siognomy from his foregoers, varies also in constitution, in the characters of his disease, and in his susceptibility to the influence of medicine.

Neuralgia, and chronic enlargement of the TESTICLE, one of the morbid effects of chronic syphilis, and occupying, according to Ricord, a transition position between secondary and tertiary syphilis, requires iodide of potassium for its treatment. The enlargement of the testis, mentioned in case 4, was quickly and effectually removed by this medicine, and the pains in the organ subsided at the same time with those in the joints.

Affections of a later period of chronic syphilis, and all those coming under the category of the "tertiary” syphilis of Ricord, namely, such as are developed at a long period after the occurrence of the primary disease, and affect the deeper structures of the body; for example, the fibrous tissue of the penis, the periosteum, and bones, giving rise to periosteal inflammation, nodes, and exostoses-are also to be treated with the iodide of potassium.

Locally, affections of the bones and periosteum, if they do not immediately yield to the iodide of potassium, require the addition of local applications, such as a few leeches; followed by poultices, fomentations, and sedatives, if the pain be acute; or a blister followed by sedatives, if the pain be chronic or obstinate; sometimes a repetition of blisters is necessary; and if there be a purulent formation, the matter must be let out by incision. The chronic thickening which sometimes succeeds to nodes must be treated by frictions of iodine or mercury, or the application of the ammoniaco-mercurial plaster.

The iodide of potassium seems to act, generally, upon all the tissues of the body, in a remarkably short space of time, and especially on the kidneys. Its combination

with the compound decoction of sarsaparilla facilitates its action, notably increasing its diuretic properties, and supplying a convenient vehicle, by which the poison may be excreted by the mucous membranes and by the skin.

After it has been taken for a time, it begins to excite an over-action in the various tissues of the body; firstly, in the mucous membrane; then, in the nervous system and brain; and these actions may be regarded as evincing the poisonous properties of the medicine. I have said that the symptoms now referred to are first perceived in the mucous membranes, and especially in that of the fauces, the nose, and the eyes. All that is necessary, therefore, is to watch for these symptoms, and if it be thought desirable, as soon as they occur, the use of the remedy should be suspended, or the dose reduced. In this way we are enabled to put an immediate stop to the continuation of the morbid effects.

When iodine begins to act as an irritant to the system, there is a feeling of stiffness and dryness in the throat; more or less coryza, and an uncomfortable feeling with increased secretion from the nose; sometimes tenderness of the salivary glands and salivation. By degrees the congestion extends to the trachea and bronchial tubes, adding bronchitis to the other symptoms. These indications of irritation of the mueous membrane generally precede those of disturbanec of the nervous system, and give sufficient warning of a necessity for putting a stop to the use of the medicine. When the iodine has been carried further, the patients complain of dimness of sight, giddiness, and pain in the head; and in one patient I saw severe palpitations of the heart. But although I have used the medicine extensively, I have seen very little of its morbid effects, probably from having exhibited it in small doses.

IRITIS, another particular affection sometimes attendant on constitutional syphilis, requires the administration of mercury until the mouth is made tender. For this purpose calomel and opium, in doses of two grains of the former combined with a quarter of a grain of the latter, and exhibited every four, six, or eight hours, in order to influence the system as speedily as possible, is the most valued treatment. The inflammation is usually of the chronic kind, and yields very favorably before the mercurial action. Bleeding is unnecessary, and the severe pains which sometimes accompany the iritis, being of a neuralgic kind, are speedily removed by the iodide of potassium.

In chronic syphilitic affections of an obstinate kind, a method of treatment is pursued on the continent, which has for its basis the bichloride of mercury. I am induced to refer to this plan, because it has been mentioned to me with praise by several physicians of northern Europe; but I must confess myself so little impressed in its favor, that I have not even ventured to give it a trial. The method is that of Dzondi, and is as follows:

He begins by exhibiting to his patient one-fifth of a grain of the bichloride of mercury, which he continues for twenty-seven days, augmenting the dose by one-tenth of a grain every third day, so that on the last day of treatment the dose has become raised to one grain and a half; and the patient will have taken in the course of twenty-seven days, twenty-two grains of the mercurial salt. During this course, the patient is to be kept warm, to live abstemiously, and to drink decoction of sarsaparilla, or of the woods. If salivation should threaten, the treatment is to be suspended until the danger is past, and then continued as before.

LOCAL TREATMENT OF THE SYPHILODERMATA.

Syphilitic eruptions of the skin, when general, require no other treatment than the occasional use of the tepid soap-bath. When local, and particularly when situated on the face, the diluted citrine ointment, or the nitricoxide of mercury ointment, applied with gentle friction, are good remedies, and tend to hasten the absorption of the pimples and tubercles, and the removal of the stains which they leave behind them.

When tubercles pass into a state of ulceration, these ointments are still of much service, as gentle stimulants. But when a more soothing remedy is required, or when we merely desire to protect the ulcer from the influence of the atmosphere, we may have recourse to the oxide of zinc ointment, either by itself or in combination with a few grains of camphor, or a few drops of liquor plumbi diacetatis.

For sloughing sores, an opiate lotion and water-dressing answer the purpose well, and if the ulcers be indisposed to heal, the black wash and yellow wash, either with or without opium. In these cases, and particularly in phagedænic sores, I have found a lotion of chloride of zinc of excellent service; a medium strength is one drachm to the half pint, but this can be increased or diminished, according to its effects, and particularly in reference to the degree of pain which it may occasion.

Of course, the local treatment is quite secondary to that of the general system; but I have succeeded beyond my expectation, in several instances, in causing the removal of local tubercular masses in a state of ulceration, by frictions with the mercurial ointment.

TREATMENT OF SYPHILITIC ALOPECIA.

It is remarkable how soon the fall of the hair, which accompanies syphilis, is checked by means of the remedies employed for the relief of the other symptoms; the mercurial preparations or the compounds of mercury with iodine. The plan of treatment is therefore simple and obvious. Occasionally, however, alopecia is the only evident symptom of the presence of the syphilitic poison in the blood, in which case we should hardly be warranted in subjecting our patient to a mercurial course. Under such circumstances, I have found the iodide of potassium, in three-grain doses, three times a day, or five grains twice a day, answer every purpose; continuing the treatment for a medium period of six weeks, unless symptoms of iodic irritation arise.

For local application the best remedy is a pomatum, consisting of one part of the nitric-oxide of mercury ointment to three of scented pomatum. This should be well rubbed into the roots of the hair at bedtime each night, and a proper degree of action maintained in the scalp, by means of plentiful friction with the hair-brush. As an aid to the stimulant excitation of the skin, the following wash, introduced among the roots of the hair by means of a sponge, may be used in the morning before brushing :

This hair-wash, besides aiding in the excitation of the skin, assists in removing the scurf which is apt to form upon the sordid skin of persons affected with constitu