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 some fluid fat. Calomel is also used suspended in olive oil. After a few months of weekly injections there should be some weeks of rest from treatment.

But the most usual, and, perhaps, the most satisfactory method of administering mercury is by the mouth, in the form of pills or mixtures. The pills generally contain metallic mercury finely divided, as in “blue pill” and as in pills made of “grey powder,” or as calomel, or some other salt of mercury, such as the bichloride or tannate. The preparation given in a mixture is usually a solution of perchloride of mercury.

Whilst the individual is undergoing mercurial treatment his diet must be regulated. Plain meat, roast and boiled, and vegetables which cannot cause indigestion or diarrhoea, will form his chief food. Spirits and liqueurs should be absolutely forbidden, but a glass or two of wholesome wine or beer may occasionally be allowed, If there is any secondary eruption of the tongue, mouth or throat, smoking must be forbidden. The dress must be warm, arid there should be no exposure to extremes of cold or heat, nor should excessive work or amusement be undertaken. Briefly, it may be said that the subject of syphilis should live low and think high. It has been said by an English physician who delighted in epigrams, “Syphilis once, syphilis ever”; but this is not true. If the individual places himself unreservedly and continuously under the treatment of a trustworthy practitioner, he may confidently look forward to a cure; and, if so be that he is eventually married, may depend upon his children showing no sign of his unfortunate infection.

Unlike whooping-cough, smallpox or pleurisy, syphilis is not a disease which, left untreated, cures itself in the course of time. Syphilis is a disease which peculiarly calls for treatment, and that treatment, to be effectual, must be prolonged. To: promote the healing of an ulcer, or to get rid of a cutaneous eruption, the result of syphilis, is not to treat syphilis. It is merely to free the patient of a symptom of the disease. To cure syphilis—and the disease is curable—the treatment must be patient and prolonged. And it must be for the surgeon to say to the individual that he may consider himself as cured, not for the patient to take upon himself the assumption that, because no secondary or tertiary symptoms have been seen for a certain number of months, he is cured.

In the midst of the uncertainties which surround the subject of syphilis, the question sometimes arises as to whether the treatment by mercury, for instance, is of the importance which is ascribed to it. Two instances may be given in proof of its Undoubted value. First, a woman who has been infected and never properly treated, becomes pregnant, and though, perhaps, showing signs of good health in every other respect, has a miscarriage; pregnancy and miscarriage follow each other at short intervals, four, six or eight times. Then, at last, she is put upon mercurial treatment, and, going to her full time, bears a healthy infant. Second, an infected but healthy-looking woman, who has not been properly treated, produces a child who, in the course of a few weeks, becomes shrivelled and wan. His food does him no good, and daily he becomes more miserable. At last some mercurial ointment is spread upon his " binder," and he quickly becomes healthy and happy, and, in due course, if the treatment is persevered in, is entirely cured.

When should the Treatment of Syphilis be begun?—The answer to this important question is: “As soon as the disease is diagnosed.” As soon as it is seen that the primary sore is hard, and that the glands in anatomical association with it are swollen, mercury should be administered. It may not prevent the outbreak of the secondary symptoms, but it may greatly modify them. But if a surgeon is in doubt as to whether a sore is truly an infecting one, he should wait before condemning the individual as syphilitic, and placing him under the necessity of submitting himself to perhaps a two years’ treatment, which, after all, may not have been necessary. Time would quickly clear up doubt.

Abortive Treatment.—When it is remembered that the germs of syphilis have been incubating at the seat of inoculation for a month, more or less, before the primary sore or chancre makes its appearance, it may be taken for granted that the removal of the sore ' by wide dissection, or its destruction by cautery, will not prevent the occurrence of secondary symptoms. For during those weeks the germs were finding their way into the lymphatics and the blood vessels and were producing a general infection.

When the disease has undergone,, a sufficient treatment by mercury, or when a patient presents himself with lesions which denote the fact that the disease has passed into the tertiary stage, a solution of iodide of potassium is given in combination with that of perchloride of mercury, or the iodide, is given by itself. In these conditions the effect of the potassium salt is often most remarkable. It is a drug of the greatest value, and, recognized as such, is apt to be found an important ingredient in popular " blood mixtures." If given, however, in doses larger than can be borne by the patient, its poisonous effects are manifested by a metallic taste, by watering of the eyes and by the breaking out on the back and shoulders of scattered pimples.

Thus, mercury in some form is the recognized and proper treatment for syphilis in the secondary stage, and iodide of potassium in the tertiary. And, for as much as one cannot say where the secondary stage ends and the tertiary begins, it is a common practice to combine the mercuric with the potash salt in the treatment of certain phases of the disease.

In 1910 attention was hopefully directed towards Professor Ehrlich’s treatment of syphilis by a complex preparation of arsenic, conveniently spoken of as “606.”

Gummata.—The most characteristic form of the generalized syphilitic infection, which may not manifest itself for several years after the reception of the virus, is a new growth in various organs —the liver, testes or brain, the muscles (tongue and jaw-muscles especially), the periosteum, the skin and the lungs. The deposits are called gummata from the tenacious appearance of the fresh-cut surface and of the discharge oozing from it. The structure consists of small round cells among thin fibres ; it closely resembles granulation-tissue, only that the cells are smaller and the intercellular substance (fibres) denser.: Molecular death, or necrosis, overtakes, this ill-organized, new formation at various central points, owing to the inadequacy of the blood supply. One remarkable feature of the process is the overgrowth of cells in the inner coat of the arteries within the affected area, which may obliterate the vessel. Gummata, and the ulcers left by them, constitute the tertiary manifestations of syphilis.

In a large proportion of cases only the secondary symptoms occur, and not the tertiary, the virus having presumably exhausted itself of been destroyed by treatment in the earlier manifestations.

Inherited Syphilis.—In the syphilis of the offspring it is necessary to distinguish two classes of effects—there are the effects of general intra-uterine mal-nutrition, due to the placental syphilis of the mother; and there are the true specific effects acquired by inheritance from either parent and conveyed, along with all other inherited qualities, in the sperm-elements or in the ovum. These two classes of effects are commingled in such a way as not to be readily distinguished; but it is probable that the ill-organized growth of bone, at the epiphysial line in the long bones (sometimes amounting to suppuration), and on the surfaces of the membrane-bones of the skull (Parrot’s nodes) is a result of general placental mal-nutrition, like the corresponding errors of growth in rickets. The rashes and fissures of the skin, the snuffles and such-like well-known symptoms in the offspring are characteristic effects of the specific taint; so also the peculiar overgrowth in the liver, the interstitial pneumonia alba of the lungs and the like. As in rickets, it is in many cases some months after birth before the congenital syphilitic effects show themselves, while other effects come to light during childhood and youth.

It must be remembered that the moist eruptions and ulcerations about the mouth and anus of the infant, as well as the skin affections generally, are charged with the spirochaetes and are highly contagious.

From the second to the sixth year there is commonly a rest in the symptoms that are regarded as characteristic, but the tibiae may become thickened from periostitis, or a joint may become swollen and painful, and resolve under mercurial treatment.

The characteristic physiognomy gradually manifests itself if the child is not treated with mercury—the flattened nose, the square forehead, the radiating lines from the mouth, the stunted figure and pallid face. During the second dentition, the three signs, as pointed out by Jonathan Hutchinson, may be looked for—the notched incisor teeth of the upper jaw, interstitial corneitis and syphilitic deafness. Perforation of the soft or hard palate may occur, and ulcerations of the skin and cellular tissue. Destruction of the nasal bones, caries of the forehead and skull, of the long bones, may also take place.

Colles’ Law.—A woman giving birth to a syphilitic infant cannot be inoculated with syphilis by the infant when she is suckling it; in other words, though the mother may have shown no definite signs of syphilis, she is immune; whereas the syphilitic infant put to the breast of a healthy woman may inoculate her nipple and convey syphilis to her. This is known as Colles’ Law, and it is explained by the theory that, the mother’s blood being already infected, her skin is proof against a local cultivation of germs in the form of a Hunterian sore.

Syphilis and Marriage.—The question as to how soon it would be safe for a person with secondary syphilis to marry is of extreme importance, and the disregard of it may cause lasting mental distress to the parent and permanent physical injury to the offspring. A man who finds himself to be the subject of secondary syphilis when he is engaged to be married would do well honourably to free himself from responsibility. But should a person who has been under regular and continuous treatment desire to marry, consent may be given when he has seen no symptoms of his disease for two full years. But even then no actual promise can be made that his troubles are at an end.

The transmission of syphilis to the third generation is quite possible, but it is difficult of absolute proof because of the chance of there having been intercurrent infection of the offspring of the second generation.

.—A. Fournier, Treatment of Syphilis, trans. C. F. Marshall (1906); R. Clement Lucas, ''Brit. Med. Journal (1908); A Manual of Venereal Diseases, by Sir Alfred Keogh and others (1907); Power and Murphy, A System of Syphilis'' (1908).