forced; and if these symptoms present while the patient is under the influence of mercury, its further use should immediately be abandoned. The tartar emetic mixture with opium will here be found a most valuable remedy, in assisting to subdue inflammatory symptoms, and in tranquillizing the nervous system. The application of the acid nitrate of mercury to the ulcerated parts, and its repetition during the continuance of the phagedenic action, will be attended with the best results. The subsequent dressing of the cavity, with balsam of Peru and castor oil in equal proportions, will promote the growth of healthy granulations; and the healing process, as in other forms of open bubo, will be completed by the employment of emollient cataplasms. The internal administration of the iodide of potassium will, in the latter stages of the disease, be highly beneficial, and will materially expedite the patient's recovery.

Buboes will occasionally show a tendency to the formation of sinuses in the fold of the groin; the margins of the skin above the ulcer assume a red and elevated appearance, and the discharge is thin and unhealthy. Weak solutions of nitrate of silver, sulphate of copper, or bichloride of mercury injected into the sinuses, together with the cauterization of the raised edges, will sometimes effect a cure; but should these applications fail, the sinus should be laid open and dressed from the bottom. Mercury, in these cases, by causing rapid extension

of the disease, will usually be productive of the most disastrous consequences. In all cases of ulcerated bubo, attended with protracted suppuration, a general line of tonic treatment will be called for; and the propriety of change of air should in every instance be inculcated. Individuals of a lymphatic temperament, or strumous diathesis, are more prone to the formation of buboes than others of a more robust and healthy constitution; hence the utility of the preparations of iodine in the treatment of this affection. In patients of decidedly scrofulous habit, the iodide of iron will, for obvious reasons in the latter stages of the disease, be preferable to the salts of potash.

CHAPTER XVI.

SYPHILIS IN PREGNANT WOMEN AND INFANTS.

Or the many causes which conspire to produce abortion and premature confinement, few hold a more prominent position, or are more decisive in their effects, than the syphilitic virus. In whatever mode introduced into the system of the mother, the fœtus in utero is, in very many instances, imbued with the poison; and, having ceased to live for some weeks previous to birth, is cast off as a foreign body. When this result occurs, it takes place for the most part antecedent to the seventh month of utero-gestation, and the fœtus is ushered into the world in a state of semi-decomposition.*

* The accuracy of the above proposition has been questioned by some writers whose opinions are entitled to respect. Thus, MM. Trousseau and Lasègue deny that syphilitic symptoms are ever apparent in the infant at birth, and affirm that they are never eliminated previous to the second week of existence; and in the recent edition of his work, Mr. Acton joins issue with Dr. Campbell of Edinburgh on this particular subject; the latter gentleman contending that abortion from syphilitic taint is a very common occurrence about the seventh month of utero-gestation, in which case a putrid child is most usually produced; and the former maintaining that such a result from venereal contamination is extremely rare. Mr. Acton, while he admits that "syphilis, like many other diseases, may blight the ovum," believes that abortion from this cause is much more unusual than

But it not unfrequently happens that the mother continues to carry the child beyond this period, and that labour is protracted till between the seventh and eighth month, when miscarriage without any appreciable cause suddenly ensues, and the child is born betraying indubitable evidence of infection. In this state it generally survives but a few hours; it has a shrivelled and emaciated appearance; its cry is hoarse and feeble; the skin hangs in folds, and is easily peeled off, and is occasionally mottled with a copper-coloured eruption. The mother of

what is generally supposed; and that if we examine into the records of venereal hospitals, we shall find that abortions are not more frequent at the seventh month than at any other period. While I coincide in. the opinion that the mere circumstance of a putrid child is not in itself a proof of venereal taint, and that it requires other corroborative symptoms to establish the fact, I have had convincing and indubitable proofs, in the wards of the Lock Hospital, that abortions at the seventh month are particularly frequent in women labouring under the secondary forms of syphilis. The previous history of the cases, in conjunction with the appearances presented in the foetus at birth, form undeniable evidences of the nature of the exciting cause. I have not, I regret, kept a registry of the cases to which I allude; but I can safely state that the principal source of infantile mortality in that institution, is attributable to a venereal taint evincing those effects at birth, and occurring about the seventh month of utero-gestation. Mr. Whitehead, likewise, in his treatise on "Hereditary Diseases," says that out of two hundred and fifty-six deliveries of syphilitic women in his own practice, one hundred and ten terminated prematurely at different periods of the process. In five, abortion took place at two months; in thirty, at three months; in thirteen, at four months; in four, at five months; in ten, at six months; in thirty-nine, at seven months; in sixteen, at eight months. Of those that arrived at the full term, ten died during the first week, two in the second, one in the third, five in the fourth, eight in the second month, six in the third month, seventeen within the first six months, three within nine months, one within one year, seven during the second year, and one in the third year.

such an offspring may be most prolific; but a series of such casualties as those already described will most probably supervene, at the time when she is looking forward, perhaps with feelings of maternal anxiety, for some reward for the pains and perils to which the ordeal of child-bearing subjects her. It does not, however, invariably happen; nor is it essential to demonstrate the venereal taint, that labour should come on before the natural term of utero-gestation; on the contrary, it very usually occurs that the mother fulfils the period allotted to healthy pregnancy, and after the ordinary time parturition is accomplished. This case differs in some respects from the two preceding; for here the infant is born apparently healthy and well nourished, and may continue so for a variable period, ranging from ten days to six weeks, and sometimes much later, when the attention of the nurse is suddenly arrested by a peculiar mode of respiration, familiarly known by the appellation of "snuffles." From the accession of this symptom, the child is observed to lose flesh rapidly, it is fretful and peevish, its sleep is broken, its skin is hot and dry, and it takes but little nutriment. A few weeks afterwards, a copper-coloured eruption encircles the anus and genitals, which spreads along the folds of the groins and back of the neck and

*

* Instances are related by M. Bertin, in which the disease did not show itself till the first, second, or third month, and frequently not till after weaning, up to which time the child continued in the enjoyment of health.