BY F. F. MAURY, M.D., Lecturer on Venereal and Cutaneous Diseases in the Jefferson Medical College, and one of the Surgeons to the Philadelphia Hospital. The accompanying photograph was taken from the skull of a colored man, who was an inmate of the venereal wards of the Philadelphia Hospital. The case, both before and after death, possessed points worthy of record. The history, gleaned from the man at the date of his admis- · sion, was extremely meagre and unsatisfactory, but nevertheless pointed without doubt to syphilis as the origin of his trouble. He stated that he was a native of Pennsylvania, a laboring man, and his supposed age about thirty-eight years. He was exceed- ing dull naturally, and possessed all the attributes of the genuine African. At the time of his admission to the hospital, which was in January, 1868, I found him evidently suffering from un- natural mental hebetude, to such a degree that the idea of elicit- ing a clear and truthful history was abandoned after several fruitless attempts. All that could be ascertained was that he had suffered from chancre some eight years before, the cicatrix then being evident at the under surface of the head of the penis near the frænum. Marked ganglionic involvement of the inguinal glands also co- existed with the chancre. Further than this nothing definite or reliable could be obtained. For the primary lesion he re- ceived no treatment whatever, but continued his daily duties, and in the apparent enjoyment of his usual good health. He sought medical aid (some five or six years from the appearance of the chancre) for what he supposed was a rheumatic or neu- ralgic affection of the head, and of some of the articulations and more superficial bones, without, however, experiencing any material relief. When admitted to the hospital he complained of great pain, of a dull, heavy, gnawing, boring character, which occupied the entire skull, and which was always aggravated at night. The body was free from marks of any previous cutaneous lesion, and indeed no other exhibition of constitutional involvement could be found. He was placed at once upon appropriate treatment, with moderate doses of iodide of potassium. After continuing this for more than a week, with little or no effect, it was determined to increase the potassium daily, which was done with decided benefit in the way of diminishing and moderating the horrible pain suffered almost continually. At the end of three weeks he took, with marked good effect, ninety grains of the iodide of potassium daily. When going to breakfast, one morning, he fell in the ward with symptoms resembling apo- plexy, and was dead in five minutes. A post-mortem examination revealed the most wonderful ero- sive and carious inflammation of the skull, which was very much thinned and lighter than usual. The brain seemed somewhat softened, with little other appreciable change. All the other viscera were entirely free from any gummous deposit or struct- ural change,-a thorough examination having been made. Remarks.—The points of interest of this case are evident. First. The entire absence of treatment of the primary sore, which in all cases, when well and promptly applied, exerts an unmistakable salutary, influence over the subsequent tendencies of the disease. Second. The peculiar elective affinity of the disease in this case for the bones of the skull to the exclusion of all the other tissues and regions,-a fact not mentioned for its rarity of occur- rence, but merely from the interest it possesses. In this rela- tion it may be of interest to state that the course of syphilis in the colored race differs very frequently, to a great extent, from that pursued in the white race. I am not prepared to state it as a broad fact, but my convictions are that cutaneous manifes- tations are more rare in the negro than in the white, while gan- glionic involvements are more constant and common in the former. The hair is rarely lost in the colored race, while cer- vical adenitis oftentimes assumes alarming proportions. It is not my desire or intention here to enter at length into this ob. scure and delicate ground of discussion, but merely to state facts. It has been my lot to see many cases of syphilitic dis- ease of the skull: in almost all the instances the carious form of ulceration has existed. In one instance a large necrosed piece of the frontal and parietal bone was removed. Where interstitial ostitis occurs, the bone is eburnated and rendered much more heavy, whereas when either table is involved by erosive action, it is much lighter than natural. Where a node exists and caries results, little good, as a general rule, is expe- rienced from any surgical interference, in the way of scraping and removing the bone; much more can be done by well-directed,