Mucous patches on the throat and mouth and about the vulva and anus, though they yield in time to the steady use of the internal mercurial, have their disappearance hastened by a light touch of the solution of the Pernitrate of Mercury, and the wa riter has often applied this to the tonsils. Warts upon the tongue may be sintilarly treated; in these cases any form of local irritation, as that induced by tobacco, will greatly aggravate matters. Where the ulcers are deep a little of the powdered lodoform may be blown into them with the insufflator. This substance may be dusted over condvlomata, hut a mixture of Calomel and Oxide of Zinc answers very well.
Throughout the mercurial course diarrhoea is to be avoided, and for this reason a small quantity of Dover's Powder or Laudanum is to be com bined with the mercury when any tendency in this direction is observed. When rapid action is desired, the patient should be advised to give himself up to the treatment, and either to remain in bed or in a warm room, as free exposure to the air retards the action of the drug, probably by hastening elimination.
In the treatment of the secondary stage with mercury it may be necessary to push iodides in large doses, especially when the temperature runs high, when the hone pains are marked, or where the mucous mem branes are extensively involved in the ulcerative process.
In the later months of treatment tonics are and they should always be employed during the suspensionof the mercurial. They are some times used in the early stages too freely, to the detriment of the patient. Cod-Liver Oil often comes in well in the late stages in thin subjects.
Potassium Cldorate is a drug of much use for its local action upon the mucous membrane of the mouth and throat, and when ptyalism occurs it may he resorted to at once as a mouth-wash and gargle (i in go). It has no action in the blood upon the disease, as some have thought. The following may be used: Polassil Chloralis 5iv.
(dycerini Boracis .Iqace Rasa' nal GargaliN11111. on.—" To be used as a gargle Jrequenlly, and one tablespoon] ul lo be swallowed after meals, Iltree lilacs a day." Treatinen, 0/ the Terliary Slage.—The tertiary manifestations of the disease will require another drug for their destruction. Iodide of Sodium or Potassium has been already referred to; seldom is it so clearly indicated in the secondary period, hut occasionally it will lie found necessary to give nt the early periostitis of bones causes much pain, and where the ulceration of t lie throat does not readily yield to mercury, and it certainly has a marked influence over the high temperature often met with during the secondary stage. As mercury is clearly indicated in the secondary,
so Iodides are to be regarded as possessing almost specific action in the tertiary stage.
Mercury, if administered continuously for a long time, very materially diminishes the chance of tertiary symptoms. It has its influence upon the treatment of the sequehe in this way— that, given marked tertiary symptoms in a patient who has had little mercury administered to him in his secondary period, this drug will be foond to act very rapidly in removing them.
Iodide of sodium or of potassium is given for every tertiary symptom. Under its use large gummatous tumours melt away. and nodes, which had withstood all other agents, disappear as if by magic. Al any affirm that its effects are transitory, and that relapses always occur, and that in no sense is it curative. This is quite if its use be not continued long after the apparent removal of the local affection; hut there is sufficient clinical evidence to show that in many cases without the use of any other remedy the iodide has effected a removal which had become permanent. In dealing with tertiary manifestations and the effect of iodides upon them one can be quite satisfied that when they disappear it is not spontane ously, but by the result of the action of the drug, as these if let alone, seldom show any tendency whatever to resolve.
It will be a safe rule for the physician to make for his own practice, notwithstanding these considerations. that in no case should the action of the iodide be depended upon unless followed immediately before or after, or used in conjunction with, salvarsan and mercury in some form or other.
For the group of symptoms known as " intermediate" the best treatment will be a combination of the iodide with the usual salvarsan and mercurial dose. Under this plan choroiditis, testicular sarcocele. and various early cerebral affections disappear, and the specific action of the iodide seems to increase as the affections become more and more separated from the primary stages.