a piece of ammoniaco-mercurial plaster; or if it threaten to pass beyond its chronic stage, by the application of nitrate of silver as a stimulant discutient..

If there be tenderness and signs of active inflammation about the glands, the patient must be kept at rest, and the enlargement treated by cold and compression; and even in this stage cauterization of the surface is often of value. Should the inflammation run on to suppuration, the abscess must be opened by the potassa fusa, or potassa cum calce. When opened, the resulting sore is to be treated with the solution of opium and waterdressing; with the addition of a solution of nitrate of silver, or sulphate of copper, should a stimulant appear desirable. When the bubo is inflamed and painful, but indisposed to suppuration, the application of a belladonna plaster is often productive of relief.

After the inflammatory action has subsided, and the glands still remain enlarged and indurated, compression comes again into action, assisted by mercurial frictions, and the use of the iodide of potass with chalybeates internally. Where the enlargement is peculiarly indolent, or irritable, a blister is often a useful remedy.

TREATMENT OF CONSTITUTIONAL SYPHILIS.

In constitutional syphilis, we have no longer to deal with a possibility of absorption of the poison; the fact is placed out of the reach of doubt; the poison is in the blood, and makes its presence known by certain signs. Our treatment, therefore, must be directed to the removal of the poison; and for this reason, every power which we possess must be made to bear upon the natural emunctories of the system; the bowels, the liver, the kidneys, and the skin.

It rarely happens that the syphilitic fever rises so

high as to require the abstraction of blood; but such cases nevertheless occur; and if the patient be full and strong, no inconvenience can arise from the practice. Local congestions are relieved by the bleeding; the nervous system oppressed by the weight of the poison is lightened; and the blood which remains is impressed with a different action to that of generating a morbid ferment; namely, one of repairing its own loss. On the other hand, it must be borne in mind, that upon the general powers of the system must fall the labor of eliminating the poison, and resisting its morbid effects; hence the constitution must not be lowered too much, and particularly so in cities and large towns.

Indeed, the power which we possess of relieving the blood through the natural emunctories is so great, that venesection is only likely to be required in very severe cases of local congestion, as of the brain or lungs; and even in such cases, the quantity requiring to be removed is very small. The general inflammatory excitement attendant on an outburst of the syphilitic fever is therefore to be combated by active purges, diuretics, and diaphoretics. A dose of calomel and colocynth, followed by a draught of senna and Epsom salts, will effect the first of these objects; and tartarized antimony, with abundance of diluent drinks, the rest. Opium is also a necessary element of the treatment, its purpose being to calm irritability and restlessness; with this object, and for the purpose of aiding the action of the mucous membranes and skin, ten grains of Dover's powder, at bedtime, will be found of much service.

As soon as the inflammatory excitement is allayed, it is time to begin the mercurial treatment. I am not aware that any particular form of mercurial preparation is superior to another for this purpose. I select usually the biniodide, which I prescribe in doses of a third of a

grain in combination with extract of lettuce, or conium, three times a day. This medicine agrees with the stomach usually very well; but if it produce nausea or uneasiness, then I either exhibit the pills less frequently, or have recourse to some other form of mercurial preparation.

Where the alimentary canal evinces a decided repugnance to the presence of mercury, we may obtain its effects by means of inunction. For this purpose a drachm of the strong mercurial ointment should be gently rubbed into the inner side of the thigh and leg every night at bedtime, changing the leg each night to avoid too much. irritation of the skin. In a case where it was of consequence that the inunction should not attract the attention of the patient's family, I limited the frictions to the soles and inner sides of the feet with perfect success. Indeed, the inunction may be made on any part of the body that shall be most convenient to the patient.

In pursuing the mercurial treatment, it is of the utmost importance to pay attention to the rules with regard to hygienic conditions and diet, already laid down for the treatment of the primary disease. Stimulants of all kinds, either in food or drink, are to be carefully avoided, as is also exposure to cold and fatigue. And the intention of the treatment should never be lost sight of, namely, to increase the natural functions of the depurating or emunctory organs, the bowels, the liver, the kidneys, and the skin.

The action of the mercury, and especially the functions of the kidneys and skin, are very much aided by the use of the compound decoction of sarsaparilla; the compound decoction of guaiacum; the decoction of saponaria, or the infusion of elder-flowers. I have no belief in the specific powers of sarsaparilla; but I cannot conceive a remedy better suited for the purpose of soothing

the alimentary canal, and at the same time of acting on the depurating organs, than the compound decoction of that root. For this purpose it must be taken largely; a pint and a half or a quart in the course of the day.

We have now the plan of treatment of constitutional or secondary syphilis before us; namely, 1. The careful avoidance of all stimulants, either mental or physical;. the patient to keep his bed or his room; and to defend himself particularly from the risk of being chilled. 2. Medicinally; if the inflammatory symptoms run high, and the powers of the system be equal to the loss, abstraction of a few ounces of blood; leeches or mustard cataplasms for local congestions; a calomel and colocynth purge, followed by a black draught, together with liquor ammoniæ citratis and tartarized antimony; or effervescent salines, with antimony; and a Dover's powder at bedtime, until the inflammatory stage is subdued. 3. Mercury in small doses, with the compound decoction of sarsaparilla; attention to the bowels, and an opiate at bedtime.

Besides the above, which may be regarded as embracing the more essential points in the treatment of constitutional syphilis, there are several appliances which may be added to the general treatment, or be made to occupy a prominent position, according to the views of the surgeon or the convenience of the patient; for example, the warm bath and vapor bath. The former of these is soothing and agreeable, and may be used daily, or even twice a day. The latter might also be used daily; it is a powerful and important remedy, and establishes an active drain, which doubtless carries off a large share of the syphilitic poison in its stream.

The vapor bath, of late years, has acquired additional importance, from its having been made the chief agent of treatment of constitutional syphilis by Langston

Parker. Mr. Parker raises the vapor of the water by means of a lamp, and he also introduces beneath the cloak which surrounds the patient, an oxide of mercury, furnished with a separate lamp, for the purpose of vaporizing it; hence, he observes, the patient is "exposed to the influence of three agents-heated air, common steam, and the vapor of mercury." Here, it will be seen, the treatment is made to turn upon the general emunctory property of mercury, and the special emunctory action of the skin.

In Germany, in addition to several curative processes, which turn upon the limitation of supplies, one method of treatment, which may be briefly defined as a triple compound of starving, purging, and sweating, enjoys especial favor. I mean the treatment by Zittmann's decoction. This treatment is as follows:

:

On the first day the patient takes a full dose of calomel and the resinous extract of jalap. During the next four days he drinks daily two quarts of Zittmann's decoction; one quart of the strong decoction, taken warm in the morning, and one quart of the weak, cold, at mid-day. On the sixth day he repeats his calomel and jalap pills; and during the four succeeding days, continues the decoction, as before. On the eleventh day, if the patient be strong, he takes another dose of the purgative pills; if not, this is dispensed with.

During the above treatment, the patient's diet is carefully regulated; on the days when he takes the purgative medicine he has three meals of broth; on the decoction days he is allowed two ounces of roast-meat and two ounces of bread. He keeps his bed during the entire treatment, and at its conclusion is not permitted to quit his room for some time longer, maintaining a low diet, and drinking the decoction of the woods. If the patient be suffering under syphilitic ulcers, these