momentary squint at first, but becoming more persistent as the case moves on to its end. In like manner a squint is developed in brain disease in adult At other times the eyeball is oscillated slightly, but rapidly, from side to side. This is called nystagmus. It has no significance.

Then the cornea may be affected, and is chronically inflamed by syphilis about puberty, and until about seventeen. Under proper treatment it may clear up; but if neglected permanent opacity may result. At the union of the cornea and the sclerotic a ring is sometimes seen; this is the arcus senilis. It indicates advancing age, as its name implies; but it is necessary to have clear ideas on the subject, else error may arise. There are two forms of arcus: one very suggestive and of evil omen; the other without any significance. The latter being the more pronounced of the two, careless observers have often been misled. To take the innocent form first may be well. It is very distinct, with sharply-defined outlines and a clear cornea. It is calcareous in its nature, and is very common in hale old people; especially persons with light-blue eyes. It corresponds to the bony plates found in birds at the point of attachment of the cornea to the sclerotic. It has no significance; but the other form tells of tissue-decay. This arcus has badly defined edges; while the cornea is hazy and cloudy from fat-granules being scattered throughout it. It is more pronounced under the eyelids, where the arcus is often to be seen very distinctly, when scarcely recognisable in that portion which is exposed to light. It is often well, then, to lift the upper eyelid when in doubt; as when the question arises as to whether or not there be fatty degeneration in the fibres of the heart. Arcus is a bow: annulus a ring. It Is arcus senilis, not annulus senilis. Then as to the pupils. Sometimes the iris is the seat of inflammation; and the formation of a tubercle at the inner or free edge of the iris is common in syphilis. Then the pupils may be of unequal size. Contraction of one pupil is often found in aneurysm of the aorta. When the pupils are both contracted, and severely contracted, then the suspicion of opium poisoning is aroused, or indulgence in cough-lozenges containing opium; or may be hæmorrhage into

the pons varolii. In apoplexy the pupil of the paralysed side is usually dilated; but this is not invariably the case. It is well to note inequalities in the pupil; but the subject of the causes of the inequalities is too wide a one to be entered upon here. In convulsive seizures the pupil may be widely dilated, contracting again when the attack is over. Dilatation of the pupil occurs just before death in opium-poisoning. As a guide to the continuance or discontinuance of belladonna given internally, the condition of the pupil is utterly valueless; and the administration of atropia, as in the night-sweats of phthisis, should not be stopped, because the pupils are dilated thereby. The mobility of the pupil under light is significant; and the circumstances under which there is mobility to light, but not to distance accommodation, are interesting, but cannot be reviewed here.

The steadiness of gaze, or the unsteadiness, often tells of the character and habits of the individual. The secret drinker rarely has a steady eye. The averted look often is significant when a question involving morals is mooted. In insanity the eye tells of the gloom of melancholia, the excitement of mania, or the elation of general paralysis; while there is the glare of suspicion or of persecution; or the vacant gaze of dementia. It is always desirable to watch the patient's eye. In all relations of life a struggle for mastery is unconsciously going on; and the eye will generally tell when the patient is going to be obedient; and also when the doctor has got the worst of it, and the patient does not intend to follow the proffered advice. And a doctor has always practically failed when he feels he has not convinced the patient sufficiently to make him or her obedient!

NOSE.-The nose often has its tale to tell. The nostrils play and quiver in thoracic disease, or conditions of nervousness. When the bridge is sunken, inherited syphilis is suggested. The 'snuffles' of syphilitic infants is well known; and the chronic inflammation of the bones of the nose set up thereby may result in their arrested growth, and thus be instructive ever afterwards. Then the alæ nasi may be full, as in struma. The tip is red and tuberous in chronic alcoholism—a condition simulated by disease in some cases. The red tip in women usually indi

cates indigestion or constipation, or both, with or without pelvic complications; or the nose may be abnormally pale. In either case there are usually cold feet.

LIPS. Sometimes a dyed moustache will reveal the design of the individual to conceal his age; a matter which may not be, at times, without significance. Then in strumous children the lips are fuller than usual. In slighter cases, this, with fulness of the alæ nasi and the long silken eyelash, gives a very pleasant, often piquant, face; but in severe struma the thick coarse lip and nose brutalise the expression of the face. Then a certain fulness of the lips, and especially of the under lip, commonly goes with well-marked sexual proclivities. The full under-lip of the House of Burgundy may still be traced in the House of Austria-the full lip and the light morals of the Hapsburgs. The lips are apt to become fuller and coarser in an individual after prolonged sexual indulgence in excess. Then scars at the angles of the mouth are always pathognomonic of syphilis. The sordes on the lips and teeth will be considered when the typhoid condition is described.

GUMS.-The blue lead line along the teeth puts the observer on the right track in lead-poisoning. A spongy state of the gums is found in purpura and scurvy; or in mercurial poisoning.

TEETH.-Much useful information may be gleaned from careful observation of the teeth. They may indicate excessive tobacco-smoking, or chewing, from their colour; and in that case are usually natural teeth. And this is a point not to make any mistake about-before observing the character of the teeth, be certain that they are the patient's natural teeth, and not artificial teeth. Artificial teeth are generally better shaped, more perfect and regular than natural teeth. Badly-decayed teeth generally indicate unsoundness of the constitution, or delicacy; persons with bad teeth rarely have robust health. Their bad teeth lead to indigestion, because the food is not properly masticated. Often when the front teeth look well, the molars are decayed or gone. Strumous persons usually have decayed teeth, with a blueish hue around the caries. Where the teeth are diseased as a consequence of mercury, they are rather

'dirty' in hue, than blue around the carious portions. Then 'gouty' teeth are thick and heavily enamelled, and usually worn down. At times the two upper incisors are very large and massive. At other times, in persons of the gouty diathesis, the teeth fall out from periostitis without any caries. The larger massive well-formed sound teeth of the gouty diathesis often furnish most useful information about the patient.

The modifications of the teeth produced by congenital syphilis have been made the subject of careful observation by Jonathan Hutchinson. He writes: 'It is very common to find all the incisor teeth dwarfed and malformed. Sometimes the canines are affected also. These teeth are narrow, and rounded, and peg-like; their edges are jagged and notched. Owing to their smallness, their sides do not touch, and interspaces are leftIt is, however, the upper central incisors which are the most reliable for purposes of diagnosis. When the other teeth are affected these very rarely escape, and very often they are mal. formed when all the others are of fairly good shape. The characteristic malformation of the upper central incisors consists in a dwarfing of the tooth, which is usually both narrow and short, and in the atrophy of its middle lobe. This atrophy leaves a single broad notch (vertical) in the edge of the tooth; and sometimes from this notch a shallow furrow passes upwards on both anterior and posterior surface nearly to the gum.

This notching is usually symmetrical. It may vary very much in degree in different cases; sometimes the teeth diverge

and at others they slant towards each other. The appended woodcut illustrates a good example of the deformity. In any case in which the malformation was as marked as in the sketch, I should feel no hesitation in pronouncing the possessor of the teeth to be the subject of inherited syphilis, even in the absence of any other testimony, I have never yet seen such teeth, excepting in patients of this class. In the majority of cases, however, the condition of the teeth is sufficient only to excite suspicion, and not to decide the question. In a few rare cases only one of the upper central incisors is malformed, the other

being of natural shape and size. A good instance of this state of things is shown in this woodcut. In a considerable number of cases of hereditary syphilis the teeth show no deviation from the normal standard, and in such the diagnosis must be guided by other conditions. In addition to the peculiar malformations above described and illustrated, there are others which, although less characteristic, are yet very valuable to a trained observer. They do not, however, admit of description without great risk of misleading the reader. Before leaving the subject of dental malformation, I may again ask attention to the fact, that it is only in the permanent set that any peculiarities are observed. The first set are liable to decay, but are not malformed.'

The student must not confound 'craggy' teeth, with their horizontal furrows, with Hutchinson's teeth with vertical furrows. Also many children have notched teeth, with the absence of the fourth denticle, who have no syphilitic taint. Where the jaw is small, and a child delicate, and its tissues imperfectly nourished, the teeth are apt to be notched, and present