with nitrate of silver or sulphate of copper every day, and their surfaces covered with dry linen rag, if they are liable to touch the skin of adjacent parts. Crusts of pustules should be well smeared with lard, and then poulticed with bread and water. The crusts thus softened can be gently removed, and the skin, if ulcerated, touched with nitrate of silver, and kept moist with ointment of red oxide of mercury. The larger bulla of pemphigus may be washed with solution of perchloride of mercury, 4 or 5 grains to the ounce, and wrapped in soft lint. Chinks between the fingers or around the nails should be protected by covering them with strips of rag smeared with dilute mercurial ointment.

One of the greatest difficulties with syphilitic children is the nasal catarrh, which hinders sucking, and is so constant a symptom. The nasal catarrh must be managed by beginning mercurial treatment as early as possible, to check the inflammation of the mucous membrane. The nostrils must be cleared regularly of inspissated mucus with a camel-hair pencil dipped in water, and excoriations touched with the ointment of red oxide of mercury of the Pharmacopoeia. The fauces should be examined, and ulcers in that situation touched with solid nitrate of silver. The mouth must be carefully cleaned after each meal with warm water and a small piece of sponge on the end of a stick; excoriated surfaces and aphthous patches being touched with solution of borax or sulphite of soda.

Management of the Diet.-Whenever the mother can suckle her child she should always do so, as the proportion of suckling infants who recover is very much larger than those who are fed by hand. The risk of communicating syphilis will, however, render it impossible to employ a wetnurse to suckle the child, and the resources of hand-feeding must be trusted to entirely when the mother has no milk. The meals must be given at stated intervals, every two,

three, or four hours, according to the age. The child must not be allowed to overcharge his stomach, which, if feverish, his thirst will induce him to do. The quality of the food fit for the child varies very much with his condition, and thus requires much careful management. As weak or exhausted children frequently die more of inanition than of the effects of the disease itself, and the milk of syphilitic women is often very poor or scanty, the child's food should be supplemented with two meals of cow's milk, or still better, ass's milk, to which a third or fourth part of veal or chicken broth is added, with a little sugar. If the cow's milk be very rich, plain water may be used occasionally instead of the broth. It is important that the same cow should always furnish the milk, and that she is fed on hay or grass, not on turnips, grains, &c. The milk should not be boiled, but warmed by mixing it with hot broth or water, or by plunging the bottle in hot water before it is given to the child. When the child is fed on milk chiefly, a small quantity at a time must be given, and one part of lime water instead of plain water, mixed with three parts of milk; farinaceous food must be allowed very sparingly, one meal aday if the child is past the first three or four months. Emaciated children will sometimes bear a few teaspoonsful of cream with sugar and limewater, when milk is rejected or keeps up diarrhoea. A few teaspoonsful of moderately. strong beef-tea, with pounded biscuit, are also useful once a-day. Older children require more solid food, and in addition to the milk, they will take small meals of sop of biscuit flour, the yolk of an egg lightly boiled, or beaten up in a little veal broth or beef-tea.

Brandy may be given in very small quantities, fifteen or twenty drops in water, three or four times a-day. The brandy should be mixed with sufficient water to prevent it from burning the mouth, when kept there a minute before

swallowing it. Children who have nearly completed their first year can often take raw meat, and after the first few times will often do so with avidity. A piece of rump-steak, carefully cleared of fat, should be scraped into shreds with a knife, or pounded in a mortar. The meat should be freshly prepared every time it is given, which may be done four times in the twenty-four hours, giving about two teaspoonsful at each meal. If the child refuses the meat, he may be induced to swallow it by rolling it into pellets and putting them in his mouth, or mixing it in his milk or beef-tea. Older children will often eat it, if spread between two thin pieces of bread and butter. But the child soon gets to relish the meat better than any other food, and this diet generally checks diarrhoea very efficiently when that is present. If the milk is thrown up, or the abdomen is distended with flatulence soon after suckling, wrapping the belly in a hot napkin while the child sucks, and keeping a roll of flannel on continuously, will often check the vomiting, and enable the stomach to digest the milk.

DIVISION III.

CHANCRE.

CHAPTER I.

NAMES-Modes of contagion-Frequency among venereal sores- -CourseVarieties-Seat-Complications, Inflammation, Sloughing, Serpiginous ulceration-Diagnosis: Syphilis, Herpes, Gonorrhoea, Fissures, Mucous patches-Prognosis-Bubo: Sympathetic, Virulent-Summary.

Chancre: soft, simple, non-infecting, chancroid sore.—The contagious venereal ulcer which is not followed by constitutional syphilis has received these various names. It is produced by inoculating the discharge of a similar sore, either on the same or on another individual, in consequence of a contagious principle in the discharge reproducing this local lesion wherever it is inserted. The excitant cause of the local sore often produces its distinctive effects, while the virus of syphilis is also developing its characteristic changes, but though contained in the same secretion the two contagious principles are independent of each other. It is still unknown what renders the pus of these ulcers contagious, whether it is due to a peculiar principle or whether to a peculiarly irritating condition of the discharge of ulcerating surfaces.

Mode of Communication.-It is highly improbable that contagion ever takes place through an unbroken surface, for

though it is conceivable that the discharge may be absorbed if allowed to remain long in contact with an unbroken mucous surface, there is no proof that absorption ever does take place by this means. On the contrary, two facts plainly show that a breach of surface is usual, namely, the favourite seats of chancre being just those localities where abrasion is most frequent, and, on the other hand, that contagion fails where there is no breach of surface. This has been shown by an experiment Cullerier made to prove the possibility of "mediate contagion," that is, contagion from a first person to a third by their both coming into intimate contact with a second who himself escapes contagion. Cullerier,1 having selected a woman in whom the vagina was free from excoriation, passed into it some chancrous pus which he left there thirty-five minutes. He then took some of the pus out of the vagina again and inoculated it on the patient's thigh; he afterwards carefully washed the vagina with alum water; the inoculation of the thigh succeeded, but the vagina completely escaped all contagion. This experiment was repeated successfully on another woman in whom the pus was left undisturbed for nearly an hour. Cullerier's object was to show that a woman, if she has intercourse with two men of whom the first is syphilitic, may be the means of transmitting the disease to the second without contracting it herself; this method he called "mediate contagion."

Individuals vary in susceptibility; this depends to some extent on the conformation of the sexual organs, and on the degree of tenderness and delicacy of the epithelium covering them; possibly also somewhat on idiosyncracy or the susceptibility to irritation which varies in individuals. For this reason, observers who have experimented with repeated inoculations find some persons much more apt to receive

1 Fournier Ricord, Leçons sur le Chancre, p. 369.