Before noticing the constitutional or secondary symptoms which follow the Hunterian or infecting sore, we shall very briefly describe the treatment required for the last three forms, in which no constitutional symptoms occur. A suppurating sore should at once be thoroughly cauterized, so as to destroy all the tissues which have imbibed the poison. To secure this result, strong caustics are desirable; and as they sometimes extend further than is desired, an antidote should be at hand, which not only checks the further exten sion of the caustic, but deadens the pain. The agents most used in these cases are caus tics and the mineral acids, and the potassa cum cake, a combination of potash and lime, is prepared in the form of small rods for this purpose. The last of these is on the whole the best, as the extent to which it acts may be accurately regulated. When the action is sufficient, the application of a dilute acid will relieve the pain. Nitrate of silver, which is often employed, is not sufficiently energetic in its action to eradicate the disease. In the ulcerative sore, which is often irritable and painful, opium is useful both locally and internally. In other respects, the same treatment must be adopted as in the preceding variety. As the various means that have been suggested for prevent ing the suppuration of the bubo, which always accompanies this sore, are of no avail, it is useless to mention them. If, after the bubo has burst, the remains of an indolent, enlarged gland, incapable of forming healthy granulations, are left, caustic must he applied, so as to cause them to slough away. In sloughing sores, the great object-is to check the destructive process; for which purpose, fomentations and poultices are applied locally, and large and repeated doses of opium are given internally. The nitric acid lotion, or a solution of potassio-tartrate of iron (10 grains to an ounce of water), is often an efficient local application in these cases.
We now return to the consideration of the Hunterian or indurated chancre, the only variety of venereal sore that gives rise to secondary or constitutional symptoms. If the patient seeks medical assistance as soon as he perceives the sore, it is possible that the application of a caustic will destroy the poison, and prevent any constitutional symp toms. If, however, four days or more elapse before treatment commences, the best local application is some form of mercury, as mercurial ointment spread on lint, or the application of black wash (see LorioNs) steeped in the same material. When the poison has once entered the circulation, and become diffused throughout the body, it is desira ble to neutralize it, if possible, before the appearance of any secondary symptoms. A. very large number of drugs have at different times possessed an anti-syphilitic reputa tion, and a few are doubtless useful; as, for example, iodide of potassium. "There is one medicine alone," says Mr. Henry Lee, one of the highest British authorities on the subject, " which, through good report and evil report, in spite of the strongest preju dices of some against its use, and the no less adverse influence of others, who have employed it to an unjustifiable extent, has maintained its general reputation."—Op. cit.,
p. 418. In these remarks on the value of mercury (if judiciously given) we fully con cur; but the mercurialists and non-mercurialists are almost equally divided. It may be given internally in pills or in solution; or it may be introduced into the system through the skin, in the form of ointment; or lastly, it may be employed in the form of vapor, and thus applied to the skin. Of these three methods, none is equal to mercurial fumi gation by calomel vapor, either in the readiness with which it removes the symptoms, or the slight disturbance it excites in the constitution, or in its certainty in preventing relapse This process is a very simple one. A piece of brick must be heated to a dull red heat, and placed in a pan having a little water at the bottom. A quantity of calo mel, varying from 10 to 20 grains, is placed on the top of the brick; and the patient the. sits over the pan iu a cane-bottomed chair, enveloped from his neck downward in a largo blanket.* The operation is best performed at bedtime; it is complete in a quarter of an hour; and when the patient is sufficiently cool to put on his night-shirt, he should go to bed without disturbing the calomel on the surface of the skin. It is almost impossible to produce salivation by this means of administering mercury; and all that is requisite is to produce a slight tenderness of the gums. The system must be kept under this gentle influence of the mercury till the induration in the primary sore has disappeared. At a period usually varying from one to two months after the first appearance of the induration (which is regarded by some writers as the first of the secondary symptoms), slight febrile symptoms, usually followed by an exanthematous eruption of the skin, often accompanied by sore throat, will occur. This eruption is a variety of roseola; it is of a rose-red color, which disappears on pressure, and is not raised above the surface. It gener ally disappears in a few days, but if it persist, it will gradually change to a copper color, which is characteristic of all syphilitic eruptions which remain for a considerable time without suppurating or ulcerating. The syphilitic eruptions which usually follow this primary rash may assume the varied forms of lichen, syphilitic tubercle, lepra, and pso riasis; and the best mode of treating them is by applying local mercurial fumigation, and at the same time giving iodide of potassium (in five-grain doses thrice a day) inter nally. Occasionally, in persons with impaired constitutions, syphilitic eruptions assume a pustular character. For a description of these eruptions, we must refer to Cazenave's Mannal of Diseases of the Skin, translated by Burgess. Similarly, there are cases in which, from some constitutional peculiarity, or, as Mr. Lee suggests, from some want of power in carrying out the natural processes of the disease, the syphilitic eruption may be accompanied by an effusion of serum only; or, in other words, may be of the vesicu lar type. Thus, we hear of syphilitic herpes, syphilitic eczema, etc. These forms must be treated as the others.