persons. Small doses of bromide of potassium in conjunction with the iodide, also increase the energy of the latter very materially; its special effects will be described further on. The iodide may be dissolved in various vehicles, plain water is often the best; in some cases it disorders the bowels, and causes purging; this may be avoided by adding some syrup of orange peel, compound tincture of bark, and a bitter infusion. The infusion of quassia is very commonly used to dissolve it in. If the patient be much enfeebled or debilitated, tartarated iron may be combined with the iodide. Large doses of iodide of potass can often be borne if dissolved in the compound decoction of sarsaparilla. When given in this way the irritation of the stomach is often avoided, and the good effect of the iodide obtained; the sarsaparilla should not be given in less doses than two or three ounces at a time, and as often as three times a day.

The iodides of sodium and ammonium have been tried as substitutes for iodide of potass, but they have never come into general use, as their taste is even more nauseous than that of iodide of potass. Mr. Langston Parker says he has used the iodide of sodium largely. He finds its effects in syphilis similar to that of iodide of potass, but that it can be given where the latter excites discharge from the nose and eyes, or swelling of the tongue, as it does not produce these effects; hence it is a resource valuable in these cases. He gives it in doses of fifteen grains three times a day. Gamberini of Florence, when at Bologna, experimented largely with it, and recommends it in preference to iodide of potass. Iodide of ammonium has also been much employed by the same surgeon, who gives it in half drachm doses three or four times daily. He claims for it equal efficacy in curing syphilitic affections, and states it rarely produces iodism.

The iodide of iron is useful in debilitated patients, acting as a tonic, though very slightly in the peculiar manner of the other iodides. It is very effective in persons who have rupia, or ulcers of the skin, and well marked poverty of blood. In children it is also exceedingly useful, if given while they are taking mercury, or if they remain feeble after the symptoms are dispersed. Large doses of iodide of iron in rare instances produce the pustular eruptions that follow the use of other preparations of iodine. The syrup and the pills of iodide of iron are the forms in which it is administered.

The bromides of potassium and ammonium are used either in conjunction with iodide of potassium or alone. They are particularly serviceable where the system has become insensible to iodine, or in syphilitic epilepsy and other varieties of nervous excitement. They are usually given in doses between three and fifteen grains, in two ounces of fluid three or four times a day.

Iron is much used in syphilitic persons to restore the blood from its anæmic condition. The tartarated iron can be given along with iodide of potash, or as steel wine. When taken by itself it often changes the aspect of spreading sores in debilitated persons with marvellous rapidity. Other forms of iron are used alone, or can be conjoined with the mineral acids, the nitric or sulphuric acids, if general tonics of a non-specific character are desired. It is rare for iron not to be required at some time during the progress of a case of syphilis.

Cod-Liver Oil is often necessary for restoring debility. In cases where neither mercury nor iodide of potass can be borne, the patient will often regain his strength and ability to take more specific medicine, after taking cod-liver oil a few weeks. I have found oleine succeed in certain cases where the repugnance to the oil itself is unconquerable. When it is desirable to give mercury with the oil, the

two can be mixed, for the oil will dissolve an etherial solution of perchloride of mercury, as already described in page 295. It will also dissolve sufficient iodide of potass, for the effect of each to be obtained. For instance, two scruples of iodide may be dissolved in eight ounces of cod-liver oil, and a tablespoonful of the oil be taken three times daily.

Sarsaparilla is held in esteem by few at the present day, though at one time it was the staple remedy in syphilis. Its value has been extolled and depreciated by so many, and the most contradictory statements made of its efficacy, that I prefer to confine myself to mentioning what I have myself observed in using it. It is now almost always given in combination with other vegetable extracts. I have found the compound extract of sarsaparilla to be decidedly beneficial, in enabling the patient to bear larger doses of iodide of potass than those he could take when dissolved in other menstrua. I have also found patients to improve rapidly when sarsaparilla has been given while they were taking or had recently taken prolonged courses of mercury. Sarsaparilla is still largely used on the Continent in the form of decoctions, which, being drunk in large quantities, cause the patient to sweat freely, and there can be no doubt in this way a benefit results from its administration, though any other sudorific would be equally useful. It forms the main constituent of Zittmann's decoction, of which the stronger form has already been mentioned among the mercurial preparations. The weaker decoction contains no mercury, and less sarsaparilla. If sarsaparilla be given at all, it must be given in large doses. Half an ounce to an ounce of the liquid extract per diem is better than a pint of the compound decoction, because in persons with feeble digestion the large bulk of liquid in the latter is apt to cause catarrh of the stomach. Sarsaparilla is only clearly useful when an adjuvant to mer

cury or iodide of potass, or as a stomachic to restore the bodily health of the patient, and enable him to take medicines that are more potent to subdue his disease. Thus the value of sarsaparilla in syphilis may be summed up by saying it is not competent to cure, but it tends to promote the healthy action of the functions, and enables mercury and iodide of potass to produce their characteristic results.

Besides sarsaparilla, the decoctions of guaiacum, mezereon, saponaria, lobelia, and many other vegetables of a diuretic or diaphoretic quality, have been recommended in the treatment of syphilis, but they have either fallen into disuse or are of doubtful value. They are employed by many surgeons with the object of promoting perspiration while the patient is taking a course of mercurial vapour baths. There can be no doubt that free transpiration through the skin should always be encouraged in treating syphilis; but it is very questionable whether, by irritating and wearying the stomach with these large quantities of fluid, the patient does not suffer more harm than he derives benefit from their sudorific action. Sufficient perspiration can be excited by the vapour bath and the wrapping in blankets for several hours, that should follow the bath in all cases.

Opium. It has already been narrated how opium was at one time extolled as a specific in the treatment of syphilis, for which purpose it was administered in very large doses, sometimes even as much as 20 grains in the course of the day. But this employment of opium was soon laid aside, and now it is given in syphilis as in other diseases to allay the irritation that accompanies great exhaustion. It is of great value in persons whose strength is worn out by protracted disease, by severe courses of mercury, or by debauchery, starvation, and drunkenness. In such persons, by taking two or three grains of opium twice or thrice a day, sleep is obtained, the appetite returns, and obstinate

ulcers heal up. Opium is also necessary to allay the pain of periostitis and other local affections, though in these cases its influence is usually more decided if it is given in conjunction with iodide of potass and mercury. Mr. L. Parker relates an instance of a girl with an obstinate spreading ulcer of the perinæum, being treated by opium, gradually carried to the amount of 8 grains per diem. The patient was constipated, and took as little food as possible, yet the ulcer was soundly healed in three weeks. The forms most adapted for these cases are the powder, the tincture, and the compound ipecacuanha powder, as they induce perspiration and check irritation of the bowels when that is present.

SPECIAL TREATMENT OF THE AFFECTIONS OF SYPHILIS. -Many consequences of syphilis require special applications both to relieve the pain and check the mischief that results from the morbid action on the part affected. Most of the affections of the surface of the body can usually be healed by local applications alone, though if treated solely in this manner there is much probability of their return, or of some other syphilitic affection succeeding them, if the activity of the virus is not overcome by simultaneous specific treatment. The surgeons who object to mercury in syphilis confine their attention to general tonic treatment, and to enforcing cleanliness and dressing any ulcers that may form. This method produces very good results in those mild cases of syphilis that are so common among women, where the course of the disease is limited to mucous patches of the vulva and throat, with, perhaps, a few papules around the neck. But this method is not to be recommended, if we consider how frequently in persons who suffer with necrosis of the bones, and other late sequelae of syphilis, the early progress of the disease excited so little disturbance, that the

1 On Syphilitic Diseases, p. 339. 1860.