been given internally; but I have not seen a single case in which this other method of treatment has failed." The ointment may be rubbed on the soles of the feet, and woollen socks worn; this answers very well: or a small quantity of the ointment may be smeared on the axilla, and worked in by the motion of the arms. I have also wrought several very good cures by dusting calomel more or less over the body of the child: it does not salivate or purge, or produce any inconvenience; but it very frequently speedily and safely removes the symptoms of syphilis. Infants are not so liable to relapse after the disappearance of the symptoms of constitutional syphilis as adults: cures in them are commonly sound and permanent.

CHAPTER XXXV.

OF THE EMPLOYMENT OF PARTICULAR REMEDIES IN THE TREATMENT OF CONSTITUTIONAL SYPHILIS.

THE MERCURIAL VAPOUR BATH.

THE patient is placed on a chair, and covered with an oilcloth lined with flannel, which is supported by a proper framework. Under the chair are placed a copper bath, containing from half a pint to a pint of water, and a tinned iron plate, on which is put from one to three drachms of the bisulphuret of mercury, or the same quantity of the grey oxide, or the binoxide, or other mercurial preparation: under each of these, a spirit-lamp. The patient is thus exposed to the influence of three agents, heated air, common steam, and the vapour of mercury, which is thus applied to the whole surface of the body in a moist state. After the patient has remained in the bath from five to ten minutes, perspiration generally commences, and by the end of twenty or thirty minutes, beyond which I do not prolong the bath, it is generally very free. The lamps are now removed, and the temperature gradually allowed to sink; when the patient has become moderately cool, the coverings are removed, and the body rubbed dry; he is then suffered to repose in an armchair for a short time, during which he drinks a cup of warm decoction of guiacum or sarsaparilla.

The apparatus requires some modification and arrangement to suit particular cases. Where it is wanted to induce a quick and decided action, the whole power of the bath should be brought into operation, and the largest quantity of mercury should be employed. In rapidly-spreading ulcers, this is required. Again, in chronic skin or throat diseases, where a powerful action would rather oppress the patient than cure his discase, the power of the bath should be modified, and not so

great a heat or so much mercury employed. This is accomplished by using smaller spirit-lamps, or, when perspiration has once been induced, by the removal of one lamp, leaving the patient thus exposed for a time to the mercurial vapour alone. This should be done where the patient has been broken down by long-continued disease, in bad or weak subjects, or where a more prolonged action is required to eradicate the more deep-seated effects of the venereal poison, as in diseases of the bones, or indurations on the penis. Each particular case would require a greater or less modification of this kind. The form of mercurial employed is also of consequence. In skin diseases, the bisulphuret is to be preferred; in diseases of the throat or nose, the grey oxide, binoxide, or calomel is better, because the patient can bear the head immersed without sneezing or coughing, which he cannot do when the bisulphuret is used.

I am in the habit of using four mercurial preparations for the bath-the bisulphuret of mercury, the binoxide of mercury, the grey or black oxide, and the iodide to this list, Mr Henry Lee has lately added the chloride of mercury. These may be used singly, or combined in different ways, to suit the peculiarities or emergencies of each particular case. The first three preparations are milder than the last, and from half a drachm to four drachms may be used with perfect safety. In one case half an ounce was used for each bath, and two applications were sufficient to bring the system fully under the influence of the remedy. The iodide must be used in smaller quantities; nearly the whole of this preparation is rapidly converted into vapour, and, unlike all the other preparations, leaves scarcely any ash behind it. From five grains to half a drachm of the iodide is sufficient, and it is better to use it in small quantities, mixed with a larger quantity of either of the other preparations. When calomel is used in ordinary cases, from ten to twenty grains may be employed for each bath. In affections of the testes (sarcocele) and of the bones (the various forms of ostitis or periostitis), a combination of a scruple of the iodide, and one or two drachms of the bisulphuret or binoxide, would be a proper form. For local application to the cavities of the nose or mouth, calomel or the grey oxide of mercury are the

best preparations. I have known the vapour of the biniodide of mercury used. A surgeon, by mistake, employed the biniodide instead of the iodide, in a most formidable case of secondary syphilitic ulceration. It produced violent diarrhoea with bloody stools, but it cured the disease. I have never used this salt by way of fumigation, on account of its irritating properties.

A short preparatory treatment should be adopted before using the baths. The bowels should be kept free, and the use of wine, spirits, &c., prohibited. The patient should be free from fever, the tongue clean, and the freedom from organic diseases, such as those of the heart and lungs, more particularly, should be ascertained. Should such or other complications be present, they might require modifications of treatment, but would not prevent its employ, as this is not only the most certain, but the safest way of curing most forms of constitutional syphilis.

This plan of treatment does not commonly require that the patient should forego his ordinary occupations of business, or that he should be confined to the house during its use. It must be admitted that its effects would be accelerated by confinement to bed, or to a couch in a moderately warm room; but this is by no means imperative, and I have very rarely advised it, except in such cases where exposure or exercise would be positively mischievous, as in the cases of sloughing, or rapidlyspreading ulcers in the throat or elsewhere.

The diet should be light, nutritious, and unstimulating: milk, chocolate or cocoa, night and morning; animal food for dinner, with weak wine-and-water. Where the patient has been reduced by mercury given internally, or by a combination of syphilis and mercury, the diet may be more nutritious; but stimulants should be avoided. Smoking must be prohibited, particularly in diseases of the throat and nose.

In a great majority of cases the moist mercurial vapour, employed as I have directed, is capable of curing the disease without the assistance of internal medicine; but the cure is generally expedited and rendered more certain by the administration of the latter in small quantities. It may be very advantageously combined with frictions of small quantities of the

Y

stronger mercurial ointment. (See the chapter On Mercurial Treatment.) The treatment is always assisted by the decoction of sarsaparilla or guaiacum, drank warm night and morning, and immediately after leaving the bath. I prefer the latter, the compound decoction, made according to the formula of the Edinburgh Pharmacopoeia. Where other medicines are required to assist the treatment, and I allude particularly to the various preparations of mercury, it is surprising how small a quantity is required when the patient is using the vapour. I have known several instances where diseases which have been rebellious to large quantities of mercury, given for long periods, yield immediately the baths were employed. The effects of mercury upon the system become very quickly manifest under the influence of the baths, when the system had previously resisted this influence. (I allude to the effects of mercury on the disease, not to its sensible effect on the mouth.) When I employ mercury internally, during the use of the baths, it is either under the form of the biniodide or bichloride, given in solution in small quantities, not exceeding the twentieth of a grain for a dose. The use of this medicine in drachm doses of the ointment in form of friction, in five grains of blue pill or calomel, two or three times a day, under the old plan of treating venereal diseases by mercury, can never be required, except it is wished to break up the health and constitution of the patient. How many have never recovered from internal mercurial treatments of this kind! I never saw the most delicate patient, either male or female, whose health was injured under the plan I recommend, and I have very rarely seen a disease that has not been cured. The experience derived from the treatment of many thousand cases warrants me in speaking thus positively on the subject.

The time occupied in the cure of venereal diseases by the mercurial vapour bath is vastly less than that consumed by any other kind of treatment; its effects are commonly immediate, one full bath very frequently making at once an impression on the disease. Where the hair has been falling rapidly, one bath has arrested this; ulcers which have been rapidly spreading have been rendered stationary by one bath. After two or three baths, the improvement is in most instances marked; and the cure is effected in one-fourth, or even one-sixth, of the time