Externally, mercury can be employed in the form of the ordinary mer curial ointment. The most convenient method of using this salve is to smear it inside the flannel band which covers the infant's belly. When this is done great cleanliness must be observed. The whole body must be washed well with soap and water every night so that all old ointment is removed before a fresh application is made. Another way of using mercury externally is in the form of mercurial baths. Thirty to ninety grains of the perchloride may be dissolved in two gallons of warm water. It is better to begin with the smaller quantity and gradually to increase the strength of the solution. The baths, besides their effect upon the general system, have a very beneficial local influence upon the cutaneous lesions. When the cachexia is very severe, it is well to combine external with internal treat ment ; and in cases where there is great irritability of the stomach or bowels, we may be forced to depend exclusively upon the cutaneous ab sorption of the remedy.
If a mother who is giving suck to her diseased infant be herself under going treatment, it may be unnecessary in addition to give mercury to the child. Doubts have been entertained as to whether mercury is really se creted by the breast. Cullerier has tested the milk of mercurialised moth ers without finding evidence of the drug in the secretion. Still, it seems certain that an appreciable amount of the remedy must reach the child by this means, for in mild cases very rapid improvement is noticed in his symptoms while he remains at the breast. In cases of severity I am disin clined to trust to the child's getting a sufficiency of the drug by this chan nel, and prefer to supplement the treatment by the direct application _of mercurial ointment to the abdomen.
While specific treatment is being adopted, we must do our best to im prove the general nutrition of the infant. The milk in syphilitic mothers is too often poor and watery, and ill-adapted for the supply of sufficient nourishment to their offspring. Therefore if the child wastes, especially if, by frequently requiring the breast and crying peevishly after his meal, he seem to be ill-satisfied by the milk he has swallowed, it is well to give alternate meals of cove's milk diluted with an equal quantity of barley water, and containing a small quantity of some malted food, such as 3Iellin's Food for Infants. If the child have a difficulty in sucking, on ac count of the condition of his nasal passages, this food must be given with a syringe. If a feecling-bottle be used, care must be taken that no other child be allowed to suck at the mouth-piece used for the diseased infant; and the nurse should be cautioned not to put the teat into her own mouth. In connection with this subject it may be well to remark that it
is a duty in all these cases to warn the nurses and servants in immediate attendanCe upon the child of the danger of infection from mucous patches and other discharging sores upon the patient's body. They should be di rected to observe great cleanliness ; to avoid wiping their hands upon any cloth or towel used for the infant ; and if they have a finger wounded by any accidental cut or abrasion, on no account to handle the child unless the part is properly protected.
The infant must be kept perfectly clean. His whole body should be bathed with warm water twice a day ; and if mercurial inunctions are being employed, soap should be used for the evening bath. Care must be taken to dry the child thoroughly after each washing. Fresh air is of the utmost importance, and if the patient be strong enough and the weather dry, he can be taken out every day warmly dressed into the air.
Vomiting is best treated by suspending the mercurial for a few days. If the symptom continue and there be a sour smell from the breath, the diet must be altered, as recommended in such cases (see Infantile Atrophy). If looseness of the bowels occur and be not arrested by stopping the medi cine, an alkali with tincture of catechu will usually check the derangement at once. Diarrhcca, is seldom obstinate in these cases if the diet be regu lated and the child's body be sufficiently protected from the cold.
It is important to attend to the condition of the nostrils. All hard crusts must be removed by bathing with warm water after softening with cold cream. An ointment of the red oxide of mercury may then be em ployed to the inside of the nostrils. Mucous patches must be well touched with the solid nitrate of silver, and if large ecthymatous crusts have formed on the body, they must be removed by poulticing. The uncovered ulcer can then be treated with the red mercurial ointment.
Internal treatment must not be continued long after the symptoms of the disease cease to be noticed. On account of the profound anaemia often induced by the long-continued administration of mercurials it is wise to change the treatment as soon as the skin has recovered its healthy appear ance, and the other specific symptoms have subsided. Cod-liver oil and iron can then be given. In addition, every care must be taken to promote healthy nutrition by judicious regulation of the diet, and vigilant attention to all the minor agencies which exert so material an influence upon the well-being of the infant.