3. Treatment of Late Hereditary the iodides take first rank and nearly always bring about rapid improvement if only given in sufficiently large doses. The daily close of the iodide salt, potassium or sodium iodide, is so regulated that the child receives a decigram (1?i gr.) per day for each year of its life. The iodide is pre scribed in aqueous solution without syrup, and the appropriate close is given three times a day in sweetened milk. Bardach recommends iodfer ratose. In case of severe visceral affections and in ulcerations, the iodide alone is sometimes inadequate and needs to be supported by a simul taneous treatment with inunctions of 2 to 3 Gm. (30-45 gr.), daily of mercurial ointment.
Madan recommends here the subcutaneous injection of 5 c.c. of a 10 per cent. solution of mercuric cyanide every second day in combina tion with the internal treatment with iodide of potassium. In older children intragluteal injections of other soluble salts of mercury can be used, especially if it is desirable to get a rapid therapeutic action on Account of the involvement of sonic important organ such as the eye or ear.
In general there is no difference between the treatment of late hereditary syphilis and that of the tertiary stage of acquired syphilis. It is even more important, however, in the former to look carefully after the general health and strength of these children who are nearly always cachectic. Following the specific treatment the use of remedies containing arsenic is to be recommended, such as Fowler's solution, Roneegno, Levigo or Guber water. If circumstances permit, drinking
and bathing in the water of springs that contain iodide and arsenic are to be recommended.
4. Treatment of Acquired Syphilis in is in every respect the same as in the adult; especially is this true with refer ence to the treatment of the primary lesion and the condylomata. The constitutional treatment should not be begun until the secondary man ifestations have set in; then it should be pushed energetically and whenever possible in the form of inunctions. In older children, the mouth requires exactly the same care as that of adults who are taking mercury. I do not think it necessary to carry out the prolonged inter mittent treatment in the acquired syphilis of childhood that is so much favored at the present time in the treatment of the adult, because of the relatively easy course and mild character of contact syphilis in child hood. I recommend treatment by inunctions until all secondary symp toms have disappeared, this treatment to be repeated as often as there recur any manifestations of the disease. One should make it a rule, to treat all recurrences of syphilis on the skin and mucous membranes, not merely locally, but also constitutionally, that is, with mercury in case of condylomata, and with iodides in case of gummata.