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The patient is directed to take half a pint of the stronger decoction the first thing in the morning, warm, and to remain in bed some time after taking it. During the day he should take at intervals a pint of the weaker decoction, and in the evening a second half-pint of the stronger. The last two doses are to be taken cold. Every fifth day the decoctions are to be omitted, and an aperient taken.

In some anomalous forms of scaly venereal diseases of the skin, arsenic has been recommended: alone, it is rarely if ever successful in pure syphilis; with the iodide of potass or mercury, it is sometimes useful. In Donovan's solution, the arsenic is combined with both remedies.1 I have found this remedy uncertain, sometimes inert, at others too active.

OPIUM.

Opium has, by a number of authorities, both ancient and modern, been extolled as a remedy of great value in the treatment of many forms of syphilis, and by many surgeons the dose has been carried to the extent of twenty or even thirty grains in the day. The cases in which opium is indicated, and in which I have employed it with success, are those of constitutional syphilis where the health has been broken by protracted disease and the use of mercury, when the nights are bad, and the patient emaciated and feeble; where a general irritability, the result of disease and mercury, prevails, and appears to be wearing the patient out.

In exostoses, periostoses, local pains, and secondary ulcerations, occurring in constitutions and in persons thus circumstanced, opium in large doses sometimes acts magically. I have employed it also with marked success in secondary ulcerations of the throat which have remained after mercury had been a long time used, and the ulcers still remained rebellious to every plan of treatment. In protracted ptyalism, resisting local treatment, it is also very efficacious. In all these instances opium appears to subdue a certain constitutional irritability which keeps up the disease, and upon which the disease appears to depend more than upon any specific cause. It is surprising

1 Liquor arsenici et hydrargyri hydriodatis, Ph. D.

what large doses of the drug patients in this state will sometimes bear without producing constipation or headache. I have rarely given more than four or five grains a day; but I have no doubt the dose, as recorded experience has already proved, might be carried much further without any risk, should the circumstances of the case require it. In summing up the history of the remedies employed in constitutional syphilis, Cazenave says, "We have yet another mode of treatment to recommend, by whose agency we have seen the most formidable symptoms yield, the most inveterate ulcerations healed, and the most durable cures produced, when all other remedies have failed. We speak of the aqueous extract of opium, a precious remedy, even in the most profound cachexia."1

M. Rodet has given the following rules for the exhibition of opium in cases of syphilis :-"1. That the opium combined with mercury in the treatment of bad chancres acts as a powerful auxiliary. 2. That it cures ulcers of this description which have not yielded to mercury. 3. That it may ameliorate, but not cure, such ulcers when given alone and without having been preceded by mercury. 4. That it is well suited for allaying the inflammation which complicates syphilitic accidents."-Med. Times and Gazette,' Aug. 16, 1859, from Bulletin de Thérapeutique,' vol. xlix.

I have used opium very successfully in obstinate syphilitic sores, both primary and secondary. A girl, aged 26, had a large phagedenic chancre occupying a great portion of the perineum, running close up to the anus; the ulcer was as large as a cheeseplate. It continued to spread for weeks in spite of various treatments, when I placed her under the use of opium, the dose of which was carried to eight grains a day. No particular disturbance was produced by it, except constipation; the bowels were not evacuated for a fortnight, and I recommended her to do with as little food as possible. In three weeks the ulcer was soundly healed. I never saw a more successful or a more remarkable case.—A gentleman had a phagedenic sore surrounding the orifice of the urethra, and occupying the glans penis; he also suffered from ague. The ulcer healed by the use of opium

1 Traité des Syphilides, &c.,' Paris, 1843.

alone, after the failure of many other remedies. I mention also another case, of a man who had a creeping phagedenic ulcer of the body of the penis. When I saw it, it had existed a year. Mercury, iodine, and other remedies had failed; but it healed in a few weeks by persevering in the use of large doses of opium. I had used the opium very largely in the treatment of syphilis before the appearance of M. Rodet's paper.

CHAPTER XXXVI.

CLINICAL OBSERVATIONS ON THE TREATMENT

OF SECONDARY

CONSTITUTIONAL AND CONFIRMED SYPHILIS, BY THE MERCURIAL VAPOUR BATH, AND OTHER REMEDIES.

CASE LV.

Various forms of constitutional syphilis for five years; failure of various remedies; rapid cure by mercurial vapour.

In

A PHYSICIAN contracted, in the year 1845, a sore at the orifice of the urethra, which was followed by two buboes, which did not suppurate freely; the patient's health was very much impaired by this disease, and his constitution had been previously debilitated by hard work, and an attack of typhus fever. August, 1849, he had ulceration of the throat; in three weeks the palate was destroyed to a considerable extent. After the ulceration had healed, an artificial palate was applied; shortly after this the ulceration again appeared, and has not again healed. In November, 1850, this gentleman placed himself under my care, and at that period he was in the following state:

A sloughy, foul, phagedenic ulcer occupied the left tonsil, the whole of the pharynx, and the back part of the roof of the mouth. In addition, there was a general faint copper-coloured mottling of the skin generally, a large scaly blotch on the chest, and a large pustulo-cutaneous spot on the back; on the legs, the cicatrices of what appeared to have been secondary ulcers, succeeding to pustules, or tubercles. The health was much impaired, the weakness great, nights bad, severe pain in the throat, and a fetid discharge from the nose.

The patient used the mercurial vapour bath every other day; was directed to take the cold infusion of sarsaparilla with limewater, with half a grain of the hydrochlorate of morphia at bedtime, and to wash out the throat frequently with a weak

kreasote gargle. The diet to consist of wine and water, fresh animal food, cocoa, and milk.

The seventh bath was administered on November 20th. The copper-coloured mottling of the skin was all gone, the pustulocrustaceous spot on the back shrivelled up into a hard crust, without an ulcer underneath. All the ulcers in the throat and pharynx rapidly healing; the general health, appetite, and strength much improved; nights good, gums sore, no salivation. This gentleman could never take mercury internally under any form; when persevered in for a few days in this manner, it always produced distressing tenesmus, and great bodily and mental depression.

Up to December 2nd, the baths were administered every third day on that date all the ulceration had healed; a very small granulating healthy sac only remained in the centre of the site of the old disease. Gums sore, appetite good, no salivation. All the skin disease had disappeared. This patient was under my treatment three weeks, during which time he took fourteen baths. He pursued the treatment after he left me for some time; but the cure has been perfect.

On writing to me a few weeks afterwards, he says, "My medical friends are quite astonished at the rapid progress I have made under the use of the vapour, both in regard to my throat and my general health."

CASE LVI.

Constitutional syphilis under various forms for three years; failure of various remedies, especially the iodide of potassium; cure by the mercurial vapour bath.

A young gentleman, apparently healthy, contracted a primary sore in 1849, which was four months healing, and left behind it an induration which lasted two months longer. The throat was attacked with secondary syphilitic ulceration before the chancre had healed. In 1850 he had an attack of skin disease, which was succeeded by nocturnal pains in the head and legs; these pains, being partially benefited by medicine, recurred with so much violence in January, 1851, that he was confined to bed till March. The pains were always mitigated, and sometimes removed for a short period, by the iodide of

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