tum. If cicatrization does not ensue, the ulcers should be covered with pledgets of lint smeared with the following ointment: B Argent. nitratis cryst., 0.10 [gr. 11]; Ung. simpl., 10·00 [ 3 ij, ▸ ij]; Bals. Peruv., 1.00 [grs. xvj]. M. Ft. ung. Iodoform, too, has rendered excellent service in torpid and proliferating ulcers. If suppurating gummata are situated upon the soft palate, and if the latter is in danger of perforation, the margins of the ulcer should be touched with lunar caustic every day. If general treatment is simultaneously instituted, small perforations of the palate will often become smaller, so that it is barely possible to put a fine probe through them—a matter that is of great importance in phonation. The perforations of the mucous membrane on the hard palate may likewise be reduced in size by the use of nitrate of silver. The local treatment of ozæna syphilitica has for its object the speedy exfoliation of the necrotic piece of nasal bone. This is best promoted by injecting dilute solutions of muriatic acid or chloride of calcium into the nasal cavities. cases we prescribe: B Acidi mur. dil., 5:00 [iv]; Aqua destil., 300.00 [ixss., ✪ iv]; M. S. For external use. B Chlor. calcis, 5·00 [ iv]; Aqua destil., 300-00 [ixss., iv]; Aqua rosarum, 15:00 [3 ss.]. M. To be put in a black bottle for external use. In these The nasal cavities should be injected with either of these solutions four or five times every day by means of a syringe provided with a long nozzle; or, if a fountain-syringe is used, the tube is inserted into the nose, the patient being directed to hold his head backward for a few moments, when some of the fluid will flow into the nasal passages. Ozana syphilitica frequently is the residuum of syphilis that has already reached its end, the prolonged ulceration of the nasal bones and nasal mucous membrane, and the ichorous discharge, being kept up by the irritation which the necrosis of the bone exercises upon the surrounding structures. General treatment is only indicated in ozæna when new syphilitic outbreaks occur on different parts of the body, or if those that already exist do not disappear. In these cases reliable proof of the specific character of the lesion will be necessary before treatment with mercury or iodine is resorted to. In most ozæna patients scrofula will be found to play a great part, and they will require cod liver oil and tonics more than anti-specific remedies. In syphilitic sarcocele Fricke's compression-bandage may be employed in addition to internal general treatment, or the affected half of the scrotum may be covered with mercurial plaster. The coexisting hydrocele disappears spontaneously when the swelling of the testis has subsided; if not, the dropsical tumor may be tapped, and a dilute solution of iodine injected, or the operation for the radical cure may be performed. In pains of the bones and joints, which sometimes do not yield to either mercurial or iodine treatment, nor are assuaged by narcotics, we found in many cases the local treatment recommended by Ricord to be of great benefit. He recommends a blister to be applied upon the painful part, and after the skin has been removed the place is either covered with cerate-plaster, or morphine is strewed upon the raw surface. In periosteal thickenings an attempt should be made to bring about resolution by painting the part with tincture of iodine or moderately concentrated iodo-glycerine. Even if fluctuation is detected, the swelling should not be hastily opened, for absorption may sometimes take place. Should the pain, however, become aggravated, and the tumor larger, it should be opened by a valvular incision, in order to prevent the entrance of air into the cavity of the abscess. In very intense, painful periosteal swellings, Ricord and other physicians recommend deep crucial incisions and scarifications of the bone. Ulcers of the rectum should be washed several times a day, especially after each stool, and a tolerably strong solution of iodo-glycerine applied four or five times a day, or they may be cauterized with nitrate of silver. In case stricture of the rectum is apprehended, in consequence of contracting cicatrices, compressed sponge-tents or cones of laminaria digitata should be inserted early into the gut. If stricture has already formed, an attempt should be made to dilate the rectum by the aid of bougies; unfortunately, the results of this treatment usually are only temporary. There is no other therapeutic resource in such cases than to promote evacuations from the bowels by the administration of oleaginous clysters and purgative remedies. The Nursing of the Syphilitic Child and the Treatment of Congenital Syphilis. So long as no evidences of syphilis are observed on a child begotten by syphilitic parents, it should not be subjected to antisyphilitic treatment, though it requires careful attention. The question arises, How should a child be nursed that is born with manifest evidences of syphilis, or that is suspected of being afflicted with hereditary syphilis? Should it be suckled by its mother, or by a wet-nurse? That the milk of a healthy wet-nurse is the best nutriment for such an unfortunate creature admits of no question. If the mother was affected with constitutional syphilis during pregnancy, and yet gave birth to a child free from all evidences of general syphilis, as is often the case, such a child, if possible, should be suckled by a healthy wet-nurse. Even admitting that the mother's milk does not serve as a vehicle for conveying the syphilitic virus, and although no morbid alteration can be discovered in it chemically or microscopically, still it can not be deemed healthy nutriment, coming as it does from a diseased, feeble constitution. But, if the mother and child are manifestly affected with syphilis, it will be absolutely necessary to procure a healthy wet-nurse for the child, because the debilitated mother will become still more enfeebled by nursing, and the infant will not thrive upon the unhealthy milk. But such a child should only be given to another woman after she has been fully in formed of the risk she runs of being infected. To hide the true nature of the child's illness, to persuade a healthy woman to undertake the nursing of a syphilitic child, would be an unpardonable act, because the health of the woman is thereby endangered, while the saving of the child is doubtful; indeed, in our opinion, highly improbable. However, if after the woman was fully informed she is disposed to undertake the duties of a wet-nurse, she should be instructed to keep herself and child scrupulously clean. On discovering any fissure on a nipple, she should not put the child to the affected breast, but nurse it on the sound breast only. She should not allow the child, as is customary with wet-nurses, to lie at her breast by the hour, for then the nipples, being in contact with the lips of the diseased child, are sure to become injured. Both the nipple and breast should be washed clean every time the baby has been suckled. A sure protection for the wetnurse is the use of a nipple-shield during the suckling of the infant. If the mother displays no evidences of constitutional syphilis, it will be far more judicious for her to wet-nurse her own child. So far, only three instances are known in which syphilitic children infected their own mothers. The circumstance that mothers are never, or hardly ever, infected during wetnursing by their hereditary syphilitic offspring, is now known by the name of Colles's law. Still, since it may happen that a perfectly healthy mother may become infected by her own syphilitic infant, it will be well, as Behrend suggests, to allow her to wet-nurse her child only so long as no evidences of syphilitic manifestations are observed on the mouth and fauces of the nursling. As soon as any specific symptoms appear on the infant, and the mother remains apparently well, she should be advised to discontinue wet-nursing it, and bring it up on artificial food. If no wet-nurse can be procured to suckle such a child, and if the mother is not very much reduced by the syphilitic diathe sis, she, being put simultaneously with the infant upon an antisyphilitic treatment, may be allowed to put it to her breast. But if the mother already shows evidences of the syphilitic dyscrasia, it will be preferable to bring up the child artificially upon good, fresh cow's milk, or the milk of a wet-nurse, obtained by a nursing-tube. In the treatment of syphilitic infants and nurslings, the care, cleanliness, and attention they will require deserve special consideration. The mouth of the nursling, especially, should be cleansed every time it is nursed, and, after each stool, the excoriated places at and around the anus should be washed clean and wiped dry. The medical treatment is both local and general. The local treatment consists in the application of slightly caustic remedies, such as the nitrate-of-silver stick to the ulcerating places on the lips and anus, for the purpose of hastening their cicatrization, of assuaging the pain during suckling and during evacuations from the bowels, and, above all, by the production of an escharotic slough to protect the ulcers on the mucous membrane against irritation and uncleanliness. For the purpose of promoting absorption of the mucousmembrane papules situated on the lips, angles of the mouth, on the anus and genital organs, and the moist papules on contiguous parts, Labaraque's paste, or a weak solution of iodoglycerine, may be used. In regard to the general treatment, it has been suggested that, in view of the tender constitution of the nursling, to administer mercurial remedies indirectly, namely, through the milk of the wet-nurse, who is treated with antisyphilitic medicine, or mercury is administered to goats or asses, and the syphilitic child is then fed with the milk from these animals. But numerous examinations of the milk of wet-nurses treated with mercury, and that of animals in whose fodder mercury was put, have shown that but very small quantities of the drug are found in it, and only after it had been administered to them for many days. In view of the fact that the dose of the medicine given to a child in this manner can not be properly controlled, as also the fact, often observed, that nurslings in many respects tolerate mercury better than adults, we prefer the direct to the indirect methods. If no diarrhoea or other complications contraindicate it, calomel should be used, this preparation being best tolerated |