We seldom prescribe calomel or submuriate of mercury; in fact, only in such cases in which we desire to administer large doses of mercury through the digestive system in a short time. In dangerous iritis especially, and in specific affections of the fauces, calomel has proved to be one of the quickest remedies to produce good effects. In adults it may be given in the following form:

B Calomel lævigati, 0.50 [grs. viij];

Opii puri, 0.10 [gr. 14].

Sacchar. alba, 5·00 [ iv].

M. Div. in dosis No. 12.

D. S. One powder to be taken morning, noon, and night.

On the whole, we have used very little sublimate or submuriate of mercury for many years past, because we have convinced ourselves that no other preparations will produce such peculiar and obstinate alterations of the epithelial cells of the mucous membrane of the mouth and tongue as these, especially if the patient is addicted to the use of tobacco. In these patients there are found most frequently on the mucous membrane of the tongue, lips, and cheeks, especially on the places that come in contact with the angles of the teeth, pearly-white, opalescent opacities of the epithelial cells, varying in size from that of a pin's head to that of a bean, which may be either scattered or aggregated. These places look as if they had been touched with nitrate of silver. They are distinguished from mucous-membrane papules by the absence of diphtheritic slough upon them; they do not ulcerate, display no local proliferation of the papilla, often terminate in retractions of the affected places of the mucous membrane, because, in consequence of the pressure of the epithelial thickening upon the affected papillæ, the latter retract, while the epithelial opacity is so persistent that it remains unaltered for many years. In accordance with an article published by Wiensky, a Russian physician, who on injecting cinnabar into the blood of animals found it again encysted in the epithelial cells, H. Zeissl feels justified in asserting that the opacities spoken of are nothing more than epithelial cells containing mercury. In proof of this view, we can say that we never saw these persistent opacities in persons who were not treated with corrosive sublimate.

As an additional proof, we may point to an analogous alteration of the epithelial cells seen in the blue color on the gums of persons who handle lead, and in the bronzing of the skin and buccal mucous membrane produced by the internal administration of nitrate of silver. As the internal employment of mercury is generally adopted in the treatment of recent manifestations of syphilis, that is to say, at a time when the indurated infecting places are still suppurating and the indolent buboes are still progressing, it will be well for the patient to avoid all active exercise, though it is not necessary that he should stay in bed. Furthermore, as the patient frequently suffers from rheumatoid pains at the beginning of syphilis, he should not expose himself unnecessarily to sudden changes of temperature, and especially should he protect himself against cold and damp night-air. It is even beneficial for him to sweat some at night. Under moderate diaphoresis, the disease not only runs a favorable course, but the internal use of mercury is better tol erated. For this reason, most physicians order the patient to take a larger dose of mercury on going to bed than at other times.

In regard to the diet, the patient may be allowed to take a moderate amount of nourishment; it is only necessary for him to avoid all kinds of vegetables and fruit that cause flatus, and all articles that contain vegetable acids, lemonades, etc., which are incompatible with the remedies, and readily give rise to nausea, colic-pains, and diarrhoea. If calomel is used internally, the patient should not be allowed to partake of very salty food, such as salt herring, or drinks containing soda; nor of ammonia, because the composition of the calomel is thereby liable to be changed, and, it is claimed by some physicians, that sudden deaths have resulted from it. He should renounce the use of tobacco in every shape absolutely during the treatment with mercury, especially when the sublimate is used. How long a time is required to accomplish a cure with mercury, and how much of the different preparations is necessary to completely annihilate syphilis, depends upon the individual case. As a rule, the mercurials should be administered to the patient, if he tolerates them, till all the symptoms have disappeared, which will seldom occur in less than two or three

months. Accordingly, a patient will consume about 4:00 [grs. lxij] of the protoiodide, or 0.5 to 100 [grs. viij to xvj] of corrosive sublimate. The treatment must be suspended, at least for a time, as soon as the mucous membrane of the mouth is affected, and the patient should rinse his mouth with some astringent preparation every half-hour.

External Application of Mercury and its Preparations.

The absorption of mercury into the blood through the skin can be accomplished in the following manner:

(a) By repeated inunctions of salve, containing mercury, over a large portion of the skin (epidermatic mercurial treatment).

(b) By injections into the subcutaneous tissue (hypodermic mercurial treatment).

(c) By the action of vapor of mercury through the skin. (d) By the use of mercurial baths. And, lastly

(e) By the local use of mercury in the form of suppositories upon the mucous membrane of the rectum.

(a) Mercurial Inunction Treatment.

The method of treating syphilis by means of mercurial ointment came into vogue at the very beginning of the epidemic. of syphilis in Europe; but even the systematic directions laid down for its application by Louvrier and Rust at the beginning of this century led to so much misuse, that all sensible physicians denounced it.

Our method of employing the inunction-cure is the following: We begin the inunctions without any special preparations, simply allowing the patient to take a lukewarm bath. We order from two to five grammes [3 ss. to 3 jss.] of blue-ointment for each inunction. The inunctions may be performed by the patient himself, or by an attendant with leather gloves upon his hands. They may be resorted to daily, or every second or third day, according to the intensity of the syphilitic lesion and the constitution of the patient, and are carried out in the following order upon the various parts of the body:

On the first day of the treatment the ointment is rubbed in on the anterior surfaces of both arms; on the second day,

on the anterior surfaces of both thighs; on the third day, on the anterior surfaces of both forearms; on the fourth day, on the anterior surfaces of both legs; on the fifth day, on both loins; on the sixth day, on the back; on the seventh day, the order of arrangement is begun anew. The patient should thoroughly rub in the whole dose of the salve, taking care that none of it remains in lumps upon his hand or upon the body. The hairy parts of the body should be avoided as much as possible, because the inunctions are there apt to produce an eruption of small pustules, an inflammation of the apertures of the hair-follicles. If the patient's hands are tough and callous, he should put on a pair of tight-fitting leather gloves wherewith to perform the inunction.

In unpleasant weather the patient should remain in his room; but when the weather is favorable, especially during the warm season of the year, he should spend the greater part of the day out-of-doors. During the cold season, the temperature of the room should be 15° or 16° Réaumur [66° or 68° Fahr.], and, if possible, the apartment should be thoroughly ventilated twice a day.

The physician should pay special attention to the condition of the mouth of the patient. From the very beginning of the treatment, the latter should be instructed to rinse his mouth repeatedly during the day with pure water, or water containing some astringent remedy, such as chlorate of potash, alum, borax, tannic acid, laudanum, etc., 1.00 [grs. xvj] to 100.00 [3j, viij] of water. In addition, he should prevent the formation of tartar on his teeth by brushing them several times daily with a soft tooth-brush and water.

In accordance with the views already enunciated, we only resort to the inunction-treatment in the advanced stages of the disease, and especially in those cases which resist the action of less powerful remedies-the iodides. All relapses of the first phase of syphilis, such as relapsing papular syphilides, psoriasis palmaris diffusa, impetigo, and ecthyma syphilitica, and partly, also, nodular syphilides, are particularly well adapted for treatment by inunction. In some cases certain special physiological and pathological conditions that may obtain will serve to determine the physician in preferring the inunction

method over any other form of mercurial treatment. Thus, it is vastly preferable to subject syphilitic pregnant, and puerperal women to an inunction-cure, than to administer mercury to them internally. Persons having feeble digestive organs, those suffering from suspicious laryngeal and bronchial catarrhs, from frequent gastro-intestinal catarrh, or those who only recently recovered from typhoid fever or dysentery, are more advantageously treated by inunctions than by the internal administration of mercury. Further, the morbid syphilitic conditions best adapted for the inunction-treatment are those which are complicated with constitutional or other affections that also require internal treatment-for instance, scrofula, tuberculosis, chlorosis, intermittent fever, etc. In these cases, codliver oil, iron, and quinine, may be employed in addition to the inunctions of mercury; but the inunctions are principally applicable in those cases in which dangerous symptoms supervene, because they afford such rapid relief: thus, in suppuration of the nasal passages, in iritis syphilitica, specific affections of the head, brain, and nerves, especially those that depend upon extra-cerebral morbid changes.

The number of inunctions that may be necessary varies, of course, according to the form and intensity of the disease; the individual condition of the patient; and, lastly, whether the patient had taken mercury shortly before beginning the inunctiontreatment or not.

The treatment of syphilitic ulcers, nodular syphilides, and large tophi, will require more inunctions than that of a papular syphilide. In regard to the individuality, experience has shown that there are persons in whom the employment of this method, and the mercurial treatment generally, exercise a favorable influence upon the involution of the morbid phenomena in a very few days, while in others the lesions obstinately resist all kinds of mercurial medication. Fewer inunctions will be required if employed in conjunction with Zittmann's decoction than without the aid of the latter. We have seldom found less than twelve to sixteen inunctions sufficient, nor more than thirty required in the patients that came under our observation. If this number is not capable of subjugating the most essential features of the disease; still more, if an aggravation