knee, and piles, which latter, from her description, I believe to have been condyloma.

She has had five children, the first was stillborn; the second survives; the remaining three were miscarriages, the last at three months.

Her husband, she says, was delicate, and thought to be consumptive until his marriage, from which time he has become healthy and robust; while she, in an equal degree, has fallen off in strength. I am at a loss whether to attach any importance to this observation; it struck me, when I noted it, as a possible instance of an hereditarily contaminated constitution becoming relieved of its poison by the creation of a new, and probably a natural outlet; while the unaffected system of the wife suffered in similar proportion. As I do not know the husband, I was unable to ascertain whether he had acquired the poison by contagion; but from the account I had of him, I thought it improbable.

CASE 52.-A gentleman, thirty-two years of age, consulted me for erythema palmare centrifugum in one hand. There were two circular patches, one in the centre of the palm; the other, on the palmar surface of the index finger. He reports himself perfectly well; hardly remembers to have suffered a day's illness, excepting gonorrhoea, which he has had several times, the last five or six years back. With the gonorrhoea, he sometimes had a slight abrasion of the skin, which always got well in the course of a few days.

At the present time, besides the erythema palmare, he has a muddy skin; his hair is thin, having been falling during the last three or four years; but he has no depression of spirits, no sore-throat, and no pains in his limbs of any kind; indeed, he has never been subject to

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either. His bowels are always regular, and his appetite good. He has never taken mercury.

The only other traces of the syphilitic poison observable in this gentleman, were an uneven and granular appearance of the surface of his tongue; a milk-like spot near its tip, and several milky-looking spots on the buccal membrane, which gave it a mottled character. He had some time since a slight ulceration of the tongue.

CASE 53.-A medical man had a small indurated chancre, at the age of twenty-two. The sore was situated on the glans, and was as large as a split pea. It was treated with nitrate of silver, and got well in ten days, but was followed by bubo. He took mercury until his mouth became sore, the quantity of mercury not exceeding a scruple. He had no secondary symptoms.

Nine years after the chancre, a circular, erythematous patch, attended with cracking of the skin and exfoliation of the cuticle, appeared on the palmar surface of the metacarpo-phalangeal joint of the middle finger of one hand. It increased in size to the diameter of a crown piece, and has resisted every kind of treatment for the space of nine months.

I prescribed for this gentleman the bichloride of mercury in the fluid extract of sarsaparilla, and in three weeks the eruption had healed.

CASE 54.-A healthy-looking man, aged thirty-nine, consulted me for erythema palmare of the left hand. It presented the usual appearance of a cracked and exfoliating epiderma, a red and tender derma. There were several patches on the palmar surface and sides of the fingers, and the disease had crept around the lateral borders of the hand, and occupied a part of the back.

There were also a few patches on the wrist. The latter were bounded by a slightly raised and map-like border, and had more or less of a circular form. The disease had been in existence eight years without much change. During that period, it had been well three times, twice for a short period each time, and once for twelve months. It is a source of much uneasiness to him, from feeling hot and tender; and particularly when, as sometimes happens, the derma cracks in the lines of motion of the skin.

He says that, three or four years before the appearance of the disease in his hand, he had a venereal affection, for which he took mercury until his mouth was made tender. He had also a feeling of soreness in the groin. A few weeks after this attack, his throat was sore and ulcerated, and he has been subject ever since to an occasional recurrence of soreness in the throat. With the sore-throat, the lymphatic glands of the neck were swollen and tender. He had also severe pains in the thighs and legs; and at the present time, is liable to occasional pains in the head. He distinctly remembers that he never had an eruption upon the skin, with the exception of a slight peeling of the skin of the feet which came on with the disease of the hand.

For treatment, he had tried in vain a number of remedies; two years back, he commenced taking arsenic, with antimony and guaiacum, and although he has continued it until the present time, it has been unproductive of any good effect.

The points of interest about this case are, the absence of any syphilitic affection of the skin, excepting that in the palm of one hand; and the long and unavailing trial which was given to arsenic as a remedy. Had the case been one of psoriasis, it would undoubtedly have yielded to the arsenical treatment. The length of time

intervening between the primary disease and the syphiloderma, namely, three or four years, and the duration of the latter, namely, eight years, are the common features of the disease. In cases 54, 53, and 49, recorded in this chapter, the respective periods of appearance of the syphiloderma after the primary disease were five, nine, and ten years. In cases 54, 51, 49, and 50, the duration of the disease up to the time of coming under my treatment was three, three, ten, and twelve years. In cases 50 and 51, there had been no recognized primary disease; in case 51, no other syphiloderma but condyloma; and in case 53, none whatever. In cases 49 and 50, a syphiloderma accompanied the palmar affection; in the rest, it existed alone.

In the succeeding case, the syphiloderma occupied the back and not the palmar surface of the hand.

CASE 55.-A gentleman, thirty-eight years of age, married, and the father of several fine children, consulted me for an inflamed state of the skin of the hand. The disease occupied the back of one hand, the wrist both in front and behind, and the ball of the thumb. It was of a vivid red color, and swollen; the cuticle had been cast from the entire surface, and was still undergoing the process of exfoliation in various parts, and in patches of various size and form. Moreover, there were numerous chaps and fissures through the newly-formed cuticle, and several ridges of a tubercular character on the back of the wrist.

On inquiring into his previous history, I learned that, eight years before, he had had a sore of small size on the prepuce, for which he took mercury. During the following year, he had occasional appearances of stains on the skin; and during the last three years, has been troubled

by the present form of the disease, which has been sometimes better and sometimes worse.

CONDYLOMA.

When syphilitic tubercles occur on parts of the body where there is naturally an increased degree of moisture, or where they are kept in a softened condition by morbid secretions, they are apt to assume a state of chronic growth. Such tuberculous growths are termed soft tubercles, or condylomata. Their common situation is the perineum, particularly in the female, where their growth is favored by the secretions of the vulva. They are also found occasionally between the greater labium and the thigh, on the scrotum, between the scrotum and the thigh, around the anus, and in the groins. I have also seen them in the axilla.

I will now relate a case in which this kind of growth was developed in the groin; the case is further interesting, as showing the succession of cutaneous eruption, from roseola to annulate tubercle.

CASE 56. In the month of August, 1848, a widow lady, aged thirty, observed, while bathing, a small flat sore, about three-quarters of an inch in diameter (as large as a sixpenny piece), upon the inner side of one of the greater labia. She covered it with a piece of gold-beater's skin, and took twelve mercurial pills, one night and morning. The mercury affected her mouth, and the sore soon got well.

Between three and four months later, namely, in the beginning of December, she perceived two sores, similar in appearance to that above described, only slightly elevated, in the groin. These she bathed with vinegar and water: they healed in about a fortnight, but left