of his body. At the period of his visit to me, ten days after the appearance of the eruption, I found a number of dirty red, circular spots (roseola orbicularis), measuring three and four lines in diameter, dispersed over his limbs, the front of his trunk, and face. In some, the dull-red had faded into a brownish or yellowish-brown hue; in others, the cuticle covering the spots had become thickened, and was beginning to crack near the outer margin of the spot; in some, the cuticle had separated partially or completely, leaving either a thin scale over the central part, or leaving it entirely smooth, and in some few, a fresh exfoliation of cuticle had commenced, or was in progress. The edge of cuticle remaining connected with the margin of the spot, formed around it a kind of frill (Plate 1, E).

His voice is husky; he has an uncomfortable feeling in the throat, not amounting to sore-throat; and he has felt deep-seated pains in the thighs during the past three weeks.

The treatment pursued in this case was in the first instance, the usual remedies for gonorrhoea. As soon as the superficial sore at the root of the penis appeared, he began to take the iodide of potassium, which he continued for a week. And for the three weeks previous to my seeing him, he had been taking the biniodide of mercury, i'th of a grain at first; then th twice a day. I prescribed for him a third of a grain three times a day, which he took very regularly for five weeks. During this period, his gums were, on several occasions, tender for two or three days at a time; and during the last four days of the treatment, the tenderness of the gums was more marked. He did not suspend the remedy on account of the tenderness; for, after a few days, the feeling in the mouth subsided.

In a week after commencing the biniodide in the doses

above named, the spots began to fade, and in a month they had entirely disappeared.

Three weeks after the disappearance of the rash, and two months after its outbreak, a second attack of the exanthem occurred, this time assuming the form of roseola annulata (Plate 1, D). The rings were dispersed over various parts of the body, more especially the limbs, and were accompanied, a week later, with pains in the joints; a little soreness of throat; slight swelling of the tonsils; pains and tenderness of the urethra, and a return of the gleet. By the aid of the bichloride of mercury and country air, all these symptoms disappeared in three weeks.

Taking a summary of the five cases just detailed, we perceive that the primary disease in two of the number was the simple chancre; in two, gonorrhoea with excoriation, and in the remaining one, balanitis, with possibly a simple chancre; although the presence of the latter must not be considered as at all necessary to the production of the constitutional disease which followed. The roseola made its appearance at the several periods of six, eight, nine, and seventeen weeks after the manifestation of the primary disease. In case 10, the series of symptoms accompanying the roseola were, sordid skin, night perspirations, congested fauces; and, a week or two later, nocturnal neuralgia; and a similar series of pathognomonic symptoms were seen in 11, 12, and 13.

In case 13 there is, moreover, at a later period of the disease, the additional symptom, an aphthous state of the mucous membrane of the mouth. The concurrence or immediate succession of the three typical forms of constitutional syphilis is also illustrated by these cases. case 10, there were lichenous papules on the face at the same time with the roseola on the rest of the body. In case 13, a second attack of roseola was accompanied with

In

lichen on the head and face. In case 11, a subsequent attack of eruption assumed the lichenous form, and in case 12 the tubercular character.

These cases, also, taken at hazard, illustrate the sources of obscurity which attend the manifestation of syphilis, and the necessity for a thorough knowledge of the laws of the syphilitic poison, to enable us to form a just diagnosis, and, consequently, adopt a sound treatment. In two out of the five cases there existed the complication of a morbid secondary action at the seat of the original sore, which might be mistaken for a new sore in the one case, and for an uncured primary sore in the other; both being, as I believe, the effects of the secondary poison. Thus in case 13, a month after the primary gonorrhoea and excoriation, there occurred a thickening and induration of the tissues of the part which had been excoriated; and soon after, the mucous membrane became abraded, and a superficial ulceration took place. At that time, the proper period for the manifestation of secondary disease, there was no other symptom of constitutional syphilis; but five weeks later, the period when a second crisis of the syphilitic poison might have been expected, a variety of roseola made its appearance, namely, roseola orbicularis: a similar order of symptoms was seen in case 14. In case 11, on the occurrence of the secondary symptoms, nine weeks after the commencement of the primary disease, the swelling of the prepuce returned, indicating a secondary action in the part. The case then became obscured by the exposure of the patient to a new source of contagion, and three weeks afterwards a superficial sore (secondary, as I believe) made its appearance on the prepuce. Five weeks later, the syphilitic crisis resumed its more recognizable character, of a cutaneous eruption. As I before remarked, these cases are important, as exhibiting

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the frequency of causes of obscurity, and the impossibility of forming a correct diagnosis without the most careful and ample consideration of all the features of the case.

SYPHILODERMA PAPULATUM.

LICHEN SYPHILITICUS.

As an illustration of the mode of manifestation of the lichenous eruption, I will now narrate some cases, taken, as in the instance of roseola, without selection, from my note-book.

CASE 15.-A young man, a carpenter by trade, aged twenty, contracted gonorrhoea and a venereal sore in the month of January, 1845. The sore got well at the expiration of two months, without leaving any afterconsequences.

In February, 1846, he again became the subject of venereal sore, this time situated in the fossa glandis. He was treated with mercury, and the sore healed in six weeks. While under mercurial treatment, he was frequently exposed to cold, having, in the prosecution of his avocations, to pass from a warm workshop into the cold air during the prevalence of a north-easterly wind. In consequence of this exposure, he became affected, three weeks after the first appearance of the sore, with severe rheumatic pains in his shoulders and knees, and at the same time was visited by a papular eruption, which broke out, first on the face, and then on the arms, legs, front of the trunk, and back.

He was in this state when he first came under my notice. The pimples offered some variety in point of

size, those of medium bulk being about equal in magnitude to a millet-seed. They were of a dull-red or purplish hue, and were collected into groups or clusters, varying in number from three or four to thirty (lichen corymbosus, Plate 1, G). The majority of the clusters contained ten or twelve of these pimples; and here and there a few solitary ones might be observed dispersed among the clusters. The patch of skin on which the clusters were placed was slightly raised, wrinkled, and of a dull-red hue.

After a week of treatment the greater part of the pimples had subsided, and were each covered with a little, thin, brownish scale of desiccated epiderma; there was also an epidermal exfoliation from the altered skin which formed the ground of the patch. The patches had become brownish in hue, and contrasted strongly with the color of the adjacent skin, although the latter presented the muddy and yellowish tint of syphilitic cachexia. Some few of the pimples, however, still lingered, and contained at their summits a whitish pus, and here and there a single fresh pimple showed itself.

At the end of another week every pimple was gone, and the ground of the patches was undergoing a general exfoliation. The patient had no sore-throat throughout. the whole course of the complaint; but, upon inspection, a slight congestion of the fauces was evident. He had no tumefaction or tenderness of the inguinal or other lymphatic glands; and the eruption, though somewhat tender on pressure, was unattended with pruritus.

CASE 16.-A young man, seventeen years of age, of delicate constitution, and inclined to scrofula, suffered, in May, 1848, from enlargement of a gland in the groin, the consequence of a sprain.

In the month of June he had suspicious connection,