pain in the stomach and vomiting. The decomposition of the iodide of iron is prevented in Blancard's pills, which are wrapped up in balsam of Tolu.

Each pill contains 0·07 [1

gr.], of which the patient takes four or five each day. Much benefit is derived from the internal use of iodoform, according to H. Zeissl's method. It is prescribed in pill-form:

Iodoform., 1.50 [grs. xxiij];

Ext. et pulv. trifolii fibrini āā ut ft. pil. No. 20.

Consperge pulvere eodem.

S. Five pills to be taken daily.

Good results are obtained from iodoform, especially in cases of neuralgia caused by syphilis. In addition, we only wish to mention here that patients, after the internal use of iodoform, sometimes suffer for a long time from unpleasant eructations. It should not be prescribed in large doses; some physicians have seen intense excitement and mental disturbances arise in patients to whom large quantities of the drug were administered.

Iodide of lithium, which till now has not been much noticed, may be given in doses similar to those of iodoform. We have used it for several months, injecting it subcutaneously. It forms a perfectly clear solution when dissolved in water; 1.50 [grs. xxiij] may be injected hypodermically. The patients complain of pain at the site of injection, but it soon subsides. In this manner the preparation is very well tolerated, producing no other unpleasant effects except a moderate iodine acne in some cases. The involution of the syphilitic phenomena proceeded as rapidly as after the use of any other preparation of iodine. Iodide of lithium may also be administered internally in pills from 0.50 [grs. viij] to 1·00 [grs. xvj] per day. This preparation accomplishes as few miraculous cures as any other. Recently Thomann, of Gratz, and J. Neumann, injected iodoform in solution or emulsion hypodermically with good effect. As already said, all phases of syphilis are adapted for treatment with the preparations of iodine. We have seen numerous cases of iritis cured by the administration of iodine and application of atropine to the eye, not the least impairment of vision remaining in a single patient.

The rule that mercury causes the symptoms of syphilis in all cases to disappear more rapidly than any other anti-specific remedy, has but a limited application; in some cases both mercury and iodine act quickly, in others their effects upon the patient are very slow. Too much stress can not be laid upon the fact that even in the gravest forms of syphilis the preparations of iodine alone will often be found sufficient.

In regard to the subcutaneous employment of the preparations of iodine, it may be used with advantage in persons troubled with weak digestive organs; but this method will no more take the place of the internal use of the drug than the hypodermic injection of mercury has till now succeeded in replacing mercurial inunction. However slight the pains may be, the patients seek to avoid them if not absolutely necessary. Besides, it has the additional diadvantage that in private practice a syphilitic patient can not be seen every day.

Patients, whose health and other circumstances permit, should go at the proper season of the year to iodine mineral springs. There are several places in the Austro-Hungarian Empire where valuable iodine springs are found, such as Hall in Upper Austria, Ivonicz in Galicia, Lippik in Slavonia, Luhatschowitz in Mahren, and Darkau in Silesia. In these places the patients not only drink iodine-water, but also bathe in it. Professor Rosenthal, of Vienna, under the direction of Professor Schneider, has shown, in a paper presented to the Imperial Academy of Sciences in the year 1862, that iodine is absorbed into the blood by the skin.

It is a mistaken idea to prohibit the patient from partaking of articles of food containing starch during the treatment with iodine. Starch alone, without the simultaneous intervention of an acid, is not capable of separating the iodine from its compounds and forming a combination with it. The acids of the stomach are much too feeble for that purpose; and admitting that a partial decomposition of the iodides takes place from an excess of starch in the stomach, then only an iodide of starch would form, which is the very substance recommended by Buchanan against syphilis on account of its nonirritating action on the gastric mucous membrane. Equally little injury results to the patient, according to our experience,

from the decomposition of the preparations of iodine, owing to the use of acids during the treatment with iodides. Recently, English physicians have actually sought to increase the action of this remedy, and obtained favorable results from the combined use of tolerably strong acids (ozonized water, nitric acid) with preparations of iodine. The powerful action of the salts of iodine, in bringing about a metamorphosis of the tissues, is reason enough for allowing the patient, during the iodine-cure, to partake of as much nourishing diet, especially animal food, as possible, still the cure should not be made unnecessarily irksome by prohibiting the ingestion of bread.

The preparations of iodine, as already stated above, are adapted to all forms of syphilitic disease.

The iodides have proved especially efficacious against gummous periostitis and ostitis, gummata of the skin, tongue, respiratory organs, etc.; in muscular contractions, sarcocele syphilitica, specific eye, brain, and nervous affections, inherited syphilis, appearing in the shape of scrofulous manifestations, and in cases in which scrofula and syphilis are combined.

Still, there are cases in which all the morbid forms mentioned obstinately resist the action of the iodine remedies; in such, if the condition of the patient permits, we resort to the mildest of all mercurial preparations, Zittmann's decoction. The mercurials generally achieve more if they have been preceded by a course of treatment with iodine.

It follows, from what has been said, that the salts of iodine are the chief remedies for so-called tertiary syphilis. Still, it can not be denied that all the other specific phenomena may be made to undergo involution by the use of iodine; but it is equally true that there are exceptional cases, which can not be foretold, in which mercury may be advantageously substituted for the iodide.

When iodine preparations are used in appropriate cases and in proper doses, the appetite of the patient increases, and nutrition improves proportionally. Sometimes, however, the appetite increases to a ravenous hunger. Occasionally the internal use of the iodides causes ringing in the ears and intestinal catarrh, which sometimes is attended by loose stools, then again by constipation. The pathogenic action of iodine manifests

itself most strikingly upon the nasal mucous membrane, a violent nasal catarrh originating in most patients after this remedy has been used for two or three days. This phenomenon is generally accompanied by an irritated condition of the mucous membrane of the fauces and pain over the frontal sinus. The catarrhal affection of the mucous membranes mentioned extends to the lachrymal apparatus and Eustachian tube. More or less severe febrile movement, according to the sensitiveness of the patient, ensues. In most cases we noticed, in consequence of the continuous use of the iodides, marked redness and looseness of the gums of the upper incisor teeth (gingivitis), which persisted for many weeks, along with obstinate salivation. The pathogenic action of iodine salts manifests itself just as frequently upon the general skin as upon the naso-faucial mucous membrane. An acne-like eruption occurs in some persons, especially those having a tender skin, on the face, nape, shoulders, and upper arms. The iodine catarrh and acne may indeed occur simultaneously, but, as a rule, these two affections exclude each other. In some patients the use of the salts of iodine produces sleeplessness. In rare cases we have observed, in consequence of the internal use of the preparations under consideration, episcleral ecchymoses and navuslike teleangiectases, as big as a pin's head, on the general integument. In some cases the action of the heart is accelerated to such a degree, by a prolonged use of this remedy, that the rapidity of the pulse is increased to one hundred and forty per minute, the patient being at the same time exceedingly irritable and exhausted. We also saw pleurodynia occasionally in consequence of the use of iodine-a phenomenon first pointed out by Wallace. The pain, which is usually limited to the left side of the thorax, is so violent at times as to hinder the patients from breathing, resembling very much in severity that occurring in true pleurisy.

Iodine catarrh and iodine acne disappear when the iodides are discontinued. For the relief of the gingivitis, the astringent mouth-washes recommended against mercurial stomatitis may be used. The ravenous hunger and sleeplessness, the pleurodynia, and increased action of the heart are markedly diminished by an active purgative (Saidschützer or Püllnaer

bitter-water), and disappear entirely after the use of a few doses of quinine, 0.3 to 0-4 [grs. v to vij] daily.

The Treatment of Syphilis by Vegetable Remedies.

Of the vegetable remedies, we will only mention tayuya, pilocarpine, and Zittmann's decoction. Tayuya-tincture has been recommended by the Ubicini brothers. It is prepared from the root or bulb of one of the cucurbitacea plants. This remedy was used in the form of subcutaneous injection, and also internally in H. Zeissl's hospital division. The results were such that it may be said that time and not the remedy accomplished the cure. However, it exercises no injurious effect upon the system. Lewin made numerous experiments with pilocarpin, the alkaloid of jaborandi. He used the muriate, and treated thirty-two women with it by hypodermic injections; twentyfive of the patients were cured. In three of the seven that were not cured, such violent symptoms of collapse appeared that the treatment had to be discontinued. One patient was attacked by hæmoptysis-in another endocarditis supervened. In two others the syphilitic manifestations did not disappear, notwithstanding the large doses of pilocarpine employed. The longest time required for a cure was forty-three days, the shortest fourteen. Lewin thinks that a cure could be achieved in a still shorter time, if it were not necessary to suspend the treatment, even when no accidents occurred, on account of the patients' being frequently very much affected by it. The average quantity of pilocarpine required for a cure is 0.372 [grs.vss.].

The relation of pilocarpine to the different forms of syphilis is pretty much the same as that of mercury. The relapses in these twenty-seven patients amounted to only six per cent, against eighty per cent after a vegetable cure or previous treatment with mercury. Nevertheless, Lewin gives the preference to hypodermic injections of corrosive sublimate over the treatment with pilocarpine, for, although the percentage of cures with the latter is decidedly greater, yet the use of the remedy is attended by such unpleasant symptoms. In some cases in which we employed hypodermic injections of pilocarpine the unpleasant effects were so violent that we had to abandon all