pushed so far as slightly to affect the gums, may be attended with advantage; and the dressing of the blistered surface with the strong mercurial ointment may succeed, where every other mode of treatment has proved ineffectual. The opening of a node, with a view to the discharge of its fluid or purulent contents, should be deferred to the last moment compatible with the ease of the patient; absorption having been known to take place, even when the skin covering the tumour had assumed an almost transparent aspect. When the operation has been determined upon, a small puncture with a lancet, or perforation with a trocar, rather than a free incision, should be made in order to relieve the distension; painful suppuration, caries, and prolonged exfoliation being not unfrequently attendants upon extensive incisions. When ulceration takes place in the integuments covering the diseased portion of bone, exfoliation will usually result. Sometimes, however, red and healthy granulations spring up from numerous small apertures in the bone, and cicatrization is in a short time effected, without any apparent loss in the osseous material. But the sunken, uneven surface, after the healing process has been completed, will demonstrate a deficiency in the bony structure produced by the process of absorption. The following is an example of the primary ulcer last described, and will tend to illustrate some of the constitutional affections alluded to, as forming the sequelæ of that particular species of sore.

Case.-M. B., æt. 28, formerly a married woman, her husband dead three years, admitted into the Lock Hospital, under my care, March 5th, 1844. States that she has been in the constant habit of indulging in ardent spirits, to the amount of twelve glasses at a time, without being completely incapacitated; for the purpose, as she expresses it, of "drowning care." Had three children by her husband, one now living. Has, since her husband's death, been cohabiting with a gentleman, by whom she has had one child. Five months since, in consequence of some dispute having arisen between them, they separated; she then turned on the streets, and although from that time to the present she has been constantly in the way of getting disease, she remained free from any form of it, until about three weeks ago, when she observed for the first time a sore on the inner part of the right labia, but which caused her no uneasiness. About a week afterwards, a discharge, preceded by a scalding in passing water, was observable from the vagina, after which four or five other small sores appeared on the opposite labia. Since the first accession of the disease, she has not gone in the way of additional infection. Within the last week, a pustular eruption appeared in spots, first upon the abdomen, next upon the upper part of the thighs, and subsequently on the back of the neck; a few spots are likewise interspersed through the hair. Upon examination, four or five small ulcers,

varying from the size of a pin's head to that of a split pea, are perceptible on either side of the external labia, at the junction of the mucous membrane with the skin. The one which she states first appeared is the largest and best defined, the margins are elevated above the centre, which is even and devoid of any granulations; no induration accompanies it. The smaller ulcers preserve the same character in miniature. Complains of soreness of the throat, which upon examination appears more vascular than natural. There is also a dry and granular appearance of the back of the pharynx, but no apparent ulceration. Matter taken from the best defined ulcer was inoculated on the upper part of the thigh, the ulcers were touched with the nitrate of silver, and she was put on the use of the iodide of potassium in five-grain doses three times a day.

March 10th. Pustular spots larger; sores below contracting in size.

17th. Inoculated part presents the characteristic pustule, which was cauterized with nitrate of silver. Eruption for the most part desquamating, with the exception of one large spot in the left iliac region. Complains of pain in the right hypochondrium, which shoots up to the shoulder of the same side. Percussion over the region of the liver elicits a dull sound, and that viscus is perceptibly enlarged.

Repetat. Potass. Iodid. emp. vesicat. lateri dol. Balneum tepid.

A superficial slough covers the back of the pharynx; which is extremely granulated in appear

ance.

Garg. Chlorid. Calcis.

18th. Sores have almost healed; the eruption continues to desquamate; pain has left the side and shoulder since the application of the blister; inflammation has disappeared from the throat, and the posterior part of the pharynx looks much healthier than before.

Pergat ut antea.

21st. Throat well; sores healed; eruption fading. 28th. Discharged cured.

Having now completed the description of the second class of primary ulcer, which holds a place intermediate between that first treated of and the one next in order, and having pointed out the constitutional affections likely to result upon the absorption of the virus from that particular sore, with the treatment most appropriate for their cure, I shall now pass on to the consideration of the third variety of ulcer.

CHAPTER XI.

THIRD CLASS.

Phagedenic Primary Ulcer.-The term phagedena has been used differently by authors. By some it is employed to express every form of destructive sore, whether owing to ulceration or sloughing ;* whereas by others its signification is more limited, and a line of demarcation is attempted to be drawn from the appearances which the ulcer may at one time or other assume. Thus, Mr. Evans, in his treatise on ulceration of the genital organs, speaking of phagedenic and sloughing ulcers, says :-" By the first of these terms I understand the removal or dissolution of a part, without any trace of its existence being left; by the second, the removal of a part which still exists in substance, though in an altered or perhaps diminished form." Whilst a more modern writer,† without giving any general definition of the terms, proceeds to arrange the disease under different classes, according to the colour of the slough, and the constitutional distur

Abernethy on Diseases resembling Syphilis, p. 67.

A Treatise on Venereal Diseases, by William Wallace, M.R.I.A. 1833.