tional syphilis, and affords great comfort to the patient. By these means I have never failed in checking the fall of the hair, and causing its reproduction where it had already fallen.

TREATMENT OF SYPHILITIC AFFECTIONS OF THE HANDS AND

FEET.

The chronic affections of the nails, attended with dryness and imperfect formation, come into the same category with erythematous affections of the palms of the hands and soles of the feet, and their treatment is mercurial; either the biniodide or the bichloride. It is quite remarkable how rapidly chronic erythemata of the hands and feet, attended with desiccation, cracking, and exfoliation of the cuticle, and depending on syphilis, give way to the action of either of the above preparations, in alterative doses. In three weeks the misery of years may frequently be entirely cured, after every other remedy and mode of treatment had been tried in vain. Medical men suffering from this complaint have been startled at my audacity, when I have promised them a cure, in three weeks, of that which has baffled themselves for months, and more frequently for years; but my promise has rarely failed to be accomplished.

I must mention, however, that these erythematous disorders are apt to return from time to time; but the remedy may be repeated as often as they appear, and in the end will prove triumphant. I do not believe that any good results from continuing the medicine for many days beyond the period of cure: I order it to be left off at the end of a week after the skin is healed; and prefer, in case of any return, to resume the remedy as before.

For the local treatment of these erythemata, the camphor cerate is the best application, or the oxide of

If

zinc ointment with honey or the spirit of camphor. In either case, the proportion is a drachm to the ounce. glycerine can be procured free from odor, an ointment containing a drachm of that fluid to the ounce of simple cerate is a good application; or a lotion, containing one part of glycerine to three of camphor mixture, or rose

water.

The purpose of these local remedies is simply to keep the skin moist; and great comfort is sometimes obtained by sleeping with a water-dressing on the parts; the cure is to be looked for from the internal remedies alone.

ONYCHIA and the painful granulating sores which sometimes form under and around the nails, also derive their cure from the constitutional treatment; but they at the same time require some local management. When in an inflamed state, water-dressing, or a solution of opium in place of simple water; when less painful, a weak solution of chloride of zinc, or acetate of lead, are the proper remedies. Sometimes the zinc ointment, or simple cerate with camphor, or an ointment of Peruvian balsam, answer better than the lotions; and in two or three instances I have obtained the best results from covering the granulations with powder of charcoal.

TREATMENT OF CONDYLOMA.

Condyloma, like other forms of syphilitic tubercle, obeys the will of the internal remedies employed against the manifestation of the syphilitic poison on the skin. It would get well without any external application; but sometimes we may be required to treat it locally, when the nitrate of silver, the oxide of zinc ointment, or a lotion of chloride of zinc, or alum, or the black or yellow wash, will be found the best suited to our purpose.

After drying the tubercles well, it has been recommended to powder them with calomel.

TREATMENT OF AFFECTIONS OF THE MUCOUS MEMBRANE OF THE MOUTH AND THROAT.

What I have said with regard to all the other syphilitic affections which have been passed in review before us, must be repeated with regard to those of the mucous membrane of the mouth and throat. The disease is not in the mucous membrane, but in the blood; and therefore the general constitutional treatment directed towards the removal of the poison from the blood must be looked to for relief to the local affections, which are mere manifestations of the existence of the poison, and probably outlets for its escape. The ulcerations of the tonsils, the mucous membrane of the pharynx and fauces, and of the tongue, will heal under the use of the general treatment of constitutional syphilis; but their progress may be assisted, or local indications may be fulfilled, by the application of nitrate of silver, or the use of antiseptic and gently stimulating gargles, such as that of alum in compound infusion of roses; hydrochloric acid in simple infusion of roses; the bichloride of mercury in a weak solution of hydrochloric acid; the nitric-acid lotion; a weak solution of tannin; an infusion of green tea (zij ad Oj); or a lotion of chloride of soda. Where the ulceration is extensive, advantage may be attained by the use of mercurial fumigations; or by touching the sores with the bichloride of mercury in honey, in the proportion of from five to ten grains to the ounce.

If the affection of the throat belong to the latter period of the secondary disease, our chief reliance must be placed in the iodide of potassium.

TREATMENT OF CONGENITAL SYPHILIS.

In the instance of the infant affected with syphilis, the treatment must consist of mercury; and the best remedies, in every respect, according to my experience, are, the bichloride or the hydrargyrum cum cretâ, which may be administered either to mother or child, or both, according to the judgment of the surgeon. If the mother evince symptoms of constitutional syphilis, it may be sufficient to exhibit the mercury to her only, the infant drawing its nourishment from her breast being regarded as part of herself. If the proportion of mercury thus conveyed to the infant be deemed insufficient, there can be no objection to give it independently to the latter. And in several instances I have satisfied myself with giving it to the infant only. I have not, in this case, for an instant imagined that the mother was free from the poison; but only that her tissues were so far accustomed to its presence, that it was incapable of setting up any morbid action, at least so long as she continued to suckle, and the milk performed the office of an emunctory current; and I was quite prepared, should any retardation in the cure of the infant occur, to exhibit the remedy to the mother also. In a word, I consider the safest practice in these cases to be, to give mercury to the mother as well as to the infant; taking care to moderate the dose to such a degree as not to check or injure the secretion of milk.

I have heard it suggested, that the infant may be affected with syphilis in the womb of its mother, without the latter being contaminated; and that contamination of the mother may subsequently occur in consequence of the transmission of the poison of the diseased child to the tissues of the parent. Such a theory I consider

to be most unphilosophical: it is easy to comprehend that, in the instance of syphilitic contagion, the child may be the seat of manifestation of the disease, just as in a male, the disease may fix upon one spot or one organ of the entire body; indeed, not merely because the foetus under such circumstances is a part of the whole, but because it is also a part of more recent formation, a new organ, and made up of new tissues, which we may conceive to be more susceptible of receiving, and more easily influenced by, a morbid poison.

It is also perfectly consistent with physiological laws, that the foetus having become the focus of excessive accumulation of the poison, the latter may react upon the parent with such force as to cause a manifestation of the presence of the poison in her tissues as well. The problem, therefore, resolves itself simply into one of latency and development.

The dose of the bichloride to the mother, under the above circumstances, should be one-sixteenth of a grain in combination with syrup of poppies and tincture of bark, or the compound fluid extract of sarsaparilla, three times a day; and to the infant, one twenty-fourth of a grain in syrup of poppies and dill-water.

The local treatment for excoriations around the nose and mouth of the infant is the oxide of zinc ointment, or an ointment composed of a drachm of the unguentum hydrargyri nitratis to the ounce of ceratum cetacei. The latter is especially applicable to excoriations in the neighborhood of the eyelids. For cracks upon the hands and feet, and for excoriations around the pudendum and anus, the oxide of zinc ointment is also the proper application; and secretions in these parts may be absorbed by the oxide of zinc powder. For discharges from the meatuses of the ears, soap and water is the best remedy.