required for the success of ordinary treatments. The nature of the cases determines the time occupied in the cure. In superficial skin diseases, or superficial ulcers of the nose and throat, the cure is very rapid. I have constantly known affections of this kind entirely cured in a fortnight or three weeks, with pleasure rather than inconvenience to the patients. In enlargements of the bones and testes, in indurations of the penis, persistent induration of the cicatrix of a primary sore, the cure is necessarily more tedious; the change of structure produced in such diseases must have time for removal: nevertheless, in these cases, which require months of treatment, under common circumstances, and which are not unfrequently considered or given up as incurable, the moist mercurial vapour will do more in a month than any other treatment in six. I have known cases of induration of the penis removed in three or four weeks, which have not shown the slightest disposition to amendment after months of ordinary internal treatment. The effects of the mercurial vapour bath upon the patient vary under different circumstances. If the general health of the patient be apparently good, and we have to control a single isolated symptom of disease, such as a primary sore, an enlarged testis, or an indurated cicatrix, and the baths be used too frequently, the patient would become a little languid, and probably a little thinner; this would be avoided by properly timing the intervals between the baths. Should the patient be labouring under general constitutional taint, and exhibit as local symptoms loss of hair, sore throat, ulcers of the nose, or skin diseases, he almost invariably gets fat under the treatment. The mouth is commonly affected, after using four or six baths, more quickly if the head be immersed, which is better; some patients can bear the head in the bath for five, ten, or even twenty minutes without inconvenience; patients vary in this particular; and it depends very much on the form of mercurial employed. The gums, when affected, are red, elevated, and tender; but the baths very rarely produce salivation. Some forms of constitutional syphilitic diseases more readily yield to the use of the vapour than others. Some are cured with an extraordinary degree of rapidity, and are perfectly cured, which is proved by their not having relapsed, or presented a fresh venereal symptom after many years. These forms are superficial diseases of the skin, loss of hair, superficial ulcerations of the nose and throat. Some varieties require a longer treatment, as diseases of the deeper-seated parts of the skin, some forms of ulceration, diseases of the testicles and of the bones. To most forms of constitutional syphilitic disease, the treatment by vapour is applicable, and beyond all doubt the most speedy, certain, and safe remedy that can be employed; yet there are some forms of disease which yield with greater rapidity than others. That which gives way with the greatest difficulty is the induration which succeeds to the healing of a primary sore. I do not mean that soft fulness which is sometimes found in such situations, but that specific induration which is met with under the skin, and which is sure, sooner or later, to end in local or constitutional mischief. I have seen cases which have resisted all modes of treatment but the baths; to these they yield but slowly, but they do yield, after other plans of treatment have been followed for months without success, or with but partial amendment. One or two objections have been raised to this plan of treatment by reviewers. These are easily answered, and would never have been made had those gentlemen been familiar with its practical working. The chief objection which has been raised. is that it is unmanageable, and the quantity of mercury introduced into the system cannot be regulated, and that rapid and severe salivation might occur. For more than twenty years I have administered or superintended the administration of this bath, from four to six times every day, and I have never seen one case where such an effect has been produced. I have employed it in many thousand cases. The analogy has been made with the dry fume, which sometimes has produced such an effect: the mixture and dilution of the vapours of mercury with common steam, and the sweating induced by the bath, entirely removes any fear of this kind, and I would stake my reputation that with proper management it cannot occur. I must not be understood to say that I consider or recommend the mercurial vapour bath as a specific remedy in all forms of constitutional syphilis, but I repeat that it is the most powerful therapeutic agent in the removal of disease, and the least harmful to the constitution of the patient, of any remedy with which I am acquainted; neither am I so, prejudiced in favour of this remedy as to reject the assistance of all others, which, as we shall presently see, when associated with it, under certain circumstances, produce the best effects, but which effects, I am bound to say, would not, under many circumstances, occur without the assistance of the vapour, since in numerous instances these remedies have failed in curing the disease when used alone. The profuse sweating induced by the bath prevents the accumulation of either iodine or mercury in the system, and thus contributes materially to the preservation of the constitution of the patient.1 THE CHLORIDE OF MERCURY. Calomel may be administered internally, as an anti-syphilitic, united to opium, conium, or soap. Apart from its internal exhibition, however, it has various uses in the treatment of syphilis. Mixed with lime-water in various proportions, it forms a wash or lotion, exceedingly useful in dressing many primary and secondary venereal ulcers. Employed by way of friction on the gums and tongue, calomel has sometimes a marked effect in curing chronic secondary syphilitic ulcerations of the throat, 1 "Another method of employing mercury is by a combination of fumigation with steam, constituting what Mr Langston Parker, of Birmingham, terms the mercurial vapour bath.' I can testify, from considerable experience, to the beneficial effect of this method of mercurialization, having effected some very extraordinary cures with it after all other modes of treatment had failed. I recollect in particular the case of a young gentleman, of Arkansas, who was under my charge, in 1855, on account of tertiary syphilis of many years' standing, accompanied by an enormous amount of rupial action of the skin, one of the sores being fully as large as a dinner-plate, and with an infirm, cachectic state of the system, who was promptly cured, comparatively speaking, with the bisulphuret of mercury, conjoined with the frequent use of tepid baths and a nutritious diet, after a great variety of other means had been fruitlessly employed. My opinion is that this method of treatment is not sufficiently appreciated; it certainly deserves the highest encomiums."—S. D. Gross, Systein of Surgery,' vol. i., p. 505. fauces, and tongue. When cured in this way, the saliva which flows during the process of friction should not be swallowed; the mouth should be washed out with cold water before and after the operation. This mode, I believe, originated with Clare.1 It was also highly spoken of by Swediaur and others. It had, however, as far as I know, totally fallen into disuse till I lately revived it. I could narrate a great many successful cases treated in this way, not only of the throat and adjacent parts, but of other forms of constitutional syphilis.2 Calomel is also useful dusted over various secondary syphilitic affections of the 1 'A New Method of Curing the Lues Venerea, &c.;' London, 1779. 2 Cases, showing the effects of calomel frictions: A. T., Queen's Hospital, a girl about 20 years of age, admitted with lichen, covering the face, back, and limbs; also bad ulceration of the tonsils. Treated in various ways, with varying benefit; at times she was better, and then relapsed. The ulceration of the throat remained after the other symptoms had disappeared. This is common in syphilis; one symptom will remain and prove obstinate and rebellious to the treatment which has cured the other. The ulceration of the throat quickly and permanently disappeared by rubbing three grains of calomel on the tongue, gums, and inside of the cheeks, night and morning. Mercurial vapour was not used. CASE. M. S. had indurated chancre, succeeded by lepra and ulceration of the tonsils; the lepra chiefly affected the hands with thick, hard scales. The case was very obstinate; the mercurial vapour bath was used with benefit; but whatever plan of treatment was adopted never succeeded in removing both the symptoms in the throat and on the hands; one symptom only yielded. A permanent cure was at length obtained by rubbing three grains of calomel twice a day on the tongue, and on the inside of the cheeks and gums. No salivation was produced, although the remedy was used for a month. CASE. J. M., æt. 28; constitutional syphilis for two years. All the symptoms had disappeared, except superficial aphthous patches on the fauces, tonsils, uvula, and roof of the mouth, which had rendered the mucous membrane of these parts thick and uneven. The parts surrounding the ulcers were red; if the patient drank or smoked, the parts became inflamed and painful. Various remedies employed without success; they had absolutely no effect on the throat, which seemed the same after all other symptoms had disappeared for twelve months. A perfect and permanent cure was obtained in six weeks by calomel frictions. No salivation or stomatitis was produced. skin, especially secondary condylomata. Made into an ointment with lard, it is most useful as a dressing to secondary ulcers, or employed by way of friction in scaly diseases of the skin. B Adipis ppt., 3j; Hyd. chloridi, 3j. M. Mixed with tannic acid or powdered acacia, in various proportions, it may be blown into the throat or nasal fossæ in cases of secondary ulcerations of these parts. I have practised this in the Queen's Hospital and in private practice frequently. After the failure of other means, M. Biett has used it in this way, with complete and prompt success. R Hyd. chloridi, gr. ij—v; Pulv. acaciæ, gr. v. M. ft. pulvis ter die utend. M. Biett has carried the insufflation of calomel to the extent of fifteen or twenty grains a day. Some very remarkable and good cures were thus obtained. All modes of administering calomel are open to the objection of occasionally producing salivation. THE BICHLORIDE OF MERCURY. The bichloride of mercury is a valuable remedy in the treatment of many forms of constitutional syphilis, particularly of those varieties which are complicated with ulcerations of the mucous surfaces. According to Dzondi, whose method of treating syphilis is extensively followed in Germany, and at La Charité Hospital of Berlin, the bichloride of mercury is the chief preparation of this remedy on which reliance should be placed in the treatment of constitutional syphilis. This was a favourite remedy of Dupuytren's, who gave it in small doses in the form of pills. B Hydr. bichloridi, gr. ij; M. ft. pil. xvj; j ter die. Dzondi's pills each contain one-twentieth of a grain of the |