which was followed in fourteen days by two small hard lumps on the corona glandis. These indurated pimples discharged a little ichorous fluid from their summits for about a week, and then, became small indolent ulcers, which healed in the course of a month. A week after the healing of the sores, he had a somewhat plentiful growth of warts from the fossa coronæ glandis and the inner surface of the prepuce.

Between six and seven weeks after the first appearance of the chancres, he became affected with an eruption of pimples, which broke out upon his back and arms chiefly, some few being distributed over other parts of the body, and two or three upon the face. The eruption consisted of large, isolated pimples (lichen disseminatus, Plate 1, H), of a dull red color; they attained their full growth in the course of a few days, and then became filled at their summits, some with a turbid, sero-purulent fluid, and others with a whitish pus.

On the occurrence of the eruption, he had no sorethroat, but several of the lymphatic glands became tender and enlarged. This was the case especially with the sub-occipital and cervical glands. The latter formed a tumor of large size on one side of the neck, and at a later period I was under the necessity of opening an abscess, and liberating about an ounce of pus.

In the course of treatment, fresh crops of eruption came out from time to time, and he was troubled with pains in his shoulders, but not of a severe kind.

He got well slowly with the aid of the bichloride of mercury, and it was not until after ten weeks that I was enabled to suspend his treatment.

Between five and six weeks afterwards he again appeared before me, this time complaining of soreness of throat, pains in the shoulders, and increase of size of the cervical tumor. The fauces were congested, the tonsils

being swollen and irregular, but there was no ulceration, and there was no reappearance of eruption on the skin. He attributed his present symptoms to exposure to cold.

CASE 17.-A gentleman, upwards of sixty years of age, observed, towards the latter end of January, 1847, a pimple on the prepuce. The pimple became inflamed and painful, but the inflammation was subdued by fomentation and water-dressing, and at the end of three or four weeks was to all appearance well. He had no affection of the glands in the groin, and he assured me that he had had no connection of any kind for many years. Being a man of influence and rank, I did not venture to ask him how, in that case, he had succeeded in obtaining a syphilitic sore?

A fortnight after the healing of the sore, that is, about six weeks from its first appearance, he discovered accidentally, while dressing, an eruption of dull-red spots on the front of his chest and abdomen. For this eruption he took medicine, but finding that the spots remained, and that others began to be perceptible on his arms and legs, he became alarmed, and applied to me, the eruption having by this time been in existence about two months.

I found him very much depressed in spirits; his tongue loaded with a dirty-white sordes; the fauces of a dull-red color, and congested; he was restless, and perspired much at night; his skin was muddy, and of a yellowish-brown color. He complained of being unable to get his skin clean, although he had taken a warm bath repeatedly, and was in the habit of doing so. The skin presented a curious combination of roseola and lichen in one place there were a number of dull-red spots congregated together, and forming a blotch, without any elevation, roseola; in another, the red spots were

represented by decided pimples, arranged in clusters of various dimensions, lichen corymbosus; and in a third, there were separate pimples, of somewhat larger size than those composing the clusters, lichen disseminatus. The pimples on the forehead and face, of which there were ten or twelve, were of the latter character.

I prescribed for this gentleman an aperient, to be taken every other night for a week, and a pill composed of five grains of blue pill, and one-twelfth of a grain of muriate of morphia, night and morning. A change for the better was soon apparent, both in the condition of the skin and in the patient's feelings, and on the twenty-first day of treatment, when he had taken forty-two pills, and had become aware of a metallic taste upon his tongue, and the margin of the gums was marked with the red line characteristic of the action of mercury on the mucous membrane of the mouth, the mercurial treatment was stopped, and the iodide of potassium and decoction of sarsaparilla treatment commenced. The eruption at this time was scarcely discoverable, and the induration left by the sore on the prepuce was entirely gone. This gentleman had no return of secondary symptoms.

CASE 18.-An Italian gentleman contracted a venereal sore in the month of November, 1849. The sore was trifling, and healed in twenty days with the aid of a simple ointment. He took no mercury.

About the middle of April, 1850, namely, five months after the appearance of the primary sore, he felt a little unwell, and experienced a sensation of stiffness in the skin of his head and neck. These symptoms were immediately followed by a lichenous eruption. He had no sore-throat, and only a slight degree of feverishness.

Six weeks after the outbreak of the eruption he first came under my notice; he was then covered with a

multitude of small syphilitic papules, and afforded a good example of lichen confertus (Plate 1, I). Almost every pore on his arms and trunk was raised into a small conical pimple, and the eruption presented a deeper tint than usual, from occurring in a person of dark complexion. On the face, the pimples were not so distinct; the entire skin appeared to be swollen, particularly about the eyes and forehead, and upon the latter there were several round and oblong blotches slightly raised above the level of the skin, and upon which the congested pores were very evident. This appearance afforded a good illustration of the transition of the distinct papules of lichen into those larger prominences which are known as tubercles, and the case was one in which the tubercles and papules of syphilis are found in the same person.

At this period, although he had no feeling of soreness in the throat, the fauces were congested, and he complained of the rapid loss of his hair.

Five weeks afterwards, the eruption was much improved, but he suffered an attack of syphilitic iritis.

In reviewing the four preceding cases, we are naturally led to search for some explanation of the circumstance of the syphilitic poison manifesting itself in the form of the raised eruption of lichen, instead of the merely congestive exanthem, roseola. The primary disease was of the most simple kind in all; a mere superficial sore in cases 15 and 18, two small indolent indurated ulcers in case 16, and a mere tubercle abraded on the summit in case 17. The period of outbreak of the eruption exhibits more irregularity than roseola and a minor degree of severity of febrile symptoms. In case 15, the eruption occurred three weeks after the first appearance of the primary disease, and while the latter was in full activity; in case 16, between two and three

weeks after the cure of the primary disease, and five weeks after its first outbreak; in case 17, three weeks after the cure of the primary disease, and six weeks from its first appearance; while in case 18, the eruption did not occur until four months after the cure of the primary disease.

The occurrence of the eruption in case 15, previously to the cure of the primary disease, seems explained by the fact of the patient being a young man of delicate constitution, and exposed to the cold while under the influence of mercury. Perhaps the same conditions may be sufficient to explain the eruption being lichenous instead of roseolous. In case 16, the subject was a delicate young man, predisposed to scrofulous disease, and exhibiting a pyogenic disposition, as was shown by the suppuration of some of the papules, and the formation of a large abscess in the neck. Case 17 hardly comes into the same category with the preceding, since the eruption was a mixture of roseola and lichen; but I think it more than probable, that if mercury had been administered earlier, the eruption would have been checked before it had reached the lichenous stage. Case 18 is very remarkable from the long period which intervened between the cure of the primary disease and the constitutional symptoms; the case was unalloyed by mercurial treatment. I am not prepared to say that the secondary disease would not have occurred if mercury had been given at first; but I believe that the iritis might have been prevented if mercury had been exhibited for the secondary symptoms.