was acquainted with a gentleman, lately dead, in whom it commenced at ten years of age, and returned periodically in its habitual form throughout life, although skilful measures of treatment were adopted from the onset. The taint was derived from his grandfather, who was for many years a great sufferer; his father escaped it altogether, although he endured repeated attacks of rheumatism; in his elder brother it broke out soon after the age of thirty. Both these brothers died suddenly of heart 1 Dr. Merei on Diseases of Infantile Development, p. 195. London: Churchill, 1855. disease. It seems singular, as Mercatus has remarked, that gout and other diseases which are evidently hereditary in predisposition, should not show themselves at birth, since the principle necessary to their development is undoubtedly present in the blood from the earliest age.1 The blood in those of the gouty diathesis is abnormally charged with fibrin. Its more characteristic change, however, consists in augmentation of some of the saline ingredients, lithic acid being eliminated in unusual abundance. During a paroxysm, this principle is either thrown off combined with the urine, or is deposited in the fibrous textures around the smaller joints in form of lithate of soda, known as chalk-stones. It sometimes concretes in the urinary bladder, forming the calculus peculiar to this state of the system. The hereditary continuation of the malignant diathesis is a fact so well ascertained as to need no illustration. The earliest age at which it first manifests indications of its presence, as a general rule, is from twenty-five to thirty years. Some forms of it, however, appear at an earlier period; cancer of the eye, for instance, may develope itself in infancy; one form of malignant skin disease-epithelial cancer-is perhaps more frequently encountered in boyhood and youth than at a later period of life: that, namely, which has been termed chimneysweeper's cancer. But in the majority of instances it is about the commencement of the latter stages of lifefrom the ages of forty-five to fifty-five-in both sexes, that the system begins to indicate its inability longer to conceal the accumulating load of inherited evil. Often 'Sed, mirabile dictu, qui fiat ut podagricus filius non protinus incidat in podagram, aut calculosum affectum, quem a patre accepit, sed transactis aliquibus annis.-Op. cit., p. 671. the infliction of some external injury, of so trifling a nature as scarcely to have produced a momentary disturbance in the serenity of a child's temper, will be suffi cient to set in motion a series of disasters that shall not cease but with life. The slight blow or contusion, the situation of which had been lost or forgotten, will, after a length of time, reappear as a bruise or a tumour, and the localization of the constitutional taint is thus determined. In some cases it breaks forth without any accidental cause whatever, while in others the external phenomena are preceded by constitutional changes of a nature peculiar to this diathesis. Although cancerous affections are so frequently the result of constitutional predisposition, there is yet no doubt that they are also daily rising de novo, no such predisposing cause having existed in the progenitors. Assuredly there has been a time when they had no existence. In fact, chimney-sweeper's cancer comes on in boys and young men, none of whose ancestors had been troubled with malignant affections of any kind: the disease is clearly attributable to the nature of their occupation. Again, cauliflower cancer of the uterus occurring in one derived from a healthy stock, is sometimes the result of a venereal affection, an example of which will be found in the following pages. And in some other forms of uterine disease, it is singular to witness how striking the similarity is between some which are often regarded as trivial in their nature, and others which are known to be malignant. I have had frequent opportunities of tracing the development of uterine disease supervening upon syphilis, commencing in shallow ulceration or abrasion, and ending, after a length of time, in hypertrophy and induration of the greater portion of its lower section, accompanied with lancinating pains, exquisite tenderness under pressure, an angry-looking surface, occasional sanguinolent discharges, not always inodorous, and much constitutional disturbance. I have reasons for suspecting that schirrus in many cases owes its existence to the venereal poison. The blood in this disease exhibits a remarkable deviation from the healthy state. In a case of cancer of the uterus occurring in a woman thirty-four years of age, the blood was analysed by Drs. Lenzberg and Morthier, and found to consist of water 832-35, solids 167·53, in 1000 parts. The quantity of fibrin in this specimen was singularly augmented, amounting to 16:44 per 1000. In another case, where the disease occupied the liver of a man fifty-three years of age, the proportions were, water 887-2, solids 112.8. In the latter instance the fibrin only slightly exceeded its normal amount. In both, however, the globulin was greatly deficient, scarcely surpassing the half of its normal quantity.1 Erysipelas is another disease, the tendency to which is continued from parent to offspring. It may occur at any period of life, but is most prevalent in adult age and subsequently. I am intimately acquainted with a family wherein it has prevailed under widely varying circumstances in four generations: each of these has been personally known to me. The paternal ancestor died at the age of seventy-three of angina pectoris. He had been remarkably healthy through life, with the single exception of periodical attacks of erysipelas of slight character, implicating the face and hands. His son, a medical man, now living at the age of seventy-four, has for the last thirty years suffered from a similar affection, which |