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THE 
/ 
STUDENT'S MANUAL 
OF 
VENEREAL DISEASES. 
BEING 
A CONCISE DESCRIPTION OF THOSE AFFEC- 
TIONS AND OF THEIR TREATMENT. 
BY 
BERKELEY HILL, M.D, 
PROFFESSOR OF CLINICAL SlfRGERY In' UNIVERSITY COLLEGE, LONDON; 
SURGEON TO UNIVERSITY COLLEGE AND THE LOCK HOSPITALS, 
AND 
ARTHUR COOPER, M.D., 
SURGEON TO THE WESTMINSTER GENERAL DISPENSARY; FORMERLY 
HOUSE-SURGEON TO THE LOCK HOSPITAL. 
FOURTH EDITION. REVISED. 
PHILADELPHIA : 
P. BLAKISTON, SON & CO., 
No. 1012 Walnut Street. 
1887. PREFACE TO THE FOURTH EDITION. 
In the preparation of a new edition of this little 
work our aim, as heretofore, has been to place before 
the student as concisely as possible the main ele- 
mentary facts relating to Venereal Diseases and their 
treatment. While trying to effect this our chief 
difficulty has been to keep down the size of the book. 
By careful revision and compression of the text, how- 
ever, we have been able to find room for additional 
matter in almost every chapter without very consider- 
able increase in bulk. Some additions and altera- 
tions will also be found in the list of Formulae. We 
hope the result will be to make the Manual more 
useful to the student. 
Those who seek fuller information on the subject 
will find that the arrangement of the present work 
corresponds, as far as possible, with that adopted in 
our larger treatise, " Syphilis and Local Contagious 
Disorders." 
Berkeley Hill, 
Arthur Cooper. 
April, 1886. 
V CONTENTS. 
INTR OD UCTOR Y. 
CHAPTER I. 
HISTORICAL. 
PAGE 
Antiquity of Chancre and Gonorrhoea 17 
Probable Antiquity of Syphilis 17 
Unrecognized Forms of Syphilis 18 
CHAPTER II. 
MODERN VIEWS. 
Dualism and Unicism 18 
Chancre Distinct from Syphilis 19 
SYPHILIS. 
CHAPTER I. 
OUTLINE. 
Synonyms . . . 20 
Definition 20 
General Sketch of the Course of Syphilis 20 
Pathological Anatomy 22 
Reinfection 23 
Duration . . 24 
CHAPTER II. 
CONTAGION. 
Causes of Syphilis 24 
VII VIII 
TAGE 
Vehicles of the Virus 25 
Modes of Contagion 26 
1. Direct Contact 26 
2. Mediate Communication 26 
3. Hereditary Transmission 26 
CHAPTER III. 
THE INITIAL MANIFESTATION. 
Incubation 27 
The Three Forms of Initial Manifestation 27 
Effects of Local Irritation 28 
Enlargement of Lymphatic Glands 29 
The Lymphatic Vessels .' 29 
Diagnosis of Initial Manifestation 29 
Prognosis of Initial Manifestation 30 
CHAPTER IV. 
AFFECTIONS OF THE SKIN. 
Interval Between Primary and Secondary Symptoms ... 30 
Period of General Eruption 30 
General Remarks on Syphilides 30 
Distinguishing Characteristics of Syphilides 31 
Macular Syphilide 32 
Papular Syphilides 33 
Mucous Patches 33 
Vesicular and Pustular Syphilides 34 
Rupia 34 
Pemphigus 35 
Tubercular Syphilide 35 
Serpiginous Syphilide 35 
Gummata • 36 
The Hair 36 
The Nails 37 
CONTENTS. IX 
CONTENTS. 
CHAPTER V. 
THE ALIMENTARY SYSTEM. pAge 
The Tongue 38 
The Mouth and Pharynx 38 
The CEsophagus 39 
The Stomach and Intestines 40 
The Liver 40 
The Spleen • 42 
The Pancreas 43 
The Supra-renal, Thyroid, and Pituitary Bodies 43 
CHAPTER VI. 
THE RESPIRATORY AND CIRCULATORY SYSTEMS. 
The Nose 43 
The Larynx 44 
The Trachea and Bronchi 44 
The Lungs 45 
The Heart 45 
The Blood Vessels 45 
CHAPTER VIL 
THE NERVOUS SYSTEM AND ORGANS OF SPECIAL SENSE. 
Period at which Syphilitic Nervous Affections Occur ... 46 
The Brain 46 
The Spinal Cord 48 
The Nerves 49 
Nervous Affections in Inherited Syphilis 49 
Diagnosis of Syphilitic Nervous Affections 49 
Prognosis of Syphilitic Nervous Affections 50 
The Eye 50 
The Ear 51 
CHAPTER VIII. 
THE GENITO-URINARY SYSTEM. 
The Urethra and Bladder 52 X 
PAGE 
The Kidneys 52 
The Penis 53 
The Epididymis 53 
The Testis 53 
The Vulva 54 
The Vagina and Uterus 54 
The Placenta 55 
The Ovaries and Fallopian Tubes 55 
The Breast 55 
CHAPTER IX. 
THE OSSEOUS AND MUSCULAR SYSTEMS. 
Period at which Osseous Affections Occur 55 
Ostealgia 55 
Osteo-periostitis 5 6 
Nodes 
Gumma of Bone 5$ 
Extension to Bone from Other Tissues 57 
Dactylitis 57 
Osseous Changes in Inherited Syphilis 5$ 
Symptoms of Syphilitic Disease of the Bones 59 
Consequences of 59 
The Joints 59 
The Cartilages 60 
The Muscles 60 
The Tendons 61 
The Bursse 61 
CHAPTER X. 
INHERITED SYPHILIS. 
Course and Symptoms 62 
Terminations 63 
Pathological Changes . 63 
Late Forms of Inherited Syphilis 63 
The Teeth 64 
CONTENTS. XI 
CONTENTS. 
CHAPTER XL 
GENERAL DIAGNOSIS AND PROGNOSIS OF SYPHILIS. 
PAGE 
Diagnosis of Acquired Syphilis 65 
" Inherited " 67 
Prognosis of Acquired Syphilis 68 
" Inherited " 68 
CHAPTER XII. 
TREATMENT OF SYPHILIS. 
Indications to be Followed in Treating Syphilis 70 
Period Preceding General Eruption 70 
Treatment of Initial Lesion 70 
Period of General Eruption 71 
Mercury, its Effects, and Mode of Administering it . . . 71 
Iodine and its Compounds 76 
Bromides 77 
Iron, Quinine, Cod-liver Oil 77 
Sarsaparilla, Opium 78 
SPECIAL TREATMENT OF THE AFFECTIONS OF SYPHILIS. 
The Skin 78 
Mucous Patches 79 
The Alimentary System 79 
The Air Passages 81 
The Nervous System 81 
The Eye 82 
The Ear 83 
The Generative Organs 83 
The Bones, Muscles, Joints and Bursae 83 
Treatment of Inherited Syphilis 84 
Preventive Treatment of Syphilis 85 
Marriage 86 
Nursing 87 XII 
CFIANCRE. 
CONTENTS. 
CHAPTER I. 
DESCRIPTION. 
PAGH 
Synonyms 88 
Definition 88 
Varieties and Characters of Chancre 88 
Complications of Chancre 89 
Diagnosis and Prognosis of Chancre 89 
Bubo, Simple and Virulent 90 
Inflammation of Lymphatics 90 
CHAPTER II. 
TREATMENT. 
General Treatment 91 
Local Treatment 91 
Treatment of Chancre in Different Situations 91 
" Sloughing and Phagedaena 92 
" Bubo 93 
" Sinuses 94 
GONORRHOEA. 
CHAPTER I. 
URETHRITIS IN MAN. 
Synonyms 96 
Urethritis, Causes and Seat of 96 
" Extension of, to other Parts 97 
" Anatomical Change in 97 
" Course and Symptoms of 97 
" Terminations of 98 PAGE 
Causes of Gleet 98 
Urethritis, Diagnosis of 98 
" Prognosis of 98 
" Treatment of 98 
Treatment of Gleet 100 
Complications 101 
Balanitis and Posthitis 101 
Phimosis and Paraphimosis 101 
Retention of Urine 101 
Inflammation of Lymphatic Glands and Vessels . . 102 
Hemorrhage from Urethra 102 
Peri-urethral Abscesses 102 
Prostatitis 102 
Acute and Chronic Prostatitis 103 
Cystitis 103 
Epididymitis 104 
Disorders of the Eye 105 
Gonorrhoeal Rheumatism 105 
CHAPTER II. 
GONORRHOEA IN WOMAN. 
Vaginitis 106 
" Causes of 106 
" Symptoms of 107 
" Diagnosis of 107 
" Prognosis of 107 
" Treatment of 107 
Complications 108 
Vulvitis 108 
Urethritis 108 
Acute Inflammation of the Cervix Uteri 109 
Metritis, Perimetritis, and Ovaiitis 109 
CONTENTS. 
XIII XIV 
ACCESSORY VENEREAL DISORDERS. 
CONTENTS. 
I. AFFECTIONS COMMON TO BOTH SEXES. 
PAGE 
Abrasions no 
Warts no 
Herpes in 
Phtheiriasis 112 
Scabies 112 
II. AFFECTIONS PECULIAR TO MEN. 
Balano-posthitis 113 
Phimosis 114 
Paraphimosis 115 
Rupture of the Fraenum 116 
Rupture of the Erectile Tissue 116 
III. AFFECTIONS PECULIAR TO WOMEN. 
Vulvitis 116 
Inflammation of Bartholine's Glands 116 
Phlegmonous Abscess of Labium 117 
Chronic Endometritis 117 
Granular Erosion of the Cervix Uteri 118 
Formul/e 120-132 THE STUDENT'S MANUAL 
OF 
VENEREAL DISEASES. 
INTR OD UCTOR Y. 
CHAPTER I. 
HISTORICAL. 
Venereal Diseases are three : Syphilis, Chancre, 
and Gonorrhoea. The last two have immemorial 
antiquity, being described in Chinese systems of 
medicine 4500 years old; also in Hindoo, Arabic, 
Greek and Latin literature. There is much reason 
for attributing to syphilis an equally remote origin, 
though the proof is less positive. In the Middle 
Ages a general eruptive disease called lepra was 
often propagated by sexual intercourse, along with 
local venereal disorders. This was probably syphilis, 
In the years 1490-99 an epidemic spread rapidly 
through Europe, which was also probably syphilis. 
At the time it was called the "great pox," was con- 
tagious, and was communicated most readily during 
sexual intercourse. As this disease had extended to 
several countries of Europe about the time of his 
17 18 
INTRODUCTION. 
return, there is small foundation for supposing that 
Columbus brought it from America. Sixty years 
after this outbreak, its description by Fracastor and 
others, shows that syphilis had become then what it 
is now. About the middle of the sixteenth century 
authors began to attribute all venereal disorders to 
one source, having previously drawn a distinction 
between syphilis and other venereal diseases. This 
confusion reigned until the present century. In the 
seventeenth and eighteenth centuries, the true nature 
of certain forms of syphilis prevailing in isolated dis- 
tricts was not recognized; hence the diseases called, 
at different times, Sibbens in Scotland, Radezyge in 
Norway, Scherlievo in Dalmatia, and by many other 
names in various parts of the world, were not con- 
sidered to have a venereal origin, until proved to be 
simply varieties of syphilis. 
CHAPTER II. 
MODERN VIEWS. 
The theory which maintained that a common virus 
excites constitutional syphilis, gonorrhoea, and local 
contagious ulcers, has been abandoned since Ben- 
jamin, Bell, and Ricord demonstrated gonorrhoea to 
be distinct from syphilis. In 1852 Bassereau sub- 
stantiated the truth of another suggestion of Ricord, 
namely, that of the two kinds of venereal sore, one MODERN VIEWS 
19 
is a local disorder, the other a part of the constitu- 
tional disease, syphilis. Those who agree with 
Ricord and Bassereau are dualists ; while those who 
assign a common origin to the exciting virus of both 
disorders, are now called unicists. Dualists, how- 
ever, are not all agreed respecting the nature of the 
virus which produces the local sore. Some believe it 
may be caused by pus in an unusual state of acridity 
from inflammatory or other ordinary processes. 
Others maintain that'it is due to a special virus ; and 
this is the view which is most in harmony with the 
present state of knowledge on the subject. 
The dualist theory is the one adopted in this book. 
The term chancre will be applied solely to the local 
contagious venereal ulcer, while the term syphilis will 
be used only when speaking of the general constitu- 
tional disease. SYPHILIS. 
CHAPTER I. 
OUTLINE. 
Synonyms.-Pox; Fr., Verole ; Ger., Lust- 
seuche. 
Syphilis is a specific disease which may be acquired 
or inherited. It is communicable to the sound solely 
by contact with the fluids of the diseased. A certain 
interval exists between the absorption of the poison 
and the manifestation of its effects. The poison is 
conveyed throughout the body by the blood. The 
effects of syphilis are displayed both on the surface 
of the body and internally. The natural course of 
the disease is to recovery. 
When the syphilitic poison, unmixed with irritat- 
ing matter, has been inoculated, it gives no evidence 
of its presence for three or four weeks; this period 
is called its incubation. Then it reveals its presence 
by induration of the tissue at the point of inocula- 
tion, and by the formation of an elevated papule 
(the initial lesion or manifestation), which may or 
may not become an ulcer with a hard base. About 
eleven days later than the appearance of the papule, 
the glands nearest the point of infection are found to 
20 OUTLINE. 
21 
have become enlarged. Within a few weeks from 
this, usually four or five, a red macular eruption 
appears. It may be unperceived by the patient, as 
it causes no discomfort. The rash is often preceded 
by headache and loss of appetite, and sometimes by 
fever. As the first eruption disappears, others, gen- 
erally of a papular character, may develop on the 
skin and on the mucous membrane, especially that 
of the mouth and throat. Emaciation and loss of 
strength sometimes set in at this period. Having 
made this progress, the disease may subside com- 
pletely, and never revive. Usually, however, after 
a time, an eruption of a scaly, or less commonly of a 
pustular character, appears on the skin, with excori- 
ated patches on the fauces. They are accompanied, 
in the more severe cases, by rheumatoid and perios- 
teal pains, iritis, and other symptoms. The affection 
becomes either continuous by fresh crops of eruption 
following closely on each other, or the spots alter- 
nately vanish and return, during a period not often 
exceeding two years. During this time it is com- 
mon for the patient's strength and vigor to be greatly 
lessened. Thus the second period of the disease 
terminates. Should it go further, a new series of 
morbid processes occupies the body. If the skin is 
attacked, hard tubercles appear in that tissue, which 
are very prone to ulcerate. But the internal organs 
may be also the seat of similar solid formations, 
and of other changes. Syphilis, per se, is not 
often directly fatal in adults; but by altering the 
structure of organs of vital importance, it renders 22 
SYPHILIS. 
the patient unable to repair accidental injury to 
those organs, and thus, indirectly, frequently causes 
death. 
Though the earliest manifestation is as much a 
part of the general disease as are the subsequent 
ones, it has been found convenient to arrange them 
in three groups. First, those developed at the 
point of contagion and in the nearest glands-the 
so-called primary symptoms ; next, the widely spread 
affections, observed mainly on the surface of the 
body, called secondary ; and lastly, those attacking 
usually a limited area, or a special organ, named 
tertiary affections. These sets of symptoms are usu- 
ally separated by pauses. Not invariably; for now 
and then patients present simultaneously symptoms 
proper to all three periods. To such cases the term 
"malignant" or "galloping" syphilis has been 
applied. In the majority of cases, however, when 
the disease does not end with the secondary stage, 
tertiary symptoms do not appear earlier than five 
years after contagion. 
Pathological Anatomy.-The changes pro- 
duced by syphilis are of an inflammatory nature, and 
are chiefly due to the production of a morbid growth 
which undergoes certain processes of increase and 
degeneration. This change begins by the formation 
of small round cells embedded in a delicate stroma. 
The structure is at first similar to that of ordinary 
granulation tissue, and does not present any elements 
peculiar to syphilis. The growth may develop in a 
diffused, infiltrating form, or in the circumscribed OUTLINE. 
23 
masses known as gummata. Probably no organ or 
part of the body is exempt from liability to be at- 
tacked ; and though the new growth is essentially 
the same wherever and at whatever period of the 
disease it occurs, it of course varies according to 
the tissue or organ that is its seat. The gummy 
growth is at first highly organized and very vascu- 
lar, but subsequently there is a marked tendency to 
plugging of its vessels and consequent degenera- 
tion. If disintegration take place the consequences 
vary according to the seat of the growth. If the skin 
is affected an irregular ulcerated surface remains, 
while in the case of internal organs a tough cicatricial 
fibrous tissue results, which by contraction may seri- 
ously, or even fatally, interfere with the functions of 
the affected viscus. 
Contagion is not Repeated.-By this it is 
meant that a man who has once suffered from syphi- 
lis, thereby gains immunity for the future, and 
further inoculations have no effect upon him. This 
law, commonly true, is not absolutely so ; undoubted 
instances exist of patients who have had syphilis, 
and who after a lapse of years again contract the 
disease. 
In the best recognized and undoubted cases of 
reinfection, a regular recurrence takes place, namely : 
incubation, indurated initial lesion, enlarged glands, 
and eruptions of the cutaneous and mucous surfaces. 
In the second mode in which syphilis is said to be 
repeated, the course is much modified. The earlier 
stages do not appear, but the disease advances at 24 
SYPHILIS. 
once to the later forms; and nodes, rheumatic 
pains, affections of the liver, and other viscera, 
are the first signs of general infection. As such 
cases have no clear distinction from others which 
are simply revivals of a former attack, they are open 
to doubt. 
Duration.-This varies much in different persons. 
As a practical rule, one and a half or two years should 
be fixed as the probable period during which a pa- 
tient may expect relapses of eruptions on the cuta- 
neous or mucous surfaces. It must, nevertheless, be 
borne in mind that the disease is sometimes life-long, 
and the longer it lasts the more difficult it is to cure, 
though even in these cases success is often the reward 
of perseverance, for the number of incurable cases of 
syphilis lessens as our knowledge of the disease be- 
comes more complete. 
CHAPTER II. 
CONTAGION. 
The causes of syphilis are predisposing axd exciting. 
Predisposing causes are conditions facilitating the 
spread or increasing the severity of the disease. 
Syphilis is more severe in cold than in temperate 
climates; and in hot ones for natives of cooler 
climates. Any cause which enfeebles the condition 
of the individual increases the severity of syphilis. 25 
All races are subject to the disease. When it invades 
a district not previously accustomed to it, its course, 
like that of other contagious diseases, is for a time 
more severe. Probably there are individuals insus- 
ceptible to syphilis, who escape that contagion as 
they escape contagion of other kinds. 
•The sole exciting cause of syphilis is a subtle non- 
volatile principle called the virus, which, except in 
the case of inheritance, enters only at a breach of 
surface. The essential nature of the virus is un- 
known. Certain observers, especially in Germany, 
claim the discovery of a bacillus peculiar to syphilis; 
but the question at present remains unsettled. 
The length of time which elapses between inocula- 
tion and absorption of the virus is also unknown. 
Excision of the initial lesion has hitherto failed to 
prevent general infection-indeed, cauterization with- 
in twelve hours after contagion has also failed. 
The Vehicles of the Virus are-The secretions 
of all early syphilitic affections and the blood; but the 
fluids of the body usually cease to be contagious 
when only the so-called tertiary affections are left. 
The physiological secretions of a syphilitic person- 
e.g., saliva, sweat, tears, milk, semen-have not been 
proved to be inoculable when free from admixture 
with syphilitic secretions or with the blood. 
The secretions of co-existing diseases in syphilitic 
persons should always be regarded as capable of con- 
veying syphilis, though the evidence that they have 
done so, except under the conditions mentioned in 
the preceding paragraph, is imperfect. 
CONTAGION. 26 
SYPHILIS. 
Modes of Contagion.-Syphilis may be propa- 
gated by (i) direct contact; by (2) mediate com- 
munication ; or by (3) hereditary transmission. 
1. Direct Contact.-Syphilis is most commonly 
communicated during coitus; but it is not neces- 
sarily a venereal disease, for it is sometimes conveyed 
by kissing, by suckling, by examining diseased per- 
sons, as in the case of doctors, students and mid- 
wives, and in various other ways. 
2. Mediate Communication.-More rarely syphilis 
is conveyed through the medium of drinking vessels, 
spoons, pipes, towels, or other articles that have been 
used by syphilitic persons. Dentists' and surgeons' 
instruments have also acted as media of contagion- 
as, for instance, in vaccination. 
3. Hereditary Transmission.-1Our knowledge is 
imperfect respecting the ways in which syphilis may 
be transmitted from parent to child. There is no 
doubt that if the mother be infected shortly before or 
at conception, the child will almost always receive 
the disease. The child will probably contract the dis- 
ease if the mother be infected in the early months of 
pregnancy. If she is infected after the seventh 
month the child often escapes. As the disease sub- 
sides in the mother, the chances of escape for the 
child greatly increase, and after the second or third 
year of the mother's infection the child is often 
healthy. 
It is believed by many that the child may inherit 
the disease from the father, and may in turn infect 
the mother through the placental circulation, or in THE INITIAL MANIFESTATION. 
27 
some other way (" choc en retour ") ; but this is not 
established beyond doubt. 
There are also those who believe that syphilis may 
pass from father to child while the mother escapes. 
It is most probable, however, that the mother of a 
syphilitic child never really escapes, for under such 
circumstances she never catches the disease from her 
child after its birth (Colles' Law). 
CHAPTER III. 
THE INITIAL MANIFESTATION. 
The interval between the introduction of the 
poison and the commencement of its activity is 
called the incubation. This period lasts most com- 
monly about twenty-four days. The limits of incu- 
bation are between ten and forty-six days. The 
reasons of this variation in different individuals are 
yet to be learned. 
When incubation is over, a change takes place at 
the site of inoculation. This change, the initial 
manifestation (initial lesion, primary syphilitic sore, 
hard or infecting chancre), has three forms: i, the 
elevated desquamating papule: 2, the superficial 
hard ulcer; 3, the indolent ulcer, with a hard, widely 
extended base. These three forms are produced 
quite independently of any local irritation. In the 
first variety the hard deposit remains dry, losing the 
cuticle from its surface, without reaching ulceration. 28 
SYPHILIS. 
In the second and commonest form, the induration 
of the tissue beneath the ulcerating surface is less 
abundant, and sometimes, instead of being developed 
in a mass, it is spread in a thin layer under the 
surface, which secretes a serous discharge; this 
form is called "parchment induration." In the third, 
induration is well marked, and also ulceration, but 
the discharge is not copious or purulent. This is 
the most easily recognized form, which is often called 
a " Hunterian chancre." When fully developed it has 
a hard, resisting base; the surface is covered by a 
scanty, adhesive discharge ; the edges are sloping 
and rounded; and the induration extends beyond 
the ulcer. 
Effects of Local Irritation.-If chancrous pus 
or matter from any irritable sore be inserted with 
the syphilitic secretion, immediate action of this 
irritant begins, the intensity and continuance of 
which depend on the acridity of the irritant. Simi- 
lar effects ensue if the irritant be applied to a syphi- 
litic ulcer after it is developed. Chancrous pus ap- 
plied to the surface of an indurated sore incites it to 
suppurate freely, and to acquire some of the charac- 
ters of a chancre, in which case the discharge be- 
comes auto-inoculable. When the syphilitic virus 
and chancrous pus are inoculated together, the 
lesion which results is called a " mixed chancre," by 
Rollet, Sloughing action at the point of inoculation 
is no preservative against syphilis. 
The initial manifestation is usually single. It 
may be met with on any part of the surface of the 29 
THE INITIAL MANIFESTATION. 
body, the prepuce and glans penis being the most 
frequent sites in the male, and the labia and nymphse 
in the female. The induration at the point of inocu- 
lation varies, according to its situation and the sex of 
the patient; it may be scanty, and thus liable to be 
overlooked by a superficial observer, but it is rarely 
wholly absent. Copious induration is not always 
an indication of a severe course of the disease. 
The lymphatic glands connected with the point of 
contagion enlarge, slowly and painlessly, about eleven 
days after induration of the point of contagion. 
The cellular tissue around the glands remains un- 
changed, and they can be plainly felt as a group 
beneath the skin. This local change is sometimes 
followed by general glandular enlargement, those 
most plainly affected being the cervical glands. This 
further change is accompanied by diminution in the 
number of the red corpuscles of the blood, pallor 
and languor. Enlargement of the lymphatic glands 
is sometimes ill-marked, and escapes observation. 
When it subsides, the glands shrink back to their 
original size, or even, by fatty and calcareous degen- 
eration, lose their normal structure. Suppuration in 
these glands, so common a complication of the local 
chancre, is unusual, and is the consequence of local 
irritation, never dependent on syphilis alone. Sup- 
puration is not protective against general infection. 
The lymphatic vessels, which connect the initial 
lesion with the glands, can often be felt as hard cords 
beneath the skin. 
The diagnosis of a syphilitic initial lesion depends 30 
SYPHILIS. 
on the incubation, the induration, the indolent 
superficial quality of the ulceration, should that be 
present, and the painless general enlargement of the 
nearest group of lymphatic glands. 
The prognosis is that of syphilis. 
CHAPTER IV. 
AFFECTIONS OF THE SKIN. 
After the development of the initial manifestation 
and glandular enlargement (primary symptoms), 
there is another interval before the appearance of 
the general or secondary symptoms; and this period 
of quiescence is sometimes called the "second 
incubation." 
The Period of General Eruption, when not influ- 
enced by specific treatment, begins about nine or 
ten weeks after contagion, six or seven after indura- 
tion of the point of inoculation, and four or five 
after the lymphatic glands are perceived to have 
enlarged. Malaise, pains in the head, back and limbs, 
and pyrexia, may precede or accompany the outbreak 
of the rash. The febrile action and pain are some- 
times intense, and the former may assume a periodic 
intermitting course. The fever generally subsides 
when the eruption is fully out. 
General Remarks on Syphilides.-The vari- 
ous aspects of the rashes in syphilis resemble those of AFFECTIONS OF THE SKIN. 
31 
the non-syphilitic eruptions in some degree. There 
are several characters common to all the earlier 
syphilides. i. The Papular is the commonest erup- 
tion. All the others are usually mingled with papules, 
and thus the papule becomes the type or basis of 
syphilitic eruptions. The different rashes do not 
become typical examples of the eruptions among 
which they are classed ; the vesicles, for example, 
are abortive, and the scaling patches desquamate but 
scantily. 2. Symmetry. In the earlier stages both 
sides of the body are beset with spots, because the 
virus producing them pervades all parts of the system. 
3. Color. At first this is often bright red, but it 
usually changes to the hue of raw ham, or assumes a 
coppery tint. 4. Rarity of Irritation. Syphilitic 
rashes are almost always free from heat, itching, or 
smarting. 5. Favorite Localities. Most frequently 
the trunk, the forehead, especially along the border 
of the scalp, the margins of the nostrils, and the 
nape of the neck are chosen by the eruption. The 
outer aspects of the extremities often escape, and the 
backs of the hands and feet are rarely marked. The 
palms and soles are frequently attacked by syphilis- 
situations commonly avoided by non-syphilitic rashes. 
Again, simple macular eruptions prefer the extremi- 
ties, while syphilitic maculae often spare them. Com- 
mon psoriasis always prefers the outer and rough 
aspect of the limbs. Syphilitic scaly eruptions show 
a preference for the flexor aspect. 6. The Form and 
Arrangement of the spots and patches in syphilis are 
often arches or circles, or segments of circles. 7. 32 
SYPHILIS. 
Multifarious Character. Syphilitic eruptions are very 
often present together; thus papules appear among 
the maculae, and scaling patches co-exist with mucous 
patches, or with pustules. 8. Transformation of one 
form into another is often observed when there is oppor- 
tunity for watching the progress of the disease ; e.g., 
smooth papules may become scaly, vesicular or 
pustular, or, if kept moist, develop into mucous 
tubercles. 
The later Syphilides, which appear when the dis- 
ease is losing its activity, are seldom spread widely 
over the body. The brown tint is then well marked. 
Such limited forms are slow in progress : in feeble 
persons they are prone to ulcerate, and the ulcers 
leave indelible scars. They are often the only syphi- 
litic symptoms present. They commonly heal read- 
ily under proper treatment, but are apt to recur when 
the treatment is discontinued. 
Macular Syphilide.-Roseola is the earliest rash 
after infection : .but besides being often overlooked, 
is not invariably present. It consists of spots, rosy 
red, and fading under pressure when fresh, often 
turning to coppery-brown before disappearing. The 
patches are usually slightly elevated, and sometimes 
desquamate as the rash subsides. The eruption lasts 
commonly two or three weeks, but may disappear 
in a few days, especially under specific treatment. 
Papules often form among the roseolous spots. 
There are two varieties of spots, the large and the 
small. The flanks, abdomen, and chest are the 
common seats of the eruption, but in rare cases it AFFECTIONS OF THE SKIN. 
33 
spreads all over the body. It relapses now and then. 
The diagnosis depends on the accompanying en- 
larged inguinal glands, the induration of the point of 
contagion, the erythematous redness of the fauces, 
the small amount of irritation and of constitutional 
disturbance, the rash being always most fully devel- 
oped on the trunk, and the slow course. 
Papular Syphilides.-When the papules are 
minute they are called miliary; when small, lenti- 
cular ; when large, nummular ; when desquamating, 
squamous; when arranged in circles or figures of 
eight, leprous syphilides. When the palms or soles 
are attacked, the term psoriasis palmaris or plantaris 
is often used. Miliary and lenticular syphilides are 
most frequent in the first six months after conta- 
gion ; the scaly form is generally rather later; lepra 
and papulo-squamous affections of the palms and 
soles are most often seen when the disease is of long 
standing. The papular syphilide may attack all 
parts of the body, and is the eruption which most 
frequently relapses. The color common to all 
syphilitic papular eruptions is rosy at first, fading to 
coppery or purplish brown. When the papule 
reaches full development, the cuticle separates in 
dry scales, leaving a characteristic silvery border. 
The usual accompaniments of these eruptions are 
ulcers or papules in the throat, enlarged lymphatic 
glands in various parts of the body, and alopecia ; 
less frequently, periosteal pains, nodes and iritis. 
Mucous Patches are merely syphilitic papules 
altered by moisture. When large and prominent 34 
SYPHILIS. 
they are called mucous tubercles or condylomata. 
They form on the mucous surfaces, at the orifices of 
the body and on the skin where it is kept moist. 
They secrete a thin, purulent fluid, which is highly 
contagious. When near to each other they often 
coalesce into large patches. When developed around 
the anus, they are frequently subdivided by fissures, 
called rhagades. 
Vesicular and Pustular Syphilides are much 
rarer than the papular forms. Both are observed in 
feeble rather than in robust persons. They possess 
in common a vesicle, varying in size between a pin's 
head and a bean, forming the summit of an elevated 
areola (the papule). After a few days the vesicle 
shrinks to a small scale on the areola and falls off, 
leaving a coppery-red papule. Sometimes, instead 
of drying up, the liquid becomes purulent, converting 
the vesicle into a pustule, and the congestion of the 
areola increases. Various names (herpetiform, vari- 
celliform, acneiform, impetiginous, etc.), have been 
given to these syphilides, from their resemblance to 
the corresponding simple eruptions. They appear 
usually during the first year after infection; the 
duration varies from three or four weeks to several 
months, according to treatment. If the patient be 
well cared for a serious effect is seldom produced ; if 
he be neglected deep ulcers often form. The 
diagnosis is rendered positive by the presence of 
syphilitic lesions elsewhere, and by the characters 
which this eruption shares with all syphilitic rashes. 
Rupia is a form rarely seen till some years have 35 
AFFECTIONS OF THE SKIN. 
elapsed after infection, unless the general progress of 
the disease be very rapid. Here the pustule quickly 
shrinks and the contents dry into a crust, the skin 
ulcerates under the crust, the fresh secretion dries 
into a layer wider than the first, while ulceration 
extends beneath, until a thick scab of several layers, 
of a brownish-green hue, is formed. Sometimes, 
though rarely, the vesicle is well developed. The 
crops may succeed each other for several months. 
Rheumatoid and periosteal pains and debility ordin- 
arily accompany this eruption. 
Pemphigus is of exceeding rarity in adults. When 
it attacks a child with inherited syphilis it is fre- 
quently fatal. It is one of the earliest of all syphi- 
lides, being in most cases present at birth. It develops 
on the palms and soles, and extends up the arms 
and legs. 
Tubercular Syphilide.-This consists of solid 
rounded elevations of the skin. Being a late affection, 
it appears usually in persons infected at least three or 
four years. Th£ nodules are prominent, coppery or 
purple-brown in color, collected commonly into 
groups, and most frequent on the face. This erup- 
tion is never widely spread. The tubercles are very 
liable to ulceration, and then leave indelible white 
scars. The course is slow, for fresh tubercles may 
appear as the old ones subside, and the eruption 
recur again and again. 
The Serpiginous Syphilide.-Creeping ulceration 
may attack a tubercle. Where this takes place little 
tubercles develop at the margins of the first deposit, 36 
SYPHILIS.. 
and merge into each other. The original tubercle 
soon ulcerates and a scab is formed under which an 
ulcer creeps, healing where the tubercle first began 
to melt away, and spreading by the destruction of 
the tubercles at the margin of the ulcer. The course 
of the affection is indefinite unless controlled by 
treatment. 
Gummata of the cellular tissue, more rare than 
the last, are usually met with only in cases of long- 
standing syphilis. At first they form solid nodules 
beneath the skin. Presently the skin over the tumor 
becomes adherent to it, thin, bluish-red in color, 
and breaks down by slow ulceration. The contents 
then escape and a ragged interior is left, which 
heals with a depressed scar. Under proper treat- 
ment the mass is often absorbed before ulceration is 
reached. The gummy swelling is found oftenest on 
the limbs, but may form on any part of the surface ; it 
is identical with the gummy tumor of internal organs. 
The Hair.-The hair frequently becomes dry 
and withered during the course of the cutaneous 
eruptions. It often falls partially from the scalp 
(alopecia), and the eyebrows, lashes, and down of 
the body occasionally fall too, causing complete 
baldness. In a few weeks new woolly hairs grow, 
and, commonly, in the course of a few months the 
hair is completely restored. 
The ulcerating eruptions which beset the scalp 
sometimes destroy the follicles; the hair then comes 
away in patches and permanently bald spots are 
produced. AFFECTIONS OF THE SKIN. 
37 
The Nails, in syphilis, may be atacked prima- 
rily (onychia) or by extension from the surrounding 
parts (perionychia). 
Onychia.-In the commonest form, the nail first 
loses its healthy lustre, becomes dull, brittle, and 
notched at the free edge. In some cases, also, the 
nail gradually separates from the matrix. The sepa- 
ration is usually limited to the distal portion; but 
sometimes the whole nail falls off, and when repro- 
duced, is often grooved and irregular. In rare cases 
again, the nail becomes hypertrophied and greatly 
increased in thickness. 
Perionychia.-One form arises from the extension 
of a papular syphilide to the nail matrix, producing 
dull spots and subsequently chipping and irregularity 
of the nail itself. An inflammatory form of peri- 
onychia begins with indolent, dull red swelling of the 
parts surrounding the nail and of the matrix. The 
nail often necroses, and ulceration is produced. 
Syphilitic affections of the nails are distinguished 
by their multiplicity, chronicity, and the presence or 
history of syphilitic signs elsewhere. 38 
SYPHILIS. 
CHAPTER V. 
THE ALIMENTARY SYSTEM. 
The Tongue is very commonly attacked in the 
first and second years after contagion, most fre- 
quently by excoriations and fissures along the borders 
and tip. Mucous patches also are not infrequent; 
they accompany the papular eruptions of the skin. 
At a later period the mucous membrane and sub- 
mucous tissue sometimes indurate in broad patches. 
In such cases, sinuous fissures and ulcers often form, 
from accidental irritation ; and when they heal, 
white, shining scars remain. Lastly, gummy nod- 
ules may develop in the substance of the tongue; 
when superficial they break on the surface, and leave 
large, ragged, ulcerating cavities. Irritated syphi- 
litic ulcers on the side of the tongue may be con- 
founded with the simple ulcer set up by chafing the 
organ against ragged teeth, or with cancer ; the first 
is distinguished by the rapidity of its healing when 
the cause is removed ; the second by the hard everted 
edges, the shooting pain, and by the enlargement of 
the sublingual lymphatic glands. Nevertheless, the 
diagnosis is often difficult. 
The Mouth and Pharynx.-At the time of 
roseolous rash on the skin a similar redness often 
spreads over the throat, lasting a few days, and never THE ALIMENTARY SYSTEM. 
39 
going beyond very superficial excoriation. Small, 
round, sharply cut ulcers of a superficial kind, and 
mucous patches, are seldom absent from the fauces 
and tonsils during the early papular eruptions of the 
skin. They never sink deeply or leave contracted 
scars. Deep ulcers are the consequence of gummata 
in the submucous tissue, which, reaching the surface, 
rapidly disintegrate to a grayish adherent slough that 
gradually escapes and leaves a deep cavity with 
sharply cut edges. When ulceration follows the 
diffused form of infiltration, instead of destroying 
deeply, it sometimes migrates over the surface of the 
palate and pharynx, which becomes indurated widely 
before it ulcerates. Usually the action is confined 
to the mucous and submucous tissues ; at times it 
extends to the base of the skull and vertebrae, 
through which it may reach the brain or spinal cord, 
and produce epilepsy or paralysis. Asthenic fever 
often accompanies this ulceration. The throat is 
dry, parched, and brown ; any attempt at swallowing 
is most painful, and the voice is hoarse and nasal; 
cough and expectoration of viscid mucus increase 
the sufferings. When the disease is checked the 
ulcers heal, and tough unyielding scars bind down 
the fauces and greatly impede deglutition and 
speaking. 
The CEsophagus.-Stricture of the oesophagus 
now and then occurs among the later consequences 
of syphilis. It results from gummy infiltration of 
the submucous tissue, followed by contracting cica- 
trization. 40 
SYPHILIS. 
The Stomach and Intestines.-Various di- 
gestive troubles, as well as nodules and ulcers of the 
stomach, small intestine and colon, have been attri- 
buted to syphilis; but as regards these organs our 
knowledge is at present imperfect. 
The Rectum, is liable to be attacked by syphilis, 
but not often until several years after contagion. 
Ulcers are rare, and when present are usually merely 
an extension of ulceration from the anus. Circum- 
scribed gummata have been reported, but are of ex- 
treme rarity. The most important affection of the 
rectum is that which is usually discovered as a stric- 
ture of the lowest portion, and which is probably 
caused by contraction following a diffused syphilitic 
infiltration of the rectal walls. The great majority 
of those who thus suffer are women. The anus is 
generally also involved, and is sometimes surrounded 
by fistulse and flattened red elevations, which, when 
present, are diagnostic. The rectum is narrowed at 
one or two inches within the sphincter, whilst above 
the stricture the gut is widened and ulcerated. The 
disease has a slow course and, except in the earliest 
stage, is not affected by specific remedies. The 
symptoms are at first very slight; hence the disease 
is rarely discovered early. The later symptoms are 
difficult and painful defecation, with discharge of 
pus and blood from the bowel, added to the patho- 
logical characters just mentioned. 
The Liver.-Of the internal organs the liver is 
probably the one most frequently attacked by syphi- 
lis, whether acquired or inherited. As in other THE ALIMENTARY SYSTEM. 
41 
organs, the morbid change may take the form of 
diffused infiltration or of gumma. The former, which 
is most common, originates in Glisson's capsule. 
In adults the organ is usually only partially affected, 
but in infants the change is more widely spread. 
During the growth of the new tissue the liver in- 
creases in size, but when the stage of cicatrization 
and contraction is reached the liver becomes cir- 
rhosed, puckered and reduced in bulk. Gummata 
often grow in the fibrous cicatricial tissue. They 
form grayish-yellow, opaque, rounded masses, vary- 
ing from the size of a pin's head to that of a hen's 
egg; sometimes almost diffluent, sometimes of 
cheese-like consistence, cohering sufficiently to be 
extracted en 'masse from a capsule of vascular cellu- 
lar tissue. 
The cirrhosis of syphilis is characterized by the 
great degree to which the contraction is carried, so 
that the diseased parts are deeply seamed, while 
much of the organ is often unaffected ; peritoneal 
adhesions also are usually present. In cirrhosis 
from alcoholism the contraction is not so extreme, 
but is more general throughout the organ, and the 
adhesions of the surface are generally wanting. 
Gummata are distinguished from tubercles by their 
larger size, by their location along the streaks of 
fibrous tissue, and by the absence of miliary trans- 
lucent tubercles around them. In cancer, the liver 
is enlarged, and the cancerous masses have no ob- 
vious connection with the fibrous structure. 
Lardaceous disease is one of the most frequent 42 
SYPHILIS. 
visceral changes in syphilis, but it is identical with 
that produced in other diatheses. Acute atrophy has 
also been seen in syphilitic persons. 
The symptoms of hepatic disease often attract but 
little attention at first. Pain is usually absent; now 
and then alteration in form and size are perceptible 
by palpation or percussion. Before contraction 
the liver is enlarged in some patients. Enlarge- 
ment also of a part may occur by the enormous 
growth of a gumma. Ascites, epistaxis, and 
haemorrhoidal flux may be consequences of the syphi- 
litic, as of other forms of cirrhosis. The disease has 
usually a fatal end, but may be cured if discovered 
early. 
Besides the occurrence of these organic changes, 
which are essentially late or tertiary affections, 
symptoms of hepatic derangement are occasionally 
observed at an early period. Temporary jaundice is 
one of the consequences of this derangement. It 
■ usually disappears spontaneously in the course of 
a fortnight. The area of dullness is rarely in- 
creased, but occasionally it is so, and there may be 
also tenderness on pressure over the region of the 
liver. 
The Spleen is frequently enlarged temporarily, 
especially in children, during the exanthematous 
stage of syphilis. The specific changes which occur 
in the spleen are similar to those of the liver, but are 
much more rarely met with, gummata of this organ 
being especially infrequent. When the spleen is 
affected the liver is usually diseased also. Lar- RESPIRATORY AND CIRCULATORY SYSTEMS. 
43 
daceous disease of the spleen is not uncommon in 
syphilis. 
The Pancreas.-Induration and gummata of 
this viscus have been reported in a few cases. The 
salivary glands are also said to be affected by syphi- 
lis. 
The Suprarenal, Thyroid, and Pituitary 
Bodies have been found altered by changes of a 
probably syphilitic nature. 
CHAPTER VI. 
THE RESPIRATORY AND CIRCULATORY SYSTEMS. 
The Nose.-The nasal mucous membrane is 
sometimes inflamed while roseola is present on the 
skin. The symptoms are redness, dryness, and 
itching, followed by carious secretion of mucus. 
Follicular ulcers inside, and fissures or mucous 
patches around the nostrils, often occur with the 
papular eruptions. 
Disease of the bones of the nose is usually a late 
affection. The process begins by the growth of 
gummy material in the mucous tissue and perios- 
teum. Ulceration then occurs, and the bone or 
cartilage eventually becomes exposed. Necrosis fol- 
lows, and finally the dead bone comes away piece- 
meal. Perforation of the septum also is not infre- 
quent, and if the process be not checked great de- 44 
SYPHILIS. 
formity may result. Extension may take place along 
the vomer to the hard palate, or upward to the base 
of the skull; and sometimes the mouth, nose, and 
pharynx become one cavity. Whilst ulceration and 
necrosis are going on, a very- offensive discharge 
escapes from the nares; hence the term ozana. 
When the nasal bones suffer in inherited syphilis, it 
is generally in later childhood, towards puberty, or 
afterwards. 
The Larynx.-The early forms of syphilitic dis- 
ease are erythema, superficial ulcers, and mucous 
patches. These are usually associated with similar 
affections of the mouth or pharynx, and are some- 
times accompanied by oedema. The later forms con- 
sist in the diffused or circumscribed form of new 
growth, with ulceration and the formation of con- 
tractile fibrous tissue, whereby the larynx may be 
partially or wholly occluded. Perichondritis and 
necrosis of the laryngeal cartilages may also occur, 
especially if energetic treatment be not adopted at 
an early stage of the disease. Ankylosis of the crico- 
arytsenoid articulations and laryngeal paralysis are 
also occasional consequences of syphilis. Any of 
these affections may be accompanied by oedema which 
may threaten life, and thus necessitate the perform- 
ance of tracheotomy. 
The Trachea and Bronchi.-Syphilitic affec- 
tions in these situations, are much more rare than in 
the larynx. Gummy infiltration, ulceration, and 
stenosis from cicatricial contraction have been met 
with. Such cases are usually fatal. RESPIRATORY AND CIRCULATORY SYSTEMS. 
45 
The Lungs, like other viscera, may be attacked 
by the diffused or circumscribed form of syphilitic 
growth. The affection is met with both in inherited 
and acquired syphilis. In the latter it is rarely seen 
until at least five or six years after contagion. The 
symptoms are obscure at first. At a later period they 
are in many respects similar to those of tubercular 
phthisis. The chief points of difference between the 
two diseases are that in the syphilitic affection the 
physical signs are at first usually limited to the middle 
or lower lobe of one (usually the right) lung, the 
apex being only involved at a later period; and that 
the amount of fever is much less than in ordinary 
phthisis. Haemoptysis is very common. In making 
a diagnosis, the larynx, as well as other parts of the 
body, sjiould always be examined for signs of 
syphilis, and the personaland family history carefully 
investigated. Frequently, however, the diagnosis 
can only be made by watching the effect of specific 
treatment which in syphilitic disease is often surpris- 
ingly rapid. 
The Heart is occasionally the seat both of the 
diffused and circumscribed forms of growth; but 
such cases are often only found out after death, 
which is usually sudden. Symptoms of heart dis- 
ease in a syphilitic person, in the absence of more 
probable causes, should suggest a trial of specific 
remedies. 
The Blood Vessels.-The arteries are sometimes 
attacked by syphilis, the larger vessels at the base 
of the brain being those in which the change has 46 
SYPHILIS. 
been most frequently observed. The process begins 
by an irregular cell growth in the internal coat of the 
vessel. This soon causes a projection into its lumen 
and consequent narrowing of the channel, which may 
proceed to total occlusion of the vessel. Usually, 
however, blocking occurs at an earlier stage by the 
formation of a clot at the site of narrowing. The 
other coats of the artery also become gradually af- 
fected by the new growth. 
The exact relation of syphilis to atheroma and 
aneurism of the aorta and great vessels is still unde- 
termined. 
Certain veins, especially the umbilical vein in 
dead-born syphilitic children, have been found 
thickened in a similar manner to the arteries. 
CHAPTER VII. 
THE NERVOUS SYSTEM AND ORGANS OF SPECIAL SENSE. 
Syphilitic affections of the nervous system are 
usually a somewhat late manifestation of the disease. 
The most common time for their occurrence is be- 
tween the third and tenth years after contagion; but 
in rare instances they occur within the first year. 
The Brain may be attacked by meningitis, by 
gummata, or by arterial disease. Meningitis of a 
subacute or chronic form is not very uncommon. It 
may be caused by extension of the inflammatory pro- THE NERVOUS SYSTEM, ETC. 
47 
cess from the neighboring bone or from gummata, 
or it may begin independently. 
Gummata.-The brain may suffer from the pres- 
sure of nodes situated on the internal surface of the 
cranial bones; or gummata may develop in the 
meninges, either on the surface or deep down among 
the convolutions. They spring more frequently 
from the pia mater and arachnoid than from the 
dura mater. 
Arterial Disease.-The cerebral vessels may be 
attacked by the change mentioned at the end of 
the preceding chapter. The middle and posterior 
cerebral and basilar arteries are those most com- 
monly affected. The usual result is blocking of the 
vessel and localized softening of the brain ; but occa- 
sionally aneurism occurs. 
The Symptoms of Syphilitic Disease of the Brain are 
various. Headache, often of a most severe form, 
and usually worse at night, is the most constant early 
symptom of meningitis or of gumma. There may 
be also giddiness, mental excitement, and insomnia. 
Convulsions are most commonly caused by menin- 
gitis or by growths involving the surface of the brain. 
The attacks differ from those of ordinary epilepsy, 
in that the convulsion usually begins locally-in 
one limb, or in the face, for example-and that con- 
sciousness is retained during at least the early part 
of the fit. Paralysis is a most important symptom ; 
its seat, of course, varies according to the seat and 
extent of the lesion which produces it. Hemiplegia 
is the commonest form ; but the palsy may be irregu- 48 
SYPHILIS. 
larly distributed or limited to one limb, or even to 
one group of muscles. In meningitis and gumma 
paralysis is usually gradual; whilst in arterial disease 
it is sudden, and, as a rule, not accompanied by loss 
of consciousness. Optic neuritis is very common in 
meningitis and gumma. 
The Spinal Cord may be affected by meningitis 
or gummata; but arterial disease has not yet been 
demonstrated. Gummata may occur at any part of 
the cord, but they usually affect one side before the 
other. When they spring from the dura mater the 
surrounding portion often presents a diffused thick- 
ening (pachymeningitis'), and thus the nerve roots 
may be compressed. The pia mater may be inflamed 
independently of the dura mater. In rare instances 
meningitis is set up by disease of the vertebrae. 
Myelitis, usually of a subacute or chronic char- 
acter, occasionally occurs in syphilis. In locomotor 
ataxy there is also often a syphilitic history, but the 
exact relation of this affection to syphilis is still a 
matter of dispute. 
The Symptoms of Syphilitic Spinal Affections vary 
according to the seat of the lesion, and are similar to 
those produced by non-syphilitic changes. Pain at 
the seat of disease and over the area to which the 
nerves are distributed, tenderness and spasm, occur 
both in meningitis and gumma. Hyperaesthesia, 
anaesthesia, numbness, stiffness, rigidity, wasting, 
and exaggerated or diminished reflex action, are also 
symptoms which may be present at various times and 
in various degrees, according to the extent and seat THE NERVOUS SYSTEM, ETC. 
49 
of the lesion. Paralysis, again, may be caused by 
the pressure of growths, by thickening of the men- 
inges, or by damage to the nerve roots. The symp- 
toms are gradual. 
The Nerves may be affected directly by super- 
ficial or interstitial disease ; indirectly, by the pres- 
sure of nodes or by compression through thickening 
of the meninges or of the periosteum in their foramina 
of exit. The cranial nerves suffer far more frequently 
than the spinal, and those which supply the eyeball 
and its muscles most frequently of all. Atrophy of 
the optic nerve may be caused by neuritis or by 
pressure. All the cranial nerves may be attacked ; 
but very little is known with respect to syphilitic 
affections of the glosso-pharyngeal and pneumogastric 
nerves. 
Inherited Syphilis.-The subjects of inherited 
syphilis may suffer from nervous affections similar 
to those already described ; but meningitis is most 
common, and growths are rare. It has also been 
suggested that certain functional disorders, such as 
chorea, and epilepsy, are sometimes the result of in- 
herited syphilis. 
The diagnosis of syphilitic disease of the nervous 
system is often difficult, and in many cases can only 
be arrived at by a process of exclusion; or even by 
watching the effect of specific remedies. The fol- 
lowing suggest syphilis. Headache, persistent, in- 
tense, worse at night. Convulsions, unilateral, local, 
irregular, and especially if they appear for the first 
time in adult life. Paralysis, irregular, local, par- 50 
SYPHILIS. 
ticularly of cranial nerves-the third nerve, for 
example. Sudden hemiplegia in early adult life is a 
very suspicious symptom. In all cases the history 
must be carefully inquired into, and the condition of 
the heart and kidneys investigated. 
The prognosis is most hopeful when the symptoms 
develop gradually-i.e., when they depend on irrita- 
tion or pressure caused by syphilitic growth, provided 
that energetic treatment be speedily carried out. In 
paralysis from vascular thrombosis the prospect of 
recovery is less favorable; for the softening which 
follows plugging of the vessel is of course uninfluenced 
by remedies. The prognosis in all forms of nervous 
disease is more favorable in acquired than in inherited 
syphilis. 
The Eye.-The initial lesion, papules, mucous 
patches, and gummata, are occasionally met with on 
the eyelids, caruncles, or conjunctiva. The lachrymal 
gland also has been found to be enlarged in syphilis. 
In children during the second dentition, the Cornea 
is the seat of interstitial keratitis, which may dis- 
appear under treatment, without injury, but when 
neglected it often leaves permanent opacities. This 
affection has also been observed, though very rarely, 
in acquired syphilis. Iritis in acquired syphilis is 
most common within the first six months after 
infection ; when it occurs in the later periods it is 
sometimes combined with disease of the deeper 
structures. The distinguishing characters of iritis 
are, a pink zone around the iris, dullness of its color, 
turbidity of the aqueous, and sluggishness or irregu- THE NERVOUS SYSTEM, ETC. 
51 
larity of the pupil. Sometimes gummy nodules are 
seen at one or two points on the surface. Iritis may 
subside without leaving permanent injury behind, 
but if untreated often causes synechia or other injury 
to the eye. Iritis is also seen in inherited syphilis, 
mostly in connection with keratitis (corneo-iritis). 
Choroiditis is the commonest deep-seated affection of 
the eye; it occurs both in acquired and inherited 
syphilis; but in the former is much less common 
than iritis. It is usually a later symptom than iritis, 
but in the majority of cases comes on within the first 
year. The inflammation often spreads to the retina 
and the vitreous, causing impairment of vision and 
sometimes complete blindness. Primary syphilitic 
retinitis is rare. The course of choroido-retinitis 
is slow. The prognosis depends upon the extent 
and duration of the affection, and on the adoption 
of prompt and energetic treatment. Relapses are 
frequent; hence the prognosis should always be 
guarded. 
The Ear.-The auricle and external meatus 
may be the seat of the earlier or later syphilides, 
especially of mucous patches. The middle ear may 
become inflamed in the secondary period; most fre- 
quently in connection with mucous patches or 
ulcers of the pharynx by extension along the Eusta- 
chian tube. 
The Internal Ear.-Deafness may occur during 
the early stages of syphilis, without any lesion of the 
conducting part of the ear being discovered. Such 
cases recover under general treatment. Deafness 52 
SYPHILIS. 
may also occur in the later stages, and then is often 
permanent. This form is most common in inherited 
syphilis from five to fifteen or twenty years of age. 
Its chief characters are rapidity of development, high 
degree of deafness, and absence of pain, without any 
change in the middle ear. 
CHAPTER VIII. 
THE GENITOURINARY SYSTEM. 
The Urinary Organs.-Syphilitic affections of 
the urethra are limited almost wholly to the orifice, 
which is often the seat of the initial lesion in both 
sexes. On rare occasions it has been found more 
deeply in the male urethra. It is uncertain whether 
syphilis attacks the bladder and.ureters. 
The kidneys are rarely affected by syphilitic disease. 
They suffer very similarly to the liver, the changes 
being chiefly cirrhosis of the interstitial cellular tissue, 
gummata, and lardaceous disease. The first change 
renders the kidney tough, seamed, puckered on the 
surface, and pale; section shows the cortex to be 
lessened, and the Malpighian tufts very small. This 
change, usually confined to only a part of the kid- 
ney, is sometimes general. The gummy nodules 
form round, defined, yellow masses along the seams 
of fibrous tissue produced by the cirrhosis. Larda- 
ceous disease, the most frequent change met with in 
syphilitic persons, renders the organ smooth and 53 
THE GENITO-URINARY SYSTEM. 
large ; on section the surface is pale, and the Mal- 
pighian tufts are large and distinct. Temporary 
albuminuria during the period of the earlier erup- 
tions is not very infrequent. 
The symptoms of renal disease in syphilis are similar 
to those of other chronic affections of the kidney. 
The diagnosis can only be made from the history, the 
presence of signs of syphilis elsewhere, and in some 
cases from the effects of treatment. 
Male Generative Organs.-The penis is fre- 
quently the seat of syphilitic eruptions, especially 
mucous patches, in the earlier stages, and at a later 
period gummata sometimes develop in the sheath of 
the penis, the prepuce, or the corpora cavernosa. 
How the vasa deferentia, vesiculce seminales, and 
prostate are affected by syphilis, we have no accurate 
knowledge. 
The epididymis, during the earlier stages of the dis- 
ease, is temporarily enlarged in rare cases, and one 
or both organs may be attacked. The enlargement 
is generally limited to the globus major. 
The testis proper is seldom attacked till two or 
three years after infection, and often at a much later 
period. The testis is at first slightly uneven, but as 
it enlarges usually becomes smooth and hard; the 
testicular sensation also is soon lost. The epididymis 
remains unaltered until lost in the encroaching testis. 
Pain is generally absent, or is confined to aching in 
the loins. One organ being enlarged, the other often 
follows the same course; later, the testis sometimes 
degenerates into a small fibrous mass. The scrotum 54 
SYPHILIS. 
usually remains healthy ; but occasionally adhesive 
inflammation takes place, on which softening, abscess, 
and fungous protrusion may follow. Two patho- 
logical changes take place-induration of the fibrous 
structures, and gummata. The first begins by con- 
gestion and thickening of the tunica albuginea at a 
few limited points on the surface, from which arise 
adhesions of the tunica vaginalis and serous effusion 
into its cavity. The inflammatory action also spreads 
inward, leading to cell growth between the tubules 
of the testis. This new tissue contracts and indu- 
rates, and the secreting structure is thus more or less 
destroyed. Gummata may form in this contracted 
tissue, but are less often seen than the interstitial 
induration. The testicle usually recovers if treated 
at an early stage, but relapses are frequent. Syphi- 
litic orchitis is sometimes seen in children. The 
diagnosis depends on the freedom of the cord and 
scrotum from disease, the smooth, or only slightly 
uneven surface, the absence of pain, the diminished 
sensibility, and the presence or history of syphilitic 
disease elsewhere. When gummata form near the 
surface, the nodular condition of the organ may sug- 
gest tuberculous disease, but this, in the great ma- 
jority of cases, begins in the epididymis. 
Female Generative Organs.- The vulva, be- 
sides being the usual seat of the initial lesion, is also 
frequently affected by papular and erosive syphilides, 
and sometimes by gummy disease, giving rise to 
ulceration and contraction of the vaginal orifice. 
The upper portion of the vagina and the cervix THE OSSEOUS AND MUSCULAR SYSTEMS. 
55 
uteri are also not infrequently the seat of erosions, 
papules, and ulcers similar to those which occur in 
the mouth and throat in the secondary stage. More 
rarely gummata form in the cervix. The earlier 
lesions disappear without local treatment, but are 
important because they are frequently the source of 
contagion to others. Leucorrhcea, abrasions and 
induration of the cervix, are also common in syphi- 
litic women, but are probably not directly due to 
syphilis. The placenta in syphilitic women is fre- 
quently diseased. The Fallopian tubes generally 
escape, but gummy nodules have been observed in 
them. In the ovary and breast also, on rare occa- 
sions, gummy masses are found. 
CHAPTER IX. 
THE OSSEOUS AND MUSCULAR SYSTEMS. 
The Osseous System is liable to be attacked, 
both in acquired and in inherited syphilis, at an early 
or late period of the disease. In adults, however, 
osseous lesions are not common until several years 
after contagion. 
Ostealgia frequently occurs just before the out- 
break of secondary symptoms ; it consists in violent 
aching pain (osteocopic) in the bones of the head, 
trunk, or limbs, and is nearly always worse at night. 
It commonly subsides when the rash appears. At this 56 
SYPHILIS. 
time often nothing wrong can be felt at the painful 
spots; but at a later period ostealgia is usually 
connected with obvious lesions of the periosteum or 
bone. 
Osteo-periostitis.-Inflammatory affections, due to 
syphilis, like those depending on other causes, may 
begin in the periosteum or in the medulla, and may 
lead to similar results, viz., caries, necrosis, exostosis, 
and localized or diffused thickening of a part or the 
whole of the bone affected. 
The commonest osseous lesions in syphilis are the 
circumscribed sub-periosteal swellings called nodes. 
They are most frequent on the cranium, tibia, ulna, 
clavicle, ribs, and sternum; and may appear during 
the first few months after contagion. Usually, how- 
ever, they are not seen until four or five years have 
elapsed. Early nodes disappear quickly under treat- 
ment, or even spontaneously ; but at a later period, 
though they may still be amenable to treatment, they 
not infrequently lead to permanent exostosis, or 
break down and discharge themselves, leaving necro- 
sis of the bone beneath. 
Besides this circumscribed form of periostitis, a 
bone may also be thickened by a similar process for 
a considerable part of its length, or large prominent 
tumors may develop. Such large nodes sometimes 
occur in the later stage of inherited syphilis. 
The bones may also be attacked by gumma in a 
diffused or circumscribed form. In the former the 
new growth gradually causes absorption and wasting 
of the bony tissue, and after the gummy material has 57 
itself disappeared a rarefied and porous condition of 
the bone remains. One form of this process, which 
is almost limited to the cranial bones, gives rise to 
the condition called caries sicca, in which irregular 
pits or furrows, surrounded by bony ridges, are 
produced. The depressions thus formed can be felt 
through the skin, and are characteristic of syphilis. 
Gummy nodules may form in the periosteum or 
endosteum, and are sometimes found in the hollows 
excavated by the so-called dry caries. They may 
disappear under treatment, or may break down, and 
cause more or less extensive necrosis. 
Besides these changes which begin in the perios- 
teum or medulla, the bones may also be involved by 
extension of the syphilitic process from neighboring 
tissues. This is most common in the bones of the 
hard 'palate and nose, which may be thus more or 
less completely destroyed. Periostitis is often set 
up beneath syphilitic ulcers of the skin when situated 
over a subcutaneous bone. In such cases the bone 
may be permanently thickened, or its superficial lay- 
ers may become necrosed. 
Dactylitis.-This name has been given to an en- 
larged condition of the fingers and toes, and some- 
times, also, of the metacarpal or metatarsal bones, 
which is occasionally seen in syphilitic children and, 
though rarely, in adults also. The fingers are more 
often affected than the toes, though both may be 
attacked in the same patient. In the fingers the 
proximal phalanx is usually first affected. The part 
is bluish-red, swollen, and firm to the touch. The 
THE OSSEOUS AND MUSCULAR SYSTEMS. 58 
SYPHILIS. 
usual result is resolution of the swelling under treat- 
ment ; but sometimes necrosis occurs, with subsequent 
shortening or other deformity of the part affected. 
Osseous Changes in Inherited Syphilis.-Certain 
affections peculiar to syphilitic infants have been 
described of late years. One form, which has been 
called osteochondritis, is due to disturbance of the 
process of ossification in the long bones. At first 
there is undue cell proliferation in the layer of epi- 
physeal cartilage ; calcification then proceeds rapidly 
but irregularly, and finally there is delay or even 
total arrest of bone formation. The affection causes 
loss of power in the neighboring joint, and more or 
less swelling just above the epiphysis. The humerus, 
radius, tibia, and femur, are most often thus affected, 
and both limbs usually suffer. Complete recovery is 
the rule; but occasionally separation of the epiphysis 
and even suppuration occur. 
A second change consists in the formation of 
bony swellings or osteophytes, which occur most 
frequently on the frontal or parietal bones in the 
immediate neighborhood of the anterior fontanelle. 
Sometimes there are four such swellings, symmetri- 
cally placed, and separated by the coronal and 
sagittal sutures. These enlargements are believed 
to be the cause of the prominent forehead at a later 
period of life. Of the long bones the inner surfaces 
of the humerus and tibia are the commonest seat of 
the osteophytes. 
Besides these changes, others-craniotabes, for 
example-are attributed, by some authors, to inher- 59 
ited syphilis; but further research is necessary to 
define exactly the bone lesions of infantile syphilis 
and those of rickets. 
The symptoms of syphilitic disease of the bones 
depend much on its situation and on the relation of 
the bone to surrounding parts. If situated within 
the skull, irritation of the surface of the brain, or of 
one or more of the cranial nerves from pressure, may 
produce various symptoms, e.g., severe pain, convul- 
sions, paralysis, or coma, according to the seat and 
extent of the lesion. It should be remembered that 
the pain of syphilitic bone affections is nearly always 
worse at night. 
The consequences vary according to the individual, 
and according to the treatment adopted. If the 
nature of the lesion be made out early, and treatment 
be promptly adopted, recovery without necrosis fre- 
quently takes place. But in some cases whole bones, 
those of the nose or palate, for example, are de- 
stroyed, causing irremediable deformity. Again, 
the skull may be perforated ; whilst, in other cases, 
permanent thickening of the bone remains. Another 
consequence that sometimes follows syphilitic osteitis 
in the long bones, is extreme fragility, leading to 
fracture from very slight causes. This is seen both 
in acquired and inherited syphilis. 
The Joints may be affected immediately before 
the outbreak of the first rash : or during the first 
twelve months of infection; or, lastly, not until 
several years have elapsed. 
The prodromal form consists in aching (mainly 
THE OSSEOUS AND MUSCULAR SYSTEMS. 60 
SYPHILIS. 
nocturnal) pain in one or more joints. Usually the 
pain is slight; sometimes it is intolerable. The pain 
commonly departs when the rash comes fully out. 
There is no effusion, and rarely tenderness on pres- 
sure. The secondary form, which is rare, consists 
of a somewhat fugitive synovitis, in some cases 
indicated by pain on movement, tenderness, and 
puffy swelling: in other cases, by almost painless 
hydrarthrosis. 
In the tertiary stage of syphilis gummata may form 
around the joint, with chronic thickening of the soft 
parts, and effusion into the synovial cavity. 
The Cartilages of the larynx and trachea, as 
well as the costal cartilages, are sometimes attacked 
by perichondritis leading to necrosis, as in the case 
of the bones. The intervertebral substances also may 
suffer in syphilis, as well as the vertebrae themselves; 
but articular cartilage is probably involved only by 
extension from the bone. 
The Muscles.-Pains in the muscles increased 
by their action, temporary debility and wasting, 
and, as a very rare occurrence, muscular contraction, 
are occasionally met with soon after infection. This 
contraction generally selects one biceps brachii for 
its seat. 
The late affections consist in the circumscribed or 
diffused form of syphilitic growth. Gummata occur 
as grayish or yellowish-white nodules among the 
fibres of the muscles, usually near their attachment 
to the bone. 
In the diffusedform the muscular fibres are welded THE OSSEOUS AND MUSCULAR SYSTEMS. 
61 
together by the new growth, and the muscle finally 
becomes contracted and atrophied. The change is 
accompanied by aching pain increased by movement. 
Any of the muscles may be attacked, but those of the 
limbs suffer most frequently. In its early stage the 
affection is readily curable; but when fibrous con- 
traction has taken place, but little benefit is to be 
expected from remedies. 
The Tendons are rarely affected in Syphilis. 
During the* early stages, both simple effusion into 
their sheaths and inflammatory swelling of the ten- 
dons themselves may occur. The late affections are 
identical with those of the muscles, which they gen- 
erally accompany. The aponeurosis of the thigh, 
the tendo-Achillis, and the tendons of the flexors of 
the fingers, are most commonly affected. 
The Bursae.-Simple effusion may occur during 
the early eruption, but when the bursae are attacked 
by syphilis it is nearly always at a late period of the 
disease. They may be affected primarily by gummy 
infiltration, or secondarily by its extension from the 
skin or other neighboring structures. Both forms are 
rare. The bursa in front of the patella is the one 
most frequently attacked. 62 
SYPHILIS. 
CHAPTER X. 
INHERITED SYPHILIS. 
In inherited syphilis the "primary symptoms " are, 
of course, wanting; but with this exception the course 
and symptoms are, in many respects, similar to those 
of the acquired disease. 
Syphilis frequently causes abortion or premature 
birth of the foetus, which is sometimes expelled in a 
decomposed state, or marked with bullae of pem- 
phigus ; but it may be quite free from signs of dis- 
ease. If the child be born at full term, and do not 
at once display the disease, it appears healthy for the 
first few weeks (from two to six), and is often plump 
and well nourished. This healthy aspect is, in most 
cases, soon lost; though some children, who are 
but slightly affected, retain a flourishing appearance 
throughout. In a well marked case the child snuf- 
fles as with a cold, is fretful, and wastes ; by the end 
of three or four weeks he has generally lost the ro- 
bust condition he possessed at birth, and gradually 
gets to look like a little old man ; his skin is wrin- 
kled and of a muddy or bistre hue on the forehead, 
chip, and other prominent parts, and often breaks, 
around the mouth, eyes and nose, into chaps that 
bleed easily; the cuticle peels from the fingers, 
palms, and soles, on which coppery patches can gen- 
erally be found; the hair of the scalp, the eyebrows INHERITED SYPHILIS. 
63 
and lashes may fall, and the nails are small and ill- 
developed. The bones may be affected in the ways 
already described at a very early period, even before 
birth. The cry is hoarse, peculiar and snuffling, 
from the nostrils being stuffed with thick, yellow 
mucus. The mouth and the anus are beset with 
mucous patches and sores. In the course of a few 
weeks the wasting becomes extreme, the child is 
seized with vomiting and diarrhoea, bronchitis, pneu- 
monia, or other visceral disorder, and dies. If un- 
treated, this termination is the ordinary one, especially 
among the poor ; but children with good nutrition, 
in whom the disease has been slow to develop, often 
recover in a short time, and either suffer no further 
from its influence or become, in later childhood, 
again its prey. 
After death, no particular morbid change is always 
found, but in a certain proportion of cases the vari- 
ous changes peculiar to syphilis are developed in the 
viscera and bones. These morbid processes have 
been described in the preceding chapters. 
Late Forms of Inherited Syphilis.-The 
most common periods for the appearance of these are 
during the second dentition ; on reaching puberty ; 
and during the ossification of the epiphyses and gen- 
eral knitting of the frame. It is believed by some 
that such late signs may be the first manifestation of 
inherited taint. 
The local changes are often confounded with scrofu- 
lous disorders. The skin is very prone to ulcerate. 
A common situation for these ulcei>^^rOflr^^fie< 64 
SYPHILIS. 
mouth and nostrils, where they leave linear and radi- 
ating scars ; but they may occur in any other region. 
In addition to the stunted development of the indi- 
vidual the complexion is often muddy or earthy, and 
the hair thin and brittle. The lymphatic glands may 
slowly enlarge, suppurate, and involve the skin in 
the ulceration thus set up. The bones of the cra- 
nium are thickened, whereby flattening of the vertex, 
prominence of the forehead, and widening of the 
occiput are produced. The shafts of the long bones 
are often the seat of nodes. The bones of the palate 
and nose are very liable to be attacked, the bridge 
of the nose may sink, and the spongy bones and 
more or less of the hard palate may be cleared away. 
The soft parts of the mouth also are generally in- 
volved in the extensive destruction of the bones. The 
eyes may be the seat of corneitis, iritis, or choroiditis. 
Deafness may also occur about the time of puberty, 
or later. So, also, the viscera are liable, during this 
period, to changes which have been already described. 
In the permanent teeth a peculiar change was first 
pointed out by Hutchinson. It consists in a general 
dwarfing of the tooth, which is both too short and 
too narrow ; but it is broader at the neck than at the 
cutting edge, hence the term " pegged." The cut- 
ting edge also breaks or wears away in an irregular 
manner, leaving a single shallow semilunar notch at 
the centre. This is best seen in the two central in- 
cisors of the upper jaw, and these are the only teeth 
which afford conclusive evidence. GENERAL DIAGNOSIS AND PROGNOSIS. 
65 
CHAPTER XI. 
GENERAL DIAGNOSIS AND PROGNOSIS OF SYPHILIS. 
Diagnosis.-The diagnosis of syphilis may be 
easy or difficult, according as the symptoms are well 
marked or the reverse. In cases where a sore 
appears a few days after exposure to contagion, the 
exclusion of syphilis will be impossible at first; but 
when the incubation period is over the diagnosis is 
generally easy, the induration of the initial lesion 
with its accompanying adenopathy being character- 
istic. Sometimes, however, the application of irri- 
tants to a simple sore excites an inflammatory thick- 
ening of its base, which for a time much resembles 
the syphilitic induration. A single gummy ulcer of 
the genital organs may also be mistaken for the 
initial lesion ; but the absence of glandular enlarge- 
ment and the history of the case will usually decide 
the point. 
If the initial lesion has been unnoticed, the head- 
ache, rise of temperature, and febrile disturbance 
which sometimes occur about the time of outbreak 
of the first eruption might be mistaken for the onset 
of some acute specific fever; e.g., syphilitic roseola 
has been mistaken for measles, and an early vesicular 
syphilide for smallpox. In such cases careful atten- 
tion should be given to the temperature, the condition 
of the tongue, throat, and air passages, and the pres- 66 
SYPHILIS. 
ence or absence of other signs of syphilis. The char- 
acters of the cutaneous eruptions described in Chapter 
IV are sufficient, in most cases, to separate the syphi- 
litic from the non-syphilitic diseases of the skin; 
but the whole body should be carefully examined, 
especially the genital organs and the mouth and 
throat, as well as the glands of the groin, neck and 
elbow. 
In later syphilis, when disease of the brain or 
other viscus is suspected to have a syphilitic origin, 
the skin and mucous membranes should be searched 
for scars or gummy deposits; and palpation of the 
bones and testes should not be forgotten. The eyes 
may afford important information by the detection 
of synechiae, or changes in the choroid and retina. 
The presence or history of local paralyses, especially 
of the ocular muscles, is of great importance. 
When no positive evidence of syphilis can be ob- 
tained, the absence of characters distinctive of other 
diseases (such as cancer or tubercle) are of value. 
When no light can be thrown on the subject from 
any of these sources, the history becomes all-import- 
ant. The patient should be questioned concerning 
the bygone occurrence of a venereal sore with lumps 
in the groins and followed by spots on the skin, re- 
lapsing soreness of the throat or tongue, loss of hair or 
bad eyes. Lasting or repeated nocturnal pains in the 
bones are signs of much value. Should the history 
yield no trustworthy information, anti-syphilitic 
remedies must be tried, and their effect awaited; but 
care must be taken to avoid the error of attributing GENERAL DIAGNOSIS AND PROGNOSIS. 
67 
to the remedy what may be due to other causes. Nor 
is the failure of mercury or iodide of potassium 
always conclusive evidence that the affection is not 
syphilitic; for certain processes set in motion by 
syphilis, the infiltrating sclerosis, for instance, after a 
time become insensible to the influence of specific 
remedies. 
In inherited syphilis one of the earliest and most 
valuable diagnostic signs is the inflammation and 
swelling of the nasal mucous membrane, giving rise to 
the well known "snuffling." The skin eruption also, 
and desquamation of the palms and soles, should be 
looked for. Pemphigus of these parts is diagnostic 
of syphilis, but it is rare. The peculiar cry, with 
cachexia, wasting, sleeplessness, or restlessness, may 
also assist. Again, cracks round the mouth and nos- 
trils, or mucous patches about the orifices of the body, 
are nearly always present sooner or later. Enlarge- 
ment of the spleen is a valuable corroborative sign. 
The cranium and the long bones should be carefully 
examined for osteophytes or epiphyseal disease. 
In later life the diagnostic signs are the low stature 
and puny development; the peculiar condition of the 
teeth ; the thick, pasty and greasy skin, especially that 
of the face; the muddy complexion; the sunken bridge 
of the nose; the scars round the mouth; the promi- 
nent forehead ; the signs of present or past mischief 
in the eyes, the bones or the skin, and in the mouth 
or throat. When no conclusive evidence can be 
gained from the appearances presented by the patient, 
careful inquiry into his early history and into that 68 
SYPHILIS. 
of both his parents will often furnish satisfactory 
proof. 
Prognosis.-In many persons syphilis ends spon- 
taneously ; and in the great majority the disease sub- 
sides completely within two years. The incurable 
cases are comparatively few. Again, if the disease 
does obstinately recur, its ravages are usually limited 
to one or two localities. In recurrent syphilis the 
symptoms are not exclusively those called tertiary, 
but are often dry eruptions on the skin-most fre- 
quently lepra. Medical treatment both alleviates and 
shortens the course of the disease, and diminishes 
the liability to relapses; hence the kind of treat- 
ment and the length of time it has been pursued in 
the early stages of the disease become important 
factors in prognosis. A wide-spread eruption at an 
early period usually foretells a short continuance. On 
the other hand, a history of scanty development or 
absence of the early symptoms is common in those 
who suffer from tertiary syphilis. Idiosyncrasy, cli- 
mate, age, condition, and habits of the patient, espe- 
cially as regards drinking, also affect the severity of 
the disease. It is usually worse in the young and 
growing, and in the aged and enfeebled, than in 
vigorous adults. 
In inherited syphilis, the longer the interval be- 
tween birth and the appearance of the symptoms, 
the more probable does recovery become. Two con- 
ditions mainly influence the gravity of the prognosis. 
First, the degree of general cachexia. A puny child, 
which is born with or soon becomes covered by GENERAL DIAGNOSIS AND PROGNOSIS. 
69 
eruption, will almost surely die. The appearance of 
pemphigus or ecthyma is also bad for the prognosis, 
and the irritation attending ulcers of the skin is fre- 
quently the cause of exhaustion which ends in death. 
Second, the degree to which local affections hinder 
nutrition. Thus, hepatic disease causes vomiting, 
diarrhoea, and otherwise prevents digestion. If the 
spleen be very greatly enlarged the child usually dies. 
The nasal catarrh, when severe, blocks the nostrils, 
so that the child cannot breathe through his nose 
while he sucks, and he is thus put in danger of starv- 
ation ; or bronchitis and lobular pneumonia may 
follow. The prognosis is favorable if the rash be 
not profuse, if the child's nutrition proceed favor- 
ably, if his skin remain fresh-colored and well sup- 
ported by subcutaneous fat, if the nasal catarrh be 
too slight to impede the power of sucking, if the 
digestion be good, and the bowels regular. 
The prognosis of the later forms of inherited 
syphilis is favorable if the true cause of the disease 
be made out and appropriate treatment instituted. 
If the destructive affections of the throat or face be 
treated as "scrofulous," irremediable loss of tissue 
and deformity will probably occur. 70 
SYPHILIS. 
CHAPTER XII. 
TREATMENT OF SYPHILIS. 
The indications to be followed in treatment are- 
i. To insure the highest possible condition of bodily 
vigor. 2. To control the influence of the poison. 
3. To dissipate and heal the local affections. 4. To 
prevent the spread of the disease to others. 
Period preceding General Eruption on the 
Skin.-Bodily vigor should be maintained by clean- 
liness, warm clothing, unstimulating diet, regular 
action of the bowels, abstinence from alcohol, and 
moderate exercise in the open air, unless the weather 
be very damp and cold. As soon as a diagnosis of 
syphilis has been made, mercurial treatment should 
be begun. 
The initial lesion, if healthy, merely requires 
cleanliness, and the application of a piece of lint 
wetted with a mild astringent lotion, such as F. 20 
or 22; if the surface be indolent, F. 23 or 24 may 
be used : if, through neglect, suppuration occur and 
the ulcer be inclined to spread, it should be well 
cleaned, dried, and dressed with powdered iodoform 
every six hours. If the neighboring lymphatic glands 
be tender, they should be fomented four or five times 
a day, and a poultice of linseed meal applied be- 
tween the fomentations, the patient keeping as much 
as possible in the horizontal position. If abscess be TREATMENT. 
71 
already produced, it must be treated as an ordinary 
bubo. 
The treatment of initial lesions of the female 
genitals is similar to that of sores in men. The 
patient should use the vaginal douche three or four 
times daily, and dress all excoriated surfaces with 
rag dipped in lead lotion (F. 20), arranging the 
dressing so that it intervenes between all opposed 
surfaces. If the organs become cedematous and in- 
flamed, the patient should also keep her bed and take 
some saline febrifuge draught. 
Spreading or suppurating ulcers should be treated 
as in the male. The uterus should be examined as 
soon as the passage of a speculum can be borne, and 
the discharges or erosions treated as directed in the 
section on accessory venereal disorders. 
The Period of General Eruption.-The short 
period of lassitude, inappetence, and headache, that 
in many cases precedes the outbreak of the first 
rash in patients not under the influence of mercury, 
is best treated by a saline purge to clear the bowels; 
after which mercury should be given. The discom- 
fort subsides rapidly as the drug is absorbed. The 
diet should be good, and tonics may be necessary 
(F. 30, 31, 46). 
Mercury.-If given early, it promotes the dis- 
persion of the induration at the point of contagion 
and of the enlargement of the glands; it delays and 
lessens the severity of the cutaneous eruptions, and 
of all the symptoms which •accompany them. If a 
rash be present it grows pale, the spots sink down, 72 
SYPHILIS. 
and ulcerated surfaces begin to heal. Before the 
mercurial course is begun, encrusted or decayed teeth 
should be scaled, stopped, or removed, and the gums 
put into a healthy condition by frequent washing 
with solution of alum (F. 2). 
Cases in which Mercury is appropriate.-Whenever 
a patient has a hard-based indolent sore, with en- 
larged inguinal glands. In all the earlier affections 
of the skin and mucous membrane, and in progres- 
sive ulceration, if iodide of potassium fails to check 
it. Mercury must be cautiously given to persons 
broken in health or affected by renal disease; but 
even here, when syphilis is the cause of the debility, 
mercury frequently restores the strength more rapidly 
than any other medicine. In short, whenever the 
disease makes no progress without mercury, however 
late the stage or whatever the form, that drug should 
be tried. 
The Length of Time Mercury should be adminis- 
tered.-Mercury should be given, more or less con- 
tinuously, for at least a year after infection. If symp- 
toms be present at the end of that time, treatment 
should be continued for about three months after the 
last of them has disappeared. During this period it 
will be often necessary to omit mercury for a time. 
Iodide of potassium or tonics may be given in the 
intervals, according to circumstances. 
The Effects of Mercury are substantially the same 
by whatever channel it is introduced. After absorp- 
tion it is in part excreted in the urine, sweat, saliva, 
and intestinal mucus, but a portion remains for a TREATMENT. 
73 
time in the tissues. In small doses it is a tonic, 
promoting the action of the liver and digestion 
generally. The aim should be to limit its action to 
the tonic effect. When given in large doses, the 
characteristic effects of the drug are produced. The 
gums swell, grow tender and spongy, and the teeth 
ache when snapped together. This condition is 
accompanied by fetor of the breath, coppery taste 
in the mouth, and increase of saliva. All the useful 
effects of mercury are usually attained when the 
slightest possible sign of its influence is betrayed 
by the gums. 
Salivation.-If the irritation become violent the 
gums ulcerate and the teeth loosen ; tenderness with 
swelling and throbbing of the salivary glands, and 
copious secretion of saliva accompany the other 
symptoms. These milder forms of mercurial poison- 
ing are sometimes set up by inadvertence. Further 
effects are extremely rare at the present day. The 
symptoms are best relieved by discontinuing the 
mercury, and giving a smart purge of colocynth and 
sulphate of magnesia, followed by F. 37. The 
mouth should be frequently washed with F. 2 or 3, 
and the teeth cleaned several times daily with a soft 
brush, especially after eating. Exposure to damp 
and cold is not unfrequently the exciting cause of an 
attack of stomatitis in persons taking mercury. Sali- 
vation is not the constant sign of injurious mercurial 
action, which may also show itself by depression, 
sweating, loss of appetite, purging, nervous irrita- 
bility or anaemia. 74 
SYPHILIS. 
Mercury is given internally in pills and mixtures 
and sometimes in suppositories (F. 64, 66). It may 
also be introduced by inunction, by the mercurial 
vapor bath, or by subcutaneous injection. 
When mercury is administered to a person who 
has not previously taken it, the dose should be small 
and in a form not likely to irritate the bowels; F. 
47, 48, 52 are suitable to begin with, the fact that 
women and lads are more susceptible to the influence 
of mercury than full-grown men being borne in 
mind. If blue pill be employed to produce the 
effect of mercury rapidly, it is best to begin with F. 
49 three times a day. While this dose is given the 
patient should be seen frequently. When the mer- 
cury begins to be felt, he should omit it for a day, 
and then continue with about two-thirds of the quan- 
tity at first employed. 
The perchloride is ill-adapted for producing the 
requisite effect quickly. Hence it is better suited to 
the later forms of the disease, where the action of 
mercury is required only to a slight degree. A useful 
mode of giving it is F. 53. It may also be combined 
with iron, as in F. 34. The bicyanide is sometimes 
borne when other preparations of mercury disagree 
with the patient (F. 54). The red iodide is very 
useful in relapses of the scaly eruptions on the skin 
(F. 33)- The green iodide, from the readiness with 
which it decomposes, sometimes fails to produce any 
effect, and is apt to cause griping and purging, unless 
the dose be very small (F. 50, 51). A preparation 
of mercury with sarsaparilla and aromatics, called TREATMENT. 
75 
Zittmanri s decoction, is of value in some cases of 
tertiary syphilis. 
Inunction.-This is a very good mode of adminis- 
tering mercury, especially when the drug is not well 
borne by the stomach. From 20 to 60 grains of 
mercurial ointment or of oleate of mercury (10 per 
cent.) should be rubbed every night into some part 
of the body. The parts best adapted for rubbing 
are the axillse, the sides of the arms, the thighs, and 
the flanks; but when large quantities are used, the 
whole body should be anointed in turn. A trained 
rubber anoints more effectually than the patient him- 
self can do. Before commencing the inunction, 
the skin should be well cleaned, and the effect is 
materially aided by warm baths and other methods 
of provoking perspiration. Mercurial friction excites 
in some persons an erythematous or pustular erup- 
tion, besides occasionally causing the irritation of 
the alimentary canal which often follows the admin- 
istration of the drug by the stomach. If greatly 
prolonged, inunction usually produces weakness, 
loss of appetite, accelerated pulse and sleeplessness. 
Hence, the course of rubbing should rarely extend 
beyond six weeks, without a break of two or three 
months. 
In the mercurial vapor bath (F. 1), an atmosphere 
of steam and mercuric vapor is produced, which de- 
posits on the skin a thin coating of mercury. The 
bath may be taken every night until the gums swell; 
after this, twice or thrice weekly. 
Mercury may be injected beneath the skin (F. 60) ; 76 
SYPHILIS. 
but this mode is only to be recommended when other 
means fail, or when it is necessary to obtain the in- 
fluence of mercury as quickly as possible. 
Iodine and its Compounds.-Iodine often fails 
to cure per se, but, in conjunction with mercury or 
other medicines, it is the most valuable remedy we 
have for the late stages of syphilis. It is sometimes 
of value also in the early stages. 
Iodine is given for gummy swellings of the cellular 
tissue, rupia, affections of the bones, muscles, and 
viscera. In elderly persons, and those in whom the 
cachexia is strongly marked, or in the affections of 
later childhood in inherited syphilis, iodine is of great 
service. Commonly the disease is simply controlled 
by the iodides, and is liable to break out again when 
they are discontinued. 
The form of iodine most used is the iodide of potas- 
sium. The amount to be given varies very much; 
when administered in the early stages of syphilis in 
conjunction with mercury or to increase or resusci- 
tate its effect, the iodide may be given in doses of 
five to eight grains in two ounces of water at night, 
or two or three grains may be combined with each 
dose of mercury (F. 39). When given alone, it is 
best taken three or four times daily, in combination 
with ammonia, which increases the activity of the 
iodide and also assists to prevent its depressing 
effects (F. 35). Some persons can bear only a very 
small quantity of iodine; others are insensible to 
small doses. In most, if not all persons, the influ- 
ence soon diminishes, and the requisite amount of TREATMENT. 
77 
action on the syphilitic affection can be secured only 
by frequently increasing the dose or by discontinu- 
ing the iodide for a short time. If the patient be 
much enfeebled, tartarated iron may be combined 
with the iodide (F. 38). 
The iodide of sodium or of ammonium may be 
used in similar doses when iodide of potassium 
disagrees. 
Iodoform has been given with benefit in the later 
stages of syphilis, but is liable to cause irritation of 
the stomach and bowels. It may be prescribed in- 
stead of the iodides, or in cases where those prepa- 
rations have failed (F. 55). 
lodism.-When iodine disagrees the deleterious 
effects are shown first on the mucous membrane, 
beginning with coryza and pain in the frontal 
sinuses, congestion of the conjunctivae and swelling 
of the eyelids, irritation of the throat and bronchial 
tubes. Irritation of the alimentary canal is some- 
times the chief symptom. The skin may be the seat 
of eruptions of various kinds. The nervous system 
is occasionally affected. 
The bromides of potassium and ammonium are used 
either in conjunction with iodide of potassium or 
alone. They are serviceable where the system has 
become insensible to iodine, or in syphilitic epilepsy 
or other varieties of nervous excitement (F. 36). 
Iron is much used to restore the system from its 
anaemic condition, and is usually required at some 
time during the progress of syphilis. Quinine also 
is often of service (F. 30, 31, 34, 46). Cod-liver oil 78 
SYPHILIS. 
is often necessary. Sarsaparilla.-The liquid extract 
is sometimes beneficial in enabling the patient to 
bear larger doses of iodide than he could take when 
dissolved in other menstrua. Some patients improve 
rapidly when sarsaparilla is given while they are 
taking or have recently taken prolonged courses of 
mercury. Opium 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. It is also sometimes necessary 
to allay the pain of periostitis and other local affec- 
tions. 
SPECIAL TREATMENT OF THE AFFECTIONS OF SYPHILIS. 
The Skin.-The earlier syphilides commonly 
cause no discomfort. Sometimes, if the rash spread 
rapidly, it itches a little. Soap and water allays this 
very well. Conspicuous spots on the face or neck 
may be powdered with starch, and painted with 
oleate of mercury (5 per cent.) at night. In the 
later eruptions, when the papules crack, ulcerate, or 
suppurate, iodoform ointment or red oxide of mer- 
cury ointment may be used. For chinks round the 
mouth or nose F. 43 or 44 is serviceable. Spread- 
ing ulcers of the skin are usually benefited by iodo- 
form in powder or ointment, or mercurial plaster. 
In exhausted persons the sores may be dressed with 
F. 27. 
Local fumigation by mercurial vapor is occasion- 
ally used to heal ulcers of the skin, or to procure 79 
the subsidence of obstinate leprous or tuberculous 
patches of eruption. 
In papulo-scaly eruptions of the palms or soles red 
oxide of mercury ointment, or equal parts of am- 
moniated mercury and zinc ointments should be 
well rubbed in at bedtime after bathing with hot 
water, gloves or socks being worn during the night. 
When the hair falls, F. 28 may be prescribed, though 
new hair grows again readily if constitutional treat- 
ment be carried on. Cracks and ulcers about the 
nails should be dressed with strips of mercurial 
plaster, or with red oxide of mercury ointment. 
Ulcers between the toes are to be treated by frequent 
washing, drying, and powdering with iodoform, or 
wrapping round each toe a strip of lint soaked in 
black wash. 
Mucous patches should be washed two or three times 
daily, well dried, dusted with F. 57, and covered 
with lint or rag. 
The Alimentary System.-In the mouth, ulcers 
should be touched every other day with nitrate of 
silver, and the mouth washed with F. 2 or 3, especi- 
ally after eating. Ulcers of the fauces are quickly 
relieved by a gargle of perchloride of mercury 
(F. 4). Ulcers at the side of the tongue are often 
kept up by being chafed against ragged teeth ; these 
must be filed or removed. The acute inflammation 
of the fauces that sometimes accompanies ulceration 
is relieved by the inhalation of the steam of hot 
water, to which a drachm of compound tincture of 
benzoin has been added. In ulceration of the 
TREATMENT. 80 
SYPHILIS. 
pharynx a spray producer is very useful for making 
the necessary applications (e.g., F. 3, 4, 25, 26, 59). 
When necrosis of the bones of the palate has occurred, 
and the fragments are loose, they must be removed, 
and the mouth frequently rinsed with F. 25 or 26. In 
all syphilitic affections of the mouth and throat smok- 
ing should be prohibited. 
In syphilitic affections of the anus and rectum the 
bowels must be carefully regulated. Ulcers should 
be kept scrupulously clean, and dressed with iodo- 
form or calomel ointment (F. 43, 44). In ulceration 
within the rectum iodoform suppositories should be 
used (F. 67). In stricture of the bowel bougies 
should be carefully passed. In extreme cases 
division of the stricture or colotomy may be neces- 
sary. 
The general treatment of the affections of the ali- 
mentary system depends mainly on the condition of 
the patient, and the length of time that has elapsed 
since infection. If he be in good health, and in a 
comparatively early period of the disease, mercury 
should be administered at once. In the later stages 
when the affection does not yield speedily to iodide 
of potassium, it is advisable to try the effect of mer- 
cury, though in extremely feeble persons the experi- 
ment must be made cautiously. Whichever method 
of treatment is found to succeed best should be con- 
tinued for some months, and in the case of visceral 
disease until the patient is in sound health. The 
best result often requires an occasional resort to 
specifics. TREATMENT. 
81 
The Air Passages.-Follicular ulceration and 
chinks within the nostrils are much relieved by keep- 
ing them constantly soft-with red oxide of mercury 
ointment. The fetid discharges from the nose re- 
quire frequent cleansing with F. 25 or 26, by means 
of a syringe or nasal douche. All the affections of 
the nose and air passages are increased by exposure 
to keen winds. 
In the larynx the spasmodic irritation caused by 
ulcers is relieved by iodine or creasote inhalations. 
If the ulcers can be seen with the laryngoscope, they 
may be brushed over with a solution of nitrate of 
silver (F. 58). Dyspnoea and chronic irritation are 
often relieved by applying a blister to the throat, 
and dressing it with diluted mercurial ointment. 
Rapid oedema of the larynx may occur early in 
syphilis, but it is usually soon relieved by mercury 
and iodide. In later syphilis dyspnoea is usually 
due to cicatricial contraction ; in which case specifics 
are of much less value, and tracheotomy may be 
necessary. 
Syphilitic disease of the lungs requires the same 
treatment as other kinds of phthisis, with the import- 
ant addition of iodide of potassium and mercury. 
The Nervous System.-In affections of the 
brain, spinal cord, and nerves, iodide of potassium 
and tonics should be employed; but mercury must 
also be given for some months after relief has been 
obtained. Bromide of potassium is especially useful 
when syphilitic disease of the brain causes epilepsy 
(F. 36). In cases of coma, convulsions, or other 82 
SYPHILIS. 
grave nervous symptoms, treatment must be prompt 
and energetic; e.g., a solution of mercury (F. 60) 
may be injected beneath the skin twice or thrice in 
the twenty-four hours, and fifteen to twenty grains of 
iodide given internally every three or four hours, the 
dose being increased every other day, until some 
effect is produced, after which the treatment may be 
modified according to circumstances. 
The Eye .-Sores and mucous patches of the 
eyelids must be washed and anointed with the red 
oxide of mercury ointment. Loose lashes should be 
removed. Corneitis is generally arrested by mercury ; 
F. 47 is the form most generally borne; or the mer- 
cury may be introduced through the skin. Iron, 
cod-liver oil, quinine, and a diet of which milk forms 
a large part, are best suited to feeble children. The 
eyes should be shaded, and atropine (F. 62) used 
three times a day until it can be ascertained whether 
iritis be present. The treatment of iritis is of great 
importance, from the rapidity with which irremedi- 
able mischief may be caused. A strong solution of 
atropine (F. 61) should be dropped into the eye 
every two hours, until the pupil is fully dilated; 
afterwards a weaker solution (F. 62) may be used 
three or four times a day. The eye may also be kept 
bound up with warm belladonna lotion (F. 29). 
Opiates are often required. If the pain be violent, 
three or four leeches should be applied to the temple. 
No time should be lost in getting the patient under 
the influence of mercury; F. 49 may be given every 
four or six hours till the gums begin to swell, when TREATMENT, 
83 
the dose should be reduced. In the affections of the 
choroid and retina, iodide of potassium, or mercury, 
or both, must be given for months, and in severe 
cases for a year or longer. Leeches are useful when 
there is much pain, and a dark room is beneficial. 
The Ear.-Ulcers or mucous patches of the ex- 
ternal ear must be frequently cleansed and powdered 
with iodoform ; if within the meatus a syringe should 
also be used daily. The local treatment of affections 
of the middle ear is that of inflammation from other 
causes. General specific treatment must, of course, 
be carried out in all these cases as well as in those 
where the internal ear is affected. 
The Generative Organs.-The treatment of 
these is the same as that of other late forms of 
syphilis. When the testis is attacked long after in- 
fection, iodide of potassium should be given in 
gradually increasing doses (F. 35). Some cases are 
very little improved by iodide alone, and to prevent 
relapses it is always desirable to give mercury as well 
^-g-, F. 33 or 39). 
The Uterus.-The local treatment of syphilitic 
disorders is the same as that for corresponding non- 
syphilitic affections, and is described in the chapter 
devoted to them. But constitutional treatment with 
iodide and mercury is indispensable. 
The Bones and Muscles.-The pains in early 
nodes are relieved by spirit lotion and blisters. 
When suppuration really occurs, the swelling may 
be opened. Otherwise, puncturing the node is 
always to be avoided. 84 
SYPHILIS. 
The diseases of the bones, muscles, joints and 
bursae are most readily controlled by iodide of potas- 
sium (F. 35), given in slowly increasing doses, and 
continued for a considerable time; small quantities 
of mercury should be added later. 
TREATMENT OF INHERITED SYPHILIS. 
Besides careful attention to the general state of 
health, mercury should always be given to a syphilitic 
child. Twice daily he may take a grain of gray 
powder with a little sugar; but the effect upon the 
bowels must be watched, and the dose diminished or 
combined with a grain of compound ipecacuanha 
powder, if diarrhoea or colic begin. If the symptoms 
be not affected by this quantity of gray powder, the 
dose may be cautiously increased to two grains; but 
this amount is very likely to produce purging, and it 
is not often necessary. Mercury applied externally 
to children is less likely to cause diarrhoea than when 
given internally. It may be done by rubbing the 
ointment into the skin, or by spreading fifteen to 
thirty grains of mercurial ointment diluted with its 
weight of lard on a piece of flannel which the child 
should wear constantly round its waist. The oint- 
ment should be renewed every night, and the child's 
skin carefully washed with soap and water every 
third or fourth night, before the flannel is replaced. 
The nostrils must be cleared regularly with a camel- 
hair pencil dipped in water, and excoriations touched 
with the ointment of red oxide of mercury. The 85 
TREATMENT OF INHERITED SYPHILIS. 
mouth must be carefully cleaned after each meal, 
with warm water and a small piece of sponge on the 
end of a stick; and ulcers or patches painted with a 
solution of borax (F. 59). The treatment of the 
other local affections is the same as that already de- 
scribed for those of the acquired disease. The dura- 
tion of treatment will, of course, vary according to 
the case ; but it should always extend over a period 
of about six months. 
Whenever the mother can suckle her child she 
should always do so. The risk of communicating 
. syphilis renders it impossible to employ a wet-nurse, 
unless one who has had the disease can be procured. 
In other cases ass's, goat's, or cow's milk must be 
employed 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 of the 
child. 
The treatment of the later forms of inherited 
syphilis is similar to that of the corresponding af- 
fections in acquired syphilis, and has already been 
indicated in the preceding pages. Iodide of potas- 
sium combined with mercury in some form, according 
to circumstances, is of the greatest value, and iodide 
of iron and cod-liver oil are most useful adjuvants. 
PREVENTIVE TREATMENT OF SYPHILIS. 
Every syphilitic person should be cautioned as to 
the danger of spreading it to others. Coitus must 
be forbidden while the disease remains active. The 86 
contagious nature of lesions of the mouth and throat 
should also be pointed out, and the consequent risk 
attending kissing, and the use of pipes or drink- 
ing vessels, towels, etc., in common with healthy 
persons. 
The student should also remember that syphilis 
has been conveyed by dirty surgical and dental in- 
struments and appliances ; hence the necessity for 
extreme care in cleansing all such articles. 
Marriage.-Syphilis in an adult usually subsides 
into quiescence within two years. But the disease 
sometimes retains its activity much later than this ; 
in which case, after the last symptoms have disap- 
peared, there should be an interval of at least twelve 
months before marriage takes place. Under any 
circumstances, the shortest period between infection 
and marriage ought to be three years. 
When marriage has already taken place, and the 
husband suffers a relapse, he must at once desist from 
sexual intercourse, and from close embraces or kiss- 
ing, and submit to renewed treatment of his disease. 
As regards the wife, it is best, as a general rule, to 
wait for evidence of syphilis before submitting her to 
specific treatment, but she ought to be watched, that 
treatment may be begun as early as possible, if events 
show it to be necessary. A woman who has already 
borne a syphilitic child ought to be treated through- 
out her pregnancy. In this way the child may often 
be shielded from syphilis during its maturation in the 
womb, and the mother also cured of her disease. 
SYPHILIS. PREVENTIVE TREATMENT. 
87 
Nursing.-The lesions of acquired and of in- 
herited syphilis being equally contagious, it of course 
follows that a healthy nurse should never suckle a 
syphilitic child, and that a healthy child should 
never be nursed by a syphilitic woman. CHANCRE. 
CHAPTER I. 
DESCRIPTION. 
Synonyms.-Local, soft, simple, non-infecting 
chancre or sore ; Amer., Chancroid; Fr., Chancre 
nwu ; Ger., Schanker. 
Chancre is a local, virulent, contagious sore, which 
is never the beginning of syphilis. It is produced by 
inoculating the pus of a similar ulcer on the patient 
himself or on another person. 
Chancre is often co-existent with syphilis. It has no 
period of incubation ; irritation begins immediately, 
but the activity varies much in different persons. 
The chancre is generally discovered as a minute but 
well-defined ulcer, about five or six days after con- 
tagion. It always causes destruction of the tissues 
around the point of inoculation. There are three 
varieties. In one, the sore reaches through the whole 
thickness of the skin or mucous membrane. Another 
variety is very shallow. The third variety is promi- 
nent, with spongy granulations over the surface. The 
leading characters of the local chancre are, supple- 
ness of the base, sharply cut, undermined edges, 
uneven, spongy floor, irritating and abundant puru- 
88 DESCRIPTION. 
89 
lent discharge, consecutive inoculation of neighbor- 
ing parts producing fresh sores, activity, and liability 
to inflame and spread. In men, the furrow behind 
the glans penis, in women, the fourchette and entry 
to the vagina, are favorite sites. 
The main complications of chancre are inflammation, 
sloughing phagedsena, and slow phagadaena or ser- 
piginous ulceration. The first is a consequence of 
irritation from violent exercise, debauchery or other 
cause. Phagedaena often occurs in debilitated persons, 
but its exciting cause is not seldom obscure. 
The diagnosis of the local from the syphilitic sore 
depends on the history ; the absence of incubation ; 
the activity of the ulceration ; the tendency to multi- 
plication ; the absence of induration, and of indolent 
multiple enlargement of the nearest group of lym- 
phatic glands. Though the base of a typical chancre 
is supple, a certain degree of inflammatory hardness 
is often seen in practice. Such hardness, however, 
is like that of a boil, not like the induration of syphi- 
lis. Still, both in syphilis and in chancre, the ap- 
plication of caustics or other irritation may cause so 
much inflammation, that a diagnosis cannot be made 
at the time. A primary sore on the body of the 
penis is usually syphilitic. Herpes and excoriations 
are distinguished by their readiness to heal when 
kept clean. Secondary or tertiary syphilis, when 
ulcerated, sometimes resemble chancres, but the 
presence or history of other signs of syphilis distin- 
guishes them. 
The prognosis of chancre is good ; the sore usually 90 
CHANCRE. 
heals in a month or six weeks when kept clean and 
free from irritation, and in much less time if appro- 
priately treated. The phagedsenic form may, in ex- 
ceptional cases, last for months or even years. 
Bubo is a common accompaniment of chancre ; 
it occurs more frequently in men than in women. 
There are two varieties; one, simple, lymphatic ab- 
scess from irritation ; the other, the virulent bubo, 
which may be caused either by accidental contami- 
nation of a simple abscess with matter from a chancre, 
or by absorption from the sore itself, and transmis- 
sion of the virus along the lymphatic ducts to the 
gland. The gland always suppurates, and the matter, 
when it escapes from the interior of the gland, com- 
municates to the abscess the characters of the original 
sore. Bubo from direct absorption of venereal 
matter without previous chancre, has been supposed 
possible, but such swellings are probably due to strain 
or irritation of that kind. They are called by the 
French, Bubons d.' emblee. The lymphatic vessels, as 
well as the glands, sometimes inflame, and small ab- 
scesses may form along their course, leaving tedious 
sinuses. TREATMENT. 
91 
CHAPTER II. 
TREATMENT. 
Severe exercise, stimulating diet, wine, and sexual 
excitement, must be always avoided. The horizon- 
tal position greatly promotes healing of the sore, and 
lessens the risk of bubo. 
Local Treatment.-Most chancres are best 
treated with iodoform ; under its use healthy sores 
heal rapidly, creeping sores generally cease to spread, 
and sluggish ones take on healthy action. The sore 
should be washed twice or thrice a day, dried, and 
sprinkled with finely-powdered iodoform or painted 
with an ethereal solution (F. 63), and covered with 
a piece of lint or wool, over which oil-silk should be 
applied if the sore be situated on an outward part, 
like the dorsum penis or groin. When the sore in- 
volves the urethral orifice a shred of lint should be 
inserted. Contraction nearly always follows chancres 
in this situation. When iodoform is not used, lead 
lotion (F. 20), or black wash (F. 23), or a solution 
of boric acid and glycerine, may be applied. The 
penis should be supported in a suspensory bandage 
or handkerchief against the abdomen. If the sore 
be under the foreskin, lint should be placed between 
it and the glans. Chancre under the foreskin with 
phimosis must be treated according to the directions 
g vn in the section on phimosis, (p. 114.) 92 
CHANCRE. 
In women strips of lint should be laid between the 
labia and in the folds of mucous membrane round 
the vagina, and a pledget of cotton wool placed in 
the entry to the vagina. (Edema of the vulva is 
best managed by frequent bathing and by lying 
down. 
If a Chancre slough or become phage- 
daenic, and iodoform alone fail to arrest its progress, 
the patient should be kept in a hip-bath (98° Fahr.) 
for nine or ten hours a day, care being taken that the 
affected part is thoroughly immersed. The bath 
must be continued until the sore becomes healthy. 
During the night iodoform or other dressing may be 
applied. If phimosis be present, the prepuce, to- 
gether with all loose, sloughy tissue, should be re- 
moved before the patient is put into the bath. Per- 
sulphate or perchloride of iron, or the actual cautery, 
may be used in case of severe hemorrhage. Caustics 
are rarely needed. Ricord's paste (F. 45), and the 
strongest nitric acid are best adapted for this purpose. 
Before a caustic is applied, the sore must be freed 
from loose sloughs, and well cleaned and dried. The 
escharotic must be thoroughly laid on, with a stick or 
a glass brush, to the whole of the diseased surface, as 
well as to its edges. The galvanic cautery or hot 
iron may be used where a large amount of tissue has 
to be destroyed. When dealing with large sores, 
ether or chloroform should be administered. The 
after treatment consists in the application of a poul- 
tice or water dressing; when the eschar has separated, 
iodoform should be used. Patients with sloughing TREATMENT. 
93 
phagedsena require tonics (F. 32), opium, and good 
diet. 
Treatment of Bubo.-On the first appearance 
of pain and swelling in the groin, the patient must 
desist from exercise if he have not already done so, 
and should lie in bed as much as possible. When 
the glands are swollen and painful a lead lotion 
(F. 20) may be applied, but cold applications some- 
times aggravate the pain, in which case hot foment- 
ations must be employed. Not unfrequently these 
precautions suffice to allay the irritation when it is 
not due to absorption. But if not, rest, poulticing 
with linseed meal, and fomenting with hot water 
must be maintained, to promote suppuration. 
Pressure will often disperse very slowly forming 
buboes, which are composed of enlarged glands and 
congested cellular tissue with little tendency to 
degenerate into matter. A thick pad of cotton wool 
or folded lint should be adjusted over the swelling, 
and kept in position by a firm spica bandage or by 
strips of plaster carried round the body and thigh. 
The patient should avoid exercise during this treat- 
ment. Plasters of iodine, of belladonna, or of mer- 
cury spread on leather, may sometimes be applied 
with advantage underneath the pad. When a bubo 
has been opened, and is non-virulent, the closure of 
the abscess is hastened by applying pressure over the 
dressings. 
Vesicants are serviceable at various stages of the 
bubo's progress, especially when the glands remain 
enlarged after the chancre has healed. But if irri- 94 
CHANCRE. 
tants be applied to the skin over glands already 
swelled by the irritation of a sore on the genitals, 
the probability of abscess is increased. Thus the 
custom of painting' the skin over tender glands with 
iodine is delusive and injurious. 
Incisions should be made as soon as the swelling 
fluctuates, for the pus must come out, and burrow- 
ing of matter under the skin is lessened by giving it 
free exit. It is in most cases best to make a small 
vertical opening into each pointing part, that every 
focus of matter may be drained; but if the abscess 
extends widely along the fold of the groin, it should 
be opened freely in that direction. A scrap of lint 
should be inserted into each incision, to prevent the 
wound from closing before the matter has drained 
away. After a few days, the contraction of the 
abscess may be hastened by injecting some astringent 
(F. 22) into the cavity morning and evening. 
Sinuses should be opened freely with a director 
and bistoury. Afterwards the channels must be 
filled with dry lint until suppuration begins, when 
the granulating surfaces may be dressed with strips 
of lint, soaked in carbolic lotion (F. 21), or a solu- 
tion of boric acid, or red wash (F. 22), according to 
the state of the sore. The patient's usually debili- 
tated state of health requires tonics and good diet. 
Sometimes a mass of enlarged glands lies at the 
bottom of the wound ; red precipitate powder may 
be sprinkled over them daily, and pressure applied 
by means of a pad and bandage. If this treatment 
fail, the glands may be removed with the sharp TREATMENT. 
95 
spoon, or destroyed by caustic. Any borders of skin 
which overhang the wound and are much under- 
mined, may be cut off with scissors. 
If the bubo be virulent, the treatment must be 
similar to that of the chancre. GONORRHCEA. 
CHAPTER I. 
URETHRITIS IN MAN. 
Synonyms.-Clap; Blennorrhagia; Fr., Chaude- 
pisse ; Ger., Tripper. 
Gonorrhoea in males is a contagious, purulent in- 
flammation of the urethra and its continuations ; but it 
occasionally attacks other mucous surfaces, the con- 
junctival, for example. Certain rheumatoid affections 
also attend it now and then ; namely, inflammation 
of the joints, eyes, and synovial bursae. The chief 
causes of urethritis are gonorrhoeal contagion, and 
excessive irritation of the urethra through sexual and 
other causes. Acrid discharges in the female, which 
have not arisen from contagion, may excite urethritis 
in the male. It has been asserted that the peculiar 
contagious property of gonorrhoea is due to the pres- 
ence in the discharge of a special micro-organism, 
called by Neisser, its discoverer, the gonococcus ; but 
this is not yet proved. 
The seat of urethritis is at first the urethra as far as 
the fossa navicularis, whence it gradually travels down 
to the bulbous part. It usually proceeds no further, 
96 URETHRITIS IN MAN. 
97 
but in certain cases it extends to the cellular tissue 
about the urethra, to the prostate, to the neck of the 
bladder, or to the epididymis. 
The anatomical change in the mucous membrane is 
general uniform congestion in the acute stage ; as 
inflammation subsides, the surface is marked by 
patchy redness, arborescent and punctiform conges- 
tion, and sometimes by fine granulations. After a time 
induration and contraction of the mucous membrane 
and submucous tissue may take place, causing stric- 
ture and irregularity of the urethra. 
Course.-The first symptoms of gonorrhoea usually 
appear from two to eight days after contagion, and 
consist in tickling near the meatus with redness and 
swelling of its lips and scanty, viscid secretion. The 
discharge gradually increases in quantity, and be- 
comes purulent, and by the end of about a week is 
generally copious, yellowish green, and often bloody. 
There may be also tenderness along the urethra, 
painful micturition, and aching in the penis, peri- 
naeum, and groins. Painful erections and chordee 
are frequent, and general febrile disturbance is some- 
times present. After the acute stage has lasted from 
seven to fourteen days all the symptoms improve, 
and naturally the disorder subsides in a few weeks ; 
but it is frequently prolonged or brought back to its 
first intensity by neglecting the precautions neces- 
sary to prevent irritation. There are often devi- 
ations from the ordinary course in the quantity of 
discharge, and in the severity of the symptoms, which 
depend on the patient's constitution and habits. 98 
GONORRHCEA. 
The disorder may terminate in gradual but complete 
cessation of pain and discharge ; or in cessation of 
all the symptoms, except a small quantity of discharge 
or gleet. Gleet may be due to constitutional or local 
causes, the most common of the latter being chronic 
inflammation at one or two places of the urethra 
after acute urethritis ; but it may proceed from a peri- 
urethral abscess, follicular inflammation, stricture, 
warts, or a relaxed prostate. 
The diagnosis between urethritis from contagion 
and urethritis from other causes is often impossible, 
but the treatment is similar for both. Urethral 
chancre causes a discharge from the meatus, but the 
ulcer can be seen when the lips are separated. Syphi- 
lis may accompany urethritis, and a slight muco- 
purulent discharge from the urethra without pain or 
much swelling is occasionally present during the 
period of initial lesion in syphilis. Balanitis is dis- 
tinguished by the absence of urethral discharge; 
but it is often present with gonorrhoea. Abscess of 
the prostate or perinaeum may cause purulent dis- 
charge from the urethra; but the history and con- 
dition of the patient distinguish the source of the 
discharge. 
The prognosis is favorable if precautions be taken 
early, but gonorrhoea is the predominating cause of 
stricture, and may inflict many severe consequences 
and complications. 
The Treatment of urethritis is abortive and 
systematic. Abortive treatment with strong caustic 
injections, or large doses of so-called specifics, is URETHRITIS IN MAN. 
99 
rarely successful, and not free from danger. Another 
form of abortive treatment, planned on the assump- 
tion that gonorrhoea has a parasitic origin, consists 
in the introduction of bougies of cocoa butter con- 
taining iodoform and eucalyptic oil. It has failed 
in our hands. Systematic treatment, the safest and 
best, first removes all sources of irritation, and allays 
the acute inflammation. Abstinence from alcoholic 
liquors, coffee, and strong tea, stimulating food, sex- 
ual excitement, and severe exercise must be insisted 
on. Cleanliness should be strictly observed, and the 
risk of infecting the eyes pointed out. The testes 
should be supported in a suspensory bandage. While 
the pain and swelling are great, and the discharge 
copious, the bowels should be kept freely open, and 
an alkaline mixture (F. 40) taken several times daily. 
Warm baths are useful. Painful micturition is often 
relieved by immersing the penis in ice-cold or very hot 
water during the act. For the relief of chordee, F. 
56 or 65, or a draught containing 15 to 20 grains of 
chloral hydrate with as much bromide of ammonium, 
may be prescribed. 
These measures provide for the acute stage of 
urethritis, during which the so-called specifics and 
injections are not advisable. When the inflamma- 
tion and pain subside, and the discharge becomes 
yellow instead of greenish, and less in quantity, 
copaiba (F. 41), or freshly powdered cubebs in one 
or two drachm doses, may be given. Either of 
these drugs may cause an eruption on the skin. In 
copaiba rash the spots are raised, deep red in color, 100 
GONORRHOEA. 
usually attended by intense itching, and most numer- 
ous on the backs of the hands, wrists, elbows, and 
knees. These characters distinguish it from syphi- 
litic roseola, for which, however, it is sometimes mis- 
taken. Sandal-wood oil (F. 42) resembles copaiba 
in its action, but it is often better borne by the 
stomach and is much less likely to cause a rash on 
the skin. When the inflammation is originally sub- 
acute the discharge may often be speedily controlled 
by an injection ; but it should contain belladonna or 
opium, and be at first only weakly astringent (F. 5). 
Directions for the mode of using an injection are 
given on p. 121. When pain has disappeared, the 
strength of the injection should be increased gradu- 
ally ; or the particular form may be altered from 
time to time (F. 6-14) according to the obstinacy of 
the disorder. When the discharge has apparently 
ceased, the injection should be slowly discontinued 
by using it in a more dilute form, and less often, for 
a week or fortnight longer. 
In gleet, besides injections of various kinds, soluble 
bougies are useful in some cases. A bougie should 
be passed at bedtime, and secured by a capote or 
cap of gutta percha or oiled silk. The best are 
Mitchell's or Bell's, containing chloride or sulphate 
of zinc, tannin, or rhatany, with or without bella- 
donna or opium. Before passing, the bougie is 
dipped into water to make it slippery on the surface. 
Again, the passage of bougies and metal sounds is a 
valuable means for curing chronic discharge from 
the urethra, especially when, as often is the case, it URETHRITIS IN MAN. 
101 
depends on slight stricture. They should be passed 
every other day, and in gradually increasing sizes, 
until the largest the meatus will admit slips easily 
along the urethra. Should the meatus not admit a 
sound as large as No. 12 of the English scale, it 
should be incised until a No. 14 or 16 slips in easily. 
For diagnostic purposes, a bougie with a bullet- 
shaped end is necessary; strictures being detected 
by their resistance, and inflamed patches by the pain 
felt as the bullet passes over them. The endoscope 
also is of use in determining the source of gleet, as 
well as in its treatment. 
In all cases of long-standing gleet, the patient 
should be thoroughly examined, both locally and 
generally, and the cause of the discharge ascertained 
before any treatment is instituted. Attention to the 
general health is often of quite as much importance 
as the local application of remedies. 
Complications.-Balano-posthitis is a common 
complication of gonorrhoea when the prepuce is nar- 
row. Phimosis and paraphimosis also occur in some 
cases. Either of these conditions may excite conges- 
tion, suppuration, or even sloughing of the parts (see 
p. 114). 
Retention of urine may come on at any time, but 
usually in the later stages ; it may be due to conges- 
tion and reflex muscular spasm of the urethra; but 
there is often some permanent stricture also. Seda- 
tives, warm baths, and purgation should be tried, 
and a No. 6 or 7 flexible olivary or coudee catheter 102 
GONORRHOEA. 
passed without delay, if speedy emptying of the blad- 
der be imperative. 
Inflammation of the lymphatic glands and vessels is 
not infrequent; the former causes sympathetic bubo, 
the latter produces painful enlargement of the lym- 
phatics in the skin of the penis, and oedema of the 
cellular tissue ; with rest, and lead lotion (F. 20) 
locally, these usually subside in a few days. 
Hemorrhage from the urethra through rupture of 
the congested vessels during gonorrhoea is frequent, 
but very rarely otherwise than beneficial. When 
copious, it must be stopped by ice-cold applications, 
by injections of ice-cold water, or of a diluted solu- 
tion of perchloride of iron, and by pressure. The 
corpus spongiosum occasionally inflames, causing 
violent pain and irregular erection, and sometimes 
permanent induration at the inflamed spots. 
Abscesses about the urethra may arise in several 
ways: the most common is by suppuration of the fol- 
licles and mucous glands beneath the mucous mem- 
brane. They are generally found near the glans or 
the bulbous part; in the latter case they form ab- 
scesses which point in the perinseum, are liable to 
open into the urethra, and allow the escape of urine 
into the cellular tissue. Sometimes the abscess is 
due to inflammation of Cowper's gland ; in that case 
it is closely connected with the bulb on one or other 
side. As soon as they begin to point the abscesses 
should be opened. 
Acute prostatitis is a severe complication ; it causes URETHRITIS IN MAN. 
103 
swelling of the prostate, painful, slow micturition, 
often complete retention, sense of fullness or weight 
at the anus, and irritation of the bowel with constant 
desire to defecate. Prostatitis may run on to abscess, 
and often leaves permanent enlargement of the organ. 
If suppuration take place, the pain increases till the 
matter escapes, then sudden relief follows. The ab- 
scess generally opens into the urethra, and the pus 
comes away with the urine ; but it may open into the 
rectum, the perinaeum, or the bladder. If urine 
or faeces get into the caverns made by the abscess, 
much irritation is set up, which sometimes causes a 
fatal termination, and always greatly defers the re- 
covery. The treatment of prostatitis is to allay the 
irritation by rest in bed, hot baths, fomentations, 
laxatives and sedatives (F. 40, 65). If retention 
occur, the regular passage of a catheter will be neces- 
sary. When an abscess points in the rectum or peri- 
nsum it should be opened. 
Chronic prostatitis with gleety discharge is best 
managed by careful attention to the health, and by 
counter-irritation continued a long time. In some 
cases the passage of steel sounds is very beneficial. 
Inflammation of the mucous membrane of the neck 
of the bladder [cystitis'} is much more frequent than 
acute prostatitis. The chief symptoms are constant 
desire to void urine, the drops passed last being often 
purulent or bloody, intense scalding after micturi- 
tion, and violent spasmodic contraction of the 
muscles at the neck. It comes on during the later 
stages of gonorrhoea, and is generally due to fresh 104 
GONORRHOEA. 
irritation of the urethra, but not always. It is very 
prone to relapse. In very rare cases it spreads to 
the whole of the bladder, and even to the kidneys. 
It is best treated by rest, alkalies (F. 40), warm 
baths, and sedative suppositories (F. 65). 
Epididymitis is the most frequent complication of 
gonorrhoea. It is often excited by fresh irritation, 
and is most common in the third and fourth weeks 
of the discharge. The inflammation travels to the 
lower part of the epididymis by extension from the 
prostatic part of the urethra along the vas deferens, 
and the congestion extends thence to the tunica 
vaginalis and the scrotum, the testis itself being less 
severely implicated. The right and left organs are 
attacked with about equal frequency; but now and 
then both suffer. The symptoms are swelling, 
aching, often violent pain, and extreme tenderness 
of the epididymis. The scrotum is red and swollen, 
and the tunica vaginalis often fills with serum (acute 
hydrocele). If the epididymis be examined in this 
state, the vasa efferentia and vas deferens are found 
to be congested and embedded in plastic matter 
effused around them, which also fills their interior 
and blocks them up. In double epididymitis the 
patient is, of course, sterile as long as both vasa 
deferentia are obstructed. In four or five days the 
symptoms begin to subside ; but several weeks often 
elapse before the tenderness is all gone, and some 
months before all swelling disappears, that at the tail 
of the epididymis being most persistent. 
The treatment of epididymitis consists in absolute URETHRITIS IN MAN. 
105 
rest, fomentations, purgatives, febrifuge medicines 
(F. 40), and opiates, puncturing the tunica vaginalis 
when tense, and the testis also if it be swollen and 
the pain very acute. Venesection or leeches may be 
used if the fever be high and the congestion very 
great. Painting the surface of the scrotum with 
collodion once daily gives great relief in cases of 
moderate severity. The enlargement which remains 
after epididymitis may be left to itself, or its de- 
parture may be assisted by the application of an 
elastic bandage, or by strapping the testis. Iodide 
of potassium is given internally at the same time, to 
aid the absorption of the exudation. 
Two distinct disorders of the eye depend on. gonor- 
rhoea. The one is purulent ophthalmia, caused by 
the application of pus to the eye itself; the other is 
a rheumatoid inflammation of the conjunctiva, and 
sometimes of the iris and sclerotic as well, which 
attacks certain persons if they have urethritis. It 
often affects both eyes in turn, and is liable to re- 
lapse. In most cases the joints are affected as well 
as the eye. The gonorrhoeal origin of these dis- 
orders does not affect their treatment, which is that 
suitable for purulent and rheumatic ophthalmia re- 
spectively. 
Gonorrhoeal Rheumatism.-The joints, synovial 
bursa, fascia, and great nerves are sometimes the 
seat of inflammation in gonorrhoea, most frequently 
in persons of rheumatic or gouty tendency. 
In treatment, the first point is the cure of the 
urethritis. Purgatives, alkalies, sedatives, iodide of 106 
GONORRHCEA. 
potassium, quinine, and salicylate of soda, are the 
most useful internal remedies. In arthritis the joint 
should be kept at rest by splints; and fomentations, 
sedatives, or counter-irritants applied, according to 
the more acute or chronic nature of the case. 
CHAPTER II. 
GONORRHCEA IN WOMAN. 
Gonorrhoea in woman consists primarily of con- 
tagious catarrhal inflammation of the vulva and 
vagina, often extending to the mucous membranes 
connected therewith; rheumatoid inflammation of 
the fibrous tissues is less frequent than in males. 
Vaginitis is acute and chronic. The inflamma- 
tion begins at the lower part of the vagina, and may 
spread upward to the uterus, and over the vulva to 
the urethra. It sometimes produces abscess of ac- 
cessory parts, such as Bartholine's gland or the 
lymphatic glands. In the cervix uteri and the 
urethra it often becomes chronic and very obsti- 
nate. The causes are chiefly contagion; next, 
violent sexual indulgence, rape, the irritation of 
foreign bodies in the vagina, and certain general dis- 
orders, such as scrofula and measles. Chronic 
catarrh, besides being a relic of gonorrhoea, is com- 
mon in chlorotic women or others exposed to cold 
and damp, and subject to congestion of the pelvic GONORRHCEA IN WOMAN. 
107 
blood vessels. Acute vaginitis causes swelling of 
the genitals, with heat, itching, smarting on making 
water, and aching pain at the sacrum and loins. The 
mucous membrane is at first dry and bright red ; but 
it soon secretes a thin, transparent discharge, which 
quickly becomes purulent and copious. The mucous 
membrane is more or less studded with little emi- 
nences (vaginitis granulosa). The inflammation be- 
gins to subside in about a week; the pain and swell- 
ing cease, but the discharge, though less creamy than 
before, remains plentiful. It is then mostly secreted 
in the cul-de-sac behind the cervix, which is less 
easily cleared than the anterior part of the vagina. 
The diagnosis of vaginitis depends on the swelling, 
acute inflammation and purulent discharge in the 
early stage; on the partial congestion and copious 
discharge in the chronic stage. A purulent discharge 
may come from the cervix, or from an abscess in the 
wall of the vagina ; but the introduction of the specu- 
lum makes this clear. The distinction between va- 
ginitis frotn contagion, and vaginitis from non-specific 
irritation is often impossible; it generally has a con- 
tagious origin if there be pus in the urethra also. 
The prognosis is favorable ; and dangerous compli- 
cations are very uncommon. Great difficulty exists 
in deciding whether a particular discharge is likely 
to communicate disease. Probably any discharge 
that has originated in contagion, however scanty and 
serous it may be, will be again contagious if increased 
by irritation. 
The treatment during the acute stage, consists in 108 
GONORRHCEA. 
rest in bed, warm baths, frequent injections of warm 
water, and moderate purgation. When the conges- 
tion has subsided an astringent injection (F. 15 to 19) 
should be used, and alum or tannin plugs inserted by 
means of the speculum, as described on page 119 ; 
the only general treatment of any value is regulation 
of the health and habits of the individual. 
Complications.-Among the earliest is vulvitis ; 
the labia and clitoris grow red, swell, and a fetid 
discharge is secreted. If irritation be allayed, the 
inflammation subsides in a few days. Sometimes, 
when neglected, it causes ulceration of the parts, or 
abscess in the groin. 
Urethritis is the most common, and, according to 
some, an inevitable consequence of gonorrhoeal 
vaginitis. It is rarely acute enough to cause much 
irritation. It is marked by itching and smarting at 
the meatus, which is red and swollen. A purulent 
or mucous discharge oozes or can be pressed from the 
passage, unless the patient have just micturated ; 
even then a little can often be found in the ducts of 
two glands which open close to the meatus. This 
discharge is very persistent, and probably continues 
to be a source of contagion for a long time after the 
discharge from other parts has ceased. The treatment 
consists in weak astringent injections, the internal 
administration of copaiba (F. 41), oil of sandal wood, 
(F. 42), or cubebs ; and in obstinate cases the appli- 
cation of caustic, either in a concentrated solution or 
by a pencil of nitrate of silver. Inflammation of the 
female urethra rarely excites cystitis. GONORRHCEA IN WOMAN. 
109 
In acute inflammation of the cervix titeri, the neck 
of the uterus is swollen, red, and often excoriated 
about the os, whence a copious discharge issues, at 
first clear and viscid, then purulent. This subsides 
to a thin mucus, and either shortly ceases, or becomes 
chronic and long retains its contagious quality. 
Acute inflammation of the cervix is best treated by 
complete rest, warm injections, and saline aperients. 
In the chronic stage its treatment is that of uterine 
catarrh. (See p. 118.) 
Metritis, perimetritis, and ovaritis are observed in a 
certain number of cases, but they have no peculiar 
characters when originating in gonorrhoea. ACCESSORY VENEREAL DISORDERS. 
I. AFFECTIONS COMMON TO BOTH SEXES. 
Abrasions are very frequent accidents of inter- 
course. If neglected they may cause phimosis in 
men, or vulvitis in women. They are distinguished 
from chancres by their shallowness, by their irregular 
lacerated shape, and by the smarting which follows 
quickly after the intercourse which produced them. 
Simple abrasions heal readily under cleanliness and 
the application of a lead or sulphate of zinc lotion. 
(F. 20, 22). 
Warts do not owe their origin to a specific virus, 
but arise from the continual moistening of the parts 
with unhealthy discharges. Thus gonorrhoea and 
syphilis, especially the former, are frequent causes. 
Warts do not secrete a discharge that will reproduce 
them on other individuals. Probably a peculiarity 
of constitution or predisposition is necessary, as well 
as the exciting cause. The external genitals are their 
most frequent seat. Pedunculated warts may be tied, 
or snipped off with scissors, and the base touched 
with nitrate of silver. For sessile growths caustics 
are very useful. Nitric acid and glacial acetic acid 
are both very manageable. The strong liquor plumbi 
110 AFFECTIONS COMMON TO BOTH SEXES. 
111 
subacetatis applied daily, sometimes causes warts 
to wither slowly, and is painless. But whatever 
application is used, it is essential that the surface 
be kept clean and dry. When warts are large 
enough to cause phimosis, division or removal of 
the prepuce will be necessary. For large masses 
in women, the ecraseur or galvanic wire loop should 
be used. 
Herpes of the Genital Organs.-Herpes Pro- 
genitalis (Willan). This manifests itself by circum- 
scribed reddening' and itching or burning of the 
inner surface of the prepuce or glans penis. The red 
area is quickly beset with a group of small vesicles, 
at first colorless, then yellow, which soon break into 
very shallow sores that heal quickly if the irritation 
be allayed. Herpes also occurs, though rarely, in 
women. The chief characteristic of this form of 
herpes is its tendency to recur time after time, at in- 
tervals of a few weeks or months. In those subject 
to it, an attack may be* excited by local irritation of 
any kind or by disordered digestion. 
An ordinary case of herpes is not likely to be mis- 
taken for any other disease. The group of vesicles 
with red areola, and the preceding slight itching or 
burning, together with the freedom of the lymphatic 
glands, and its disappearance under simple cleanliness 
within a week would leave no doubt as to its nature. 
If, however, irritation be caused, either by the appli- 
cation of caustic or by neglect of cleanliness, espe- 
cially if the patient be in bad health from alcoholism or 
other cause, the spots may become ulcers that spread, 112 
ACCESSORY VENEREAL DISORDERS. 
and produce many of the consequences of the inflamed 
chancre. 
The treatment consists in bathing the part twice or 
three times a day, the application of a little starch and 
oxide of zinc powder, and the interposition of a piece 
of fine linen rag between opposed surfaces. 
Phtheiriasis of the genital region depends on the 
presence of the Phtheirius or Pediculus pubis, com- 
monly called the crab-louse. The pediculi usually 
cause intense itching, and the scratching resorted to 
for its relief frequently gives rise to a papular rash, 
which, in dirty people may become pustular ; it then 
sometimes causes enlargement and even abscess of the 
lymphatic glands. 
Washing with soap and hot water, and the plentiful 
application of ammoniated mercury ointment, quickly 
kill the pediculi. 
Scabies is sometimes limited to the genital organs, 
and is then not infrequently mistaken for a venereal 
affection. The irritation and scratching produce a 
rash consisting of vesicles, papules, and pustules, 
which, like phtheiriasis, may cause enlargement, and 
even suppuration of the glands of the groin. 
The intense itching, more severe at night, the pre- 
sence of the furrows produced by the acarus, and, 
if careful search be made, the discovery of the acarus 
itself, render the diagnosis easy. General scabies is 
sometimes mistaken for a syphilide by careless ob- 
servers ; but the characters just mentioned, together 
with the absence of syphilitic lesions elsewhere, 
should be sufficient to prevent such a blunder. AFFECTIONS PECULIAR TO MEN. 
113 
II. AFFECTIONS PECULIAR TO MEN. 
Balano-Posthitis. - Inflammation of the op- 
posed surfaces of the glans penis (balanitis), and of 
the prepuce (posthitis), is a very common affection 
in dirty people, especially when the foreskin is tight 
or long. Balano-posthitis may be acute and general 
or chronic and limited to the furrow behind the 
corona. Simple accumulation of secretion from 
want of cleanliness often gives rise to it, but it is 
also caused by irritation from the discharge of gon - 
orrhcea, warts, chancre, or primary or secondary 
syphilitic lesions. 
Treatment.-The parts must be washed with soap 
and water twice or thrice a day; they should then be 
dabbed as dry as possible and sprinkled with oxide 
of zinc and starch. A piece of lint should be placed 
in the furrow, to keep apart the inflamed surfaces 
when the foreskin is drawn forward. In some cases 
the application of lint soaked in a solution of sul- 
phate of zinc (two or three grains to the ounce) 
answers better than the powder. When the dis- 
order is chronic and limited to the furrow, it should 
be painted with a solution of nitrate of silver, ten or 
fifteen grains to the ounce. When the prepuce can- 
not be retracted, the discharge must be washed away 
by frequently injecting carbolic or lead lotion (F. 20, 
21) between the glans and the foreskin with a long- 
nozzled syringe. 114 
ACCESSORY VENEREAL DISORDERS. 
Phimosis.-This is a condition of the foreskin 
which prevents exposure of the glans penis. It may 
be congenital or acquired. In gonorrhoea, temporary 
phimosis is not infrequent, from the swelling of the 
foreskin accompanying lymphangitis, and a partial 
but more permanent form occasionally arises from 
the chronic oedema that sometimes remains in such 
cases. Inflamed chancres often give rise to phimosis 
when situated on the inner surface of the prepuce or 
on the glans, especially if the former be at all narrow. 
In such cases sloughing may occur. In syphilis the 
induration of the initial manifestation not infre- 
quently prevents retraction of the foreskin. Phimo- 
sis may also be caused by balanitis and by warts. 
Treatment.-When phimosis occurs as a complica- 
tion of gonorrhoea, the patient should lie down con- 
tinuously, with the penis wrapped in lint, kept wet 
with lead lotion (F. 20), which must also be freely 
syringed beneath the swollen prepuce every two or 
three hours. 
As a complication of inflamed chancres, phimosis 
is a more serious affection. When the inflammation 
and swelling are not very great, and when the parts 
are not too sensitive to allow of the necessary manipu- 
lation, careful cleansing of the preputial cavity by 
means of a syringe, with a nozzle long enough to 
reach beyond the corona glandis, will be all that is 
required, provided the patient remain at rest. Every 
two hours a lotion of lead (F. 20) or carbolic acid 
(F. 21) should be injected. If the syringe cannot 
be inserted, owing to excessive swelling or hardness AFFECTIONS PECULIAR TO MEN. 
115 
of the tissues, and in any case if sloughing be going 
on, the diseased parts must be exposed by division 
or complete removal of the prepuce. The subse- 
quent treatment is that of sloughing chancre. 
Phimosis caused by syphilitic induration disappears 
under the influence of general specific treatment. 
Paraphimosis.-This condition is the reverse of 
phimosis-i. e., instead of inability to retract the pre- 
puce, it cannot be drawn forward after it has been 
retracted. Paraphimosis is a frequent complication 
of venereal diseases. 
Treatment.-When a prepuce naturally so narrow 
that it clips the glans has been accidentally retracted, 
reduction should always be effected without delay. 
When a patient who habitually wears the glans un- 
covered becomes affected by any disease, venereal 
or otherwise, which causes swelling of the glans or pre- 
puce, the treatment must be by rest, cooling lotions, 
and other means calculated to reduce the swelling. 
Only when the constriction is so tight that there is 
danger of sloughing should an attempt at reduction 
be made. To bring forward the foreskin, the penis 
should be grasped by the left forefinger and thumb 
in the form of a ring, while the thumb and fingers 
of the right hand compress the glans till it is small 
enough to allow of the foreskin being brought for- 
ward. If the foreskin has been kept behind the 
glans long enough for the strangulation to be liber- 
ated by ulceration, it is better simply to release any 
tight bands that may remain, and, when the parts 
have healed, to trim away the deformities. 116 
ACCESSORY VENEREAL DISORDERS. 
Rupture of the Fraenum is a common acci- 
dent during intercourse. Hemorrhage is sometimes 
very smart, especially if the meatus be also lacerated. 
The bleeding should be arrested by a ligature or by 
acupressure. 
Rupture of the Erectile Tissue of the Penis 
may be caused by violent intercourse. It also occurs 
sometimes during the chordee and distention accom- 
panying acute urethritis. The amount of blood lost 
in this way may be very great, and cause syncope- 
even death. When the urethra is lacerated, extrava- 
sation of urine is very apt to occur and produce 
abscess or sloughing. Sometimes the urethra is not 
ruptured, and the blood then percolates into the 
erectile tissue without escaping externally. 
The treatment consists in rest in bed, cold to the 
perinaeum and to the swollen part by ice-cold cloths 
round the penis, or by maintaining a continuous 
cold current through Otis's coil or Leiter's tubes. 
Stricture of a troublesome kind is a very frequent 
result of this accident. 
III. AFFECTIONS PECULIAR TO WOMEN. 
Vulvitis is a very common disorder, and may 
arise from a variety of causes. The treatment is 
simple: cleanliness by means of baths, lead lotion 
(F. 20), separation of the parts by placing linen rag 
between them, a saline purge and rest. 
Inflammation of the Vulvo-vaginal (Bar- AFFECTIONS PECULIAR TO WOMEN. 
117 
tholine's) Glands.-The most common cause is 
the extension of gonorrhoeal inflammation from the 
vulva along the duct to the gland. Abscess in these 
glands may be distinguished from abscess of the 
labium by its being limited to the furrow between 
the labia, and by its pointing on the inner side of 
the nympha, or in. the furrow. The treatment con- 
sists in warm fomentations and poultices. If ab- 
scess form, it should be opened as soon as fluctuation 
can be detected. 
Phlegmonous Abscess of the Labium may 
be caused by mechanical injury of any kind. It 
also sometimes follows irritation set up by chancres, 
follicular inflammation, gonorrhoea, or neglect of 
cleanliness. The matter should always be let out 
as soon as possible. 
Chronic Endometritis (chronic uterine catarrh, 
uterine leucorrhcea) may be the result of acute endo- 
metritis caused by extension of inflammation from 
the vagina; but it also often begins in a chronic 
form. The patient complains of pain in the back, 
with a sensation of dragging in the groins and 
weight in the pelvis. Walking or standing increases 
her distress. The most characteristic symptom is 
leucorrhcea, the fluid being tenacious and viscid, like 
white of egg. In venereal leucorrhcea the vagina 
usually secretes some part of the discharge, which 
thus becomes puriform. The cervix is enlarged, 
hard, of a livid red color, and often excoriated 
around the os, which is patulous and plugged with 
the viscid secretion. 118 
Treatment.-The patient should avoid everything 
likely to interfere with the due performance of the 
functions of the body. The diet should be simple 
and non-stimulating, and the bowels should be kept 
freely open by saline purgatives. Bromide of potas- 
sium is very useful if the nervous system be at fault. 
Ip anaemic women iron is most beneficial. The 
local treatment consists, at first, in irrigation of the 
cervix and vagina, for ten or fifteen minutes, two or 
three times a day, with warm water, followed by the 
injection of some astringent solution (F. 17 to 19). 
If these means do not suffice to cure the disease, 
iodine or caustics must be applied to the cervical 
canal. After any such application, the parts must 
be at once cleansed by injecting water through 
the speculum; a plug of cotton-wool, soaked in 
glycerine, should then be applied to the os, and 
withdrawn by the patient in ten or twelve hours, a 
thread having been attached to the wool for that 
purpose. 
Granular Erosion of the Cervix Uteri.- 
Gonorrhoea is a common cause of this affection. 
The erosion in its simplest form consists in denu- 
dation of the epithelium of one or both lips of the 
os tincae. A glairy discharge trickles from the os, 
and very commonly there is also a purulent dis- 
charge from the vagina. If the disorder which pro- 
duced the erosion is not checked, small granulations 
spring up over the denuded surface, and often ex- 
tend along the interior of the cervix. When the 
granulations grow to a large size, they project in 
ACCESSORY VENEREAL DISORDERS. AFFECTIONS PECULIAR TO WOMEN. 
119 
wart-like excrescences around the os, and may block 
up the aperture. They secrete a purulent discharge 
and bleed frequently, especially at the menstrual 
period. 
Treatment.-The most important thing is to re- 
move the congestion of the uterus. With this object, 
sulphate of magnesia, compound decoction of aloes, 
or some other aperient, must be given two or three 
times daily. The general health often needs good 
diet, sea bathing and tonics (F. 30, 31, 46). If the 
patient be syphilitic, mercury or iodide of potassium, 
or both, according to the stage of the disease, should 
be prescribed. Copious injections of warm water 
should be employed two or three times a day, fol- 
lowed by a solution of borax (F. 16). If the cervix 
is much congested, four or five leeches may be ap- 
plied. When irritation has been subdued, an astrin- 
gent injection (F. 17 to 19) may be used, and the 
cervix painted with a solution of nitrate of silver 
(F. 58). If the surface is granular, solid nitrate of 
silver should be rubbed in once or twice a week, 
according to the effect produced. When this fails, 
nitric acid may be carefully applied; but among 
hospital out-patients, the best plan is to apply solid 
nitrate of silver, and then introduce a plug of cotton 
wool, holding a drachm of alum or tannin; this the 
patient wears four days, and during that time syringes 
twice daily with water. After removing the cotton, 
she syringes freely, to clear away the inspissated 
mucus. The process should be repeated once a 
week. FORMULA. 
1. 
The apparatus consists of a lantern, supporting a 
shallow saucer in the centre, surrounded by a deeper 
one; the first receives the drug to be volatilized, the 
second contains water. Beneath these is a spirit- 
lamp. A blanket or cloak is needed to enclose the 
patient, who sits naked on a cane-seated chair, in 
front of which the lantern is placed. The length of 
time necessary for each bath varies with the form 
and quantity of mercury employed. Calomel is most 
frequently used, of which the average dose is 20 to 
30 grains, requiring from 15 to 20 minutes for vola- 
tilization. 
THE MERCURIAL VAPOR BATH. 
GARGLES. 
2. 
Alum io to 15 grs. 
Water 1 oz. 
3- 
Chlorate of Potassium 10 to 15 grs. 
Water 1 oz. 
4- 
Perchloride of Mercury to 1 gr. 
Dilute Hydrochloric Acid .... 3 min. 
Glycerine % dr. 
Water to 1 oz. 
120 FORMULAE. 
121 
The patient must be cautioned as to the poisonous 
nature of this gargle; and when it cannot be used, a 
solution of perchloride (4 to 8 grs. to the oz.) may 
be applied with a brush. 
When an injection is prescribed, the patient should 
always be instructed in the method of using it. The 
syringe should be short and wide, that one hand may 
work it easily. The nozzle, half an inch in length, 
should be bulbous at the extremity. When the in- 
jection is to be used, the patient makes water, to clear 
out the discharge that has collected in the passage. 
He then inserts the nozzle into the canal, pinches 
the glans penis on each side with the thumb and fore- 
finger of the left hand, and slowly depresses the piston. 
It is not necessary to inject more than about two tea- 
spoonfuls at a time, but the fluid shquld be retained 
one or two minutes before it is allowed to escape; if 
it has properly distended the passage, it returns with 
a spirt from the meatus. Injections should be used 
three or four times a day; they should never be 
strong enough to cause severe pain. 
5- 
Sulphate of Zinc 3 grs. 
Extract of Belladonna 5 to io grs. 
Mucilage of Acacia % dr. 
Water to I oz. 
Begin with two parts of water to one of injection, 
and gradually lessen the quantity of water. This is 
a suitable formula to begin with. 
INJECTIONS FOR THE URETHRA. 122 
6. 
Sulphate of Zinc I to 5 grs. 
Water . 1 oz. 
The sulpho-carbolate or acetate of zinc may be 
used in similar proportion. 
Useful for purulent discharges. 
7- 
Permanganate of Zinc U gr- 
Distilled Water 1 oz. 
Useful where there is no scalding. 
8. 
Subacetate of Lead 1 to 5 grs. 
Distilled Water 1 oz. 
May alternate with No. 6. 
The following six formulae are of service in obsti- 
nate gleets: - 
9- 
Nitrate of Silver gr. 
Distilled Water 1 oz. 
10. 
Subnitrate of Bismuth 8 grs. 
Mucilage of Tragacanth U dr. 
Water to 1 oz. 
II. 
Tincture of Perchloride of Iron . . 5 to 10 min. 
Water 1 oz. 
1 2. 
Glycerine of Tannic Acid .... 15 min. to 1 dr. 
Water to 1 oz. 
FORMULAE. FORMULAE. 
123 
13- 
Alum 3 to 8 grs. 
Water 1 oz. 
14. 
Alum 
Sulphate of Zinc 
Sulphate of Iron 
Sulphate of Copper 
of each 1 gr. 
Water 1 oz. 
To be diluted at first with an equal quantity of 
water, and the strength gradually increased. Not to 
be used if the patient be unaccustomed to injections. 
INJECTIONS FOR THE VAGINA. 
15 to *9- 
Subacetate of Lead 
or Borax 
or Alum 
or Sulphate of Zinc 
or Tannic Acid 
40 to 100 grs. 
To be injected twice or thrice daily by means of 
Higginson's syringe or an irrigator. 
Used in vaginitis, erosion of the cervix, chronic 
uterine catarrh, etc. Lead and Borax are suitable 
for the more acute stages. 
Water 20 oz. 
LOTIONS. 
20. 
Solution of Subacetate of Lead . . 5 to 20 min. 
Rectified Spirit 20 to 60 min. 
Distilled Water to 1 oz. 124 
FORMULAE. 
21. 
Carbolic Acid 12 to 20 grs. 
Glycerine 10 min. 
Water 1 oz. 
22. 
Sulphate of Zinc 1 to 3 grs. 
Compound Tincture of Lavender . 5 min. 
Water 1 oz. 
23- 
Calomel 3 grs. 
Lime Water I oz. 
(Black wash.) 
24. 
Perchloride of Mercury 2 grs. 
Lime Water 1 oz. 
(Yellow wash.) Used for indolent sores. 
25- 
Solution of Chlorinated Soda . . . to 1 dr. 
Water to 1 oz. 
26. 
Solution of Permanganate of Potash . 10 to 20 min. 
Water to 1 oz. 
When this, or the preceding solution, is used for 
the nose, it should be mixed with an equal quantity 
of warm water, and common salt, in the proportion 
of a teaspoonful to a pint, may be added. 
27. 
Tartarated Iron 10 to 60 grs. 
Water 1 oz. 125 
FORMULA. 
28. 
Tincture of Cantharides % dr. 
Glycerine U dr. 
Spirit of Rosemary 1 dr. 
Rose Water 1 oz. 
For the scalp in alopecia. 
To be used with a sponge night and morning. 
29. 
Extract of Belladonna 10 grs. 
Distilled Water 1 oz. 
Used in iritis and corneitis. 
MIXTURES. 
3°- 
Sulphate of Quinine i to 2 grs. 
Sulphate of Iron I gr. 
Dilute Sulphuric Acid 4 min. 
Infusion of Quassia to 1 oz. 
To be taken three times a day. *4 to 1 dr. of 
sulphate of magnesia may be added, if necessary. 
31- 
Tincture of Perchloride of Iron . . 15 min. 
Glycerine 20 min. 
Spirit of Chloroform 10 min. 
Water to • . . . 1 oz. 
To be taken three times a day. 
32- 
Carbonate of Ammonium . . . . 5 to 8 grs. 
Tincture of Opium 5 to 10 min. 
Spirit of Chloroform 20 min. 
Decoction of Cinchona to . . . . 1 oz. 126 
FORMULAE. 
To be taken three or four times a day. 
Useful in sloughing sores, etc. 
33- 
Red Iodide of Mercury tk t° % Sr* 
Iodide of Potassium 3 to 5 grs. 
Compound Tincture of Cardamoms . 20 min. 
Water to I oz. 
To be taken twice or thrice daily. 
Useful in relapses of the scaly eruptions. 
34- 
Perchloride of Mercury yV to % gr. 
Solution of Perchloride of Iron . . 15 min. 
Spirit of Chloroform 15 min. 
Water to 1 oz. 
To be taken three times a day. 
A useful mode of giving mercury when there is 
great debility. 
35- 
Iodide of Potassium 2 to toogrs. ormore. 
Aromatic Spirit of Ammonia ... 20 min. 
Water to 1 oz. 
Infusion of quassia, decoction of cinchona, liquid 
extract of sarsaparilla, etc., may be used instead of 
water, according to circumstances. The quantity of 
iodide should be gradually increased about every 
third day, if necessary, and each dose taken in a 
tumblerful of water. Milk is also a very good vehicle 
for the iodides, especially in children. 127 
FORMULAE. 
36- 
Iodide of Potassium ...... io grs. and upward. 
Bromide of Potassium or of Ammo- 
nium 15 grs. and upward. 
Carbonate of Ammonium .... 5 grs. 
Spirit of Chloroform 15 min. 
Water to 1 oz. 
To be taken three or four times a day, in water. 
Used in syphilitic affections of the nervous system. 
37- 
Chlorate of Potassium 10 to 20 grs. 
Dilute Hydrochloric Acid .... 10 min. 
Decoction of Cinchona to . . . . 1 oz. 
To be taken four or five times daily. 
Used in salivation, etc. 
38. 
Tartarated Iron 5 to 20 grs. 
Iodide of Potassium or of Sodium . 5 grs. and upward. 
Spirit of Chloroform 15 min. 
Infusion of Quassia to ■. I oz. 
To be taken three times a day, in water. 
39- 
Perchloride of Mercury tb to % gr- 
Iodide of Potassium 2 or 3 grs. 
Peppermint Water 1 oz. 
To be taken three times a day. 
40. 
Bicarbonate or Citrate of Potassium 15 to 20 grs. 
Nitrate of Potassium 3 to 5 grs. 
Tincture of Henbane to 1 dr. 
Camphor Water to 1 oz. 128 
FORMULAE. 
To be taken every three, four, or six hours, in 
water. For robust patients, to k gr. of tartarated 
antimony may often be added with advantage. 
41. 
Copaiba 20 min. 
Essence of Cinnamon 20 min. 
Mucilage of Gum Acacia . . . . % oz. 
Water to 1 oz. 
To be taken three times a day. 
(Copaiba may also be prescribed, in the form of 
capsules, globules, etc.) 
42. 
Oil of Sandal Wood 10 to 30 min. 
Mucilage of Gum Acacia . . . . ^ oz. 
Cinnamon Water to 1 oz. 
To be taken three times a day. 
OINTMENTS. 
43- 
Calomel 20 to 60 grs. 
Vaseline or Lard . . . 1 oz. 
When absorption of the drug is not desired, vase- 
line is better than lard as a basis for some ointments, 
as it does not turn rancid. 
44. 
Iodoform in fine powder 20 to 60 grs. 
Benzoated Lard 1 oz. 
PASTE. 
45- 
Strongest Sulphuric Acid . . . 
Willow Charcoal 
of each a 
sufficiency. 129 
FORMULAE. 
This is known as the carbo-sulphuric or Ricord's 
paste. 
PILLS. 
46. 
Sulphate of Quinine i gr. 
Dried Sulphate of Iron I gr. 
Dried Carbonate of Soda 2 grs. 
Extract of Rhubarb 1 gr. 
To be taken twice or three times daily. 
47- 
Mercury with Chalk 1 gr. 
Compound Ipecacuanha Powder . 1 or 2 grs. 
Useful when there is inflammation of the stomach 
or bowels. 
48. 
Mercurial Pill 1 gr. 
Extract of Gentian 1 gr. 
To be taken three or four times a day, with meals. 
49- 
Mercurial Pill 3 grs. 
Powdered Opium to gr. 
To be taken three or four times daily. 
5°- 
Green Iodide of Mercury . . . . gr. 
Sugar of Milk a sufficiency. 
To be taken four, five or six times a day. 
51- 
Green Iodide of Mercury . . . . % gr. 
Extract of Opium % gr- 
Extract of Logwood 1 gr. 
Useful when No. 50 purges. 130 
FORMULA. 
52- 
Tannate of Mercury I or 2 grs. 
Extract of Gentian 1 gr. 
To be taken three times a day. 
53- 
Perchloride of Mercury to y£ gr. 
Sugar of Milk a sufficiency. 
To be taken twice or three times a day. 
54- 
Bicyanide of Mercury to *4 gr. 
Sugar of Milk a sufficiency. 
To be taken twice or three times a day. 
55- 
Iodoform to gr. 
Extract of Gentian 1 gr. 
To be taken three or four times daily, with a 
draught of barley water. 
56- 
Camphor 3 or 4 grs. 
Extract of Belladonna % to gr. 
To be taken at bedtime. 
POWDER. 
57- 
Calomel I part. 
Oxide of Zinc 2 parts. FORMULAE. 
131 
SOLUTIONS. 
58. 
Nitrate of Silver 20 grs. 
Distilled Water 1 oz. 
59- 
Borax 30 grs. 
Glycerine 1 dr. 
Water to 1 oz. 
60. 
RAGAZZONl'S SOLUTION FOR HYPODERMIC INJECTION. 
Red Iodide of Mercury 4 grs. 
Distilled Water to 256 min. 
Iodide of Sodium sufficient to dissolve the 
iodide of Mercury. 
Dose-10 minims. 
61. 
Sulphate of Atropia 4 grs. 
Distilled Water 1 oz. 
62. 
Sulphate of Atropia 1 gr. 
Distilled Water 1 oz. 
One grain of Sulphate of Zinc may be added if 
conjunctivitis be present. 
63- 
Iodoform . 80 grs. 
Ether 1 oz. 132 
FORMULAE. 
SUPPOSITORIES. 
64. 
The Mercurial Suppository (B. P.), containing 5 
grains of Ointment of Mercury. 
$5* 
Hydrochlorate of Morphine . . . U to gr. 
Oil of Theobroma 10 grs. 
The addition of to gr. of extract of bella- 
donna is often beneficial. 
66. 
Ointment of Mercury ...... 10 grs. 
Oil of Theobroma 1 dr. 
Form into a suitable shape for introduction into 
the vagina. 
67. 
Iodoform 5 grs. 
Oil of Theobroma 10 grs. CATALOGUE No. 7. SEPTEMBER, 1890. 
A CATALOGUE 
OF 
Books for Students. 
INCLUDING THE 
? QUIZ-COMPENDS ? 
CONTENTS. 
PAGE PAGE 
New Series of Manuals, 2,3,4,5 Obstetrics 10 
Anatomy, . . . . 6 Pathology, Histology,. . 11 
Biology, . . . „. 11 Pharmacy 12 
Chemistry, . . . . 6 Physiology, . . . .11 
Children's Diseases, . . 7 Practice of Medicine, . . 12 
Dentistry, . . . ,8 Prescription Books, . . 12 
Dictionaries, . . .8 ? Quiz-Compends ? . 14,15 
Eye Diseases, . ... 8 Skin Diseases, . . .12 
Electricity, . ... 9 Surgery, . . . .13 
Gynaecology, . . .10 Therapeutics, . . .9 
Hygiene, .... 9 Urine and Urinary Organs, 13 
Materia Medica, . . . 9 Venereal Diseases, . . 13, 
Medical Jurisprudence, . 10 
PUBLISHED BY 
P. BLAK1ST0N, SON & CO., 
Medical Booksellers, Importers and Publishers. 
LARGE STOCK OF ALL STUDENTS' BOOKS, AT ' 
THE LOWEST PRICES. 
1012 Walnut Street, Philadelphia. 
*** For sale by all Booksellers, or any book will be sent by mail, 
postpaid, upon receipt of price. Catalogues of books on all branches 
of Medicine, Dentistry, Pharmacy, etc., suppliej^ppoh application. 
Gould's New Medical Dictionary Just Ready. See page 16. ■" An excellent Series of Manuals."-Archives of Gynecology. 
A NEW SERIES OF 
STUDENTS' MANUALS 
On the various Branches of Medicine and Surgery. 
Can be used by Students of any College. 
Price of each, Handsome Cloth, $3.00. Full Leather, $3.50. 
The object of this series is to furnish good manuals 
for the medical student, that will strike the medium 
between the compend on one hand and the prolix text- 
book on the other-to contain all that is necessary for 
the student, without embarrassing him with a flood of 
theory and involved statements. They have been pre- 
pared by well-known men, who have had large experience 
as teachers and writers, and who are, therefore, well 
informed as to the needs of the student. 
Their mechanical execution is of the best-good type 
and paper, handsomely illustrated whenever illustrations 
are of use, and strongly bound in uniform style. 
Each book is sold separately at a remarkably low 
price, and the immediate success of several of the 
volumes shows that the series has met with popular 
favor. 
No. 1. SURGERY. 236 Illustrations. 
A Manual of the Practice of Surgery. By Wm. J. 
Walsham, m.d., Asst. Surg. to, and Demonstrator of 
Surg. in, St. Bartholomew's Hospital, London, etc. 
228 Illustrations. 
Presents the introductory facts in Surgery in clear, precise 
language, and contains all the latest advances in Pathology, 
Antiseptics, etc. 
" It aims to occupy a position midway between the pretentious 
manual and the cumbersome System of Surgery, and its general 
character may be summed up in one word-practical."-The Medi- 
cal Bulletin. 
" Walsham, besides being an excellent surgeon, is a teacher in 
its best sense, and having had very great experience in the 
preparation of candidates for examination, and their subsequent 
professional career, may be relied upon to have carried out his 
work successfully. Without following out in detail his arrange- 
ment, which is excellent, we can at once say that his book is an 
embodiment of modern ideas neatly strung together, with an amount 
of careful organization well suited to the candidate, and, indeed, to 
the practitioner."-British Medical Journal. 
Price of each Book, Cloth, $3.00; Leather, $3.60. THE NEW SERIES OF MANUALS. 
No. 2. DISEASES OF WOMEN. 150 Ulus. 
NEW EDITION. 
The Diseases of Women. Including Diseases of the 
Bladder and Urethra. By Dr. F. Winckel, Professor 
of Gynascology and Director of the Royal University 
Clinic for Women, in Munich. Second Edition. Re- 
vised and Edited by Theophilus Parvin, M.D., 
Professor of Obstetrics and Diseases of Women and 
Children in Jefferson Medical College. 150 Engrav- 
ings, most of which are original. 
" The book will be a valuable one to physicians, and a safe and 
satisfactory one to put into the hands of students. It is issued in a 
neat and attractive form, and at a very reasonable price."-Boston 
Medical and Surgical Journal. 
No. 3. OBSTETRICS. 227 Illustrations. 
A Manual of Midwifery. By Alfred Lewis Galabin, 
m.A., m.d., Obstetric Physician and Lecturer on Mid- 
wifery and the Diseases of Women at Guy's Hospital, 
London; Examiner in Midwifery to the Conjoint 
Examining Board of England, etc. With 227 Ulus. 
" This manual is one we can strongly recommend to all who 
desire to study the science as well as the practice of midwifery. 
Students at the present time not only are expected to know the 
principles of diagnosis, and the treatment of the various emergen- 
cies and complications that occur in the practice of midwifery, but 
find that the tendency is for examiners to ask more questions 
relating to the science of the subject than was the custom a few 
years ago. * * * The general standard of the manual is high; 
and wherever the science and practice of midwifery are well taught 
it will be regarded as one of the most important text-books on the 
subject."-London Practitioner. 
No. 4. PHYSIOLOGY. Fourth Edition. 
321 ILLUSTRATIONS AND A GLOSSARY. 
A Manual of Physiology. By Gerald F. Yeo, m.d., 
f.r.c.s., Professor of Physiology in King's College, 
London. 321 Illustrations and a Glossary of Terms. 
Fourth American from second English Edition, revised 
and improved. 758 pages. 
This volume was specially prepared to furnish students with a 
new text-book of Physiology, elementary so far as to avoid theories 
which have not borne the test of time and such details of methods 
as are unnecessary for students in our medical colleges. 
"The brief examination I have given it was so favorable that I 
placed it in the list of text-books recommended in the circular of the 
University Medical College."-Prof. Lewis A. Stimson, m.d., 
3^ East 33d Street, New York. 
Price of each Book, Cloth, $3.00; Leather, $3.50. 
3 4 
THE NEW SERIES OF MANUALS. 
No. 5. ORGANIC CHEMISTRY. 
Or the Chemistry of the Carbon Compounds. By Prof. 
Victor von Richter, University of Breslau. Au- 
thorized translation, from the Fourth German Edition. 
By Edgar F. Smith, m.a., ph.d. ; Prof, of Chemistry 
in University of Pennsylvania; Member of the Chem. 
Socs. of Berlin and Paris. 
" I must say that this standard treatise is here presented in a 
remarkably compendious shape."-J. W. Holland, m.d., Professor 
of Chemistry, Jefferson Medical College, Philadelphia. 
" This work brings the whole matter, in simple, plain language, 
to the student in a clear, comprehensive manner. The whole 
method of the work is one that is more readily grasped than that of 
older and more famed text-books, and we look forward to the time 
when, to a great extent, this work will supersede others, on the 
score of its better adaptation to the wants of both teacher and 
student."-Pharmaceutical Record. 
" Prof, von Richter's work has the merit of being singularly 
clear, well arranged, and for its bulk, comprehensive. Hence, it 
will, as we find it intimated in the preface, prove useful not merely 
as a text-book, but as a manual of reference."-The Chemical 
News, London. 
No. 6. DISEASES OF CHILDREN. 
SECOND EDITION. 
A Manual. By J. F. Goodhart, m.d., Phys, to the 
Evelina Hospital for Children; Asst. Phys, ter 
Guy's Hospital, London. Second American Edition. 
Edited and Rearranged by Louis Starr, m.d., Clinical 
Prof, of Dis. of Children in the Hospital of the Univ, 
of Pennsylvania, and Physician to the Children's Hos- 
pital, Phila. Containing many new Prescriptions, a list 
of over 50 Formulae, conforming to the U. S. Pharma- 
copoeia, and Directions for making Artificial Human 
Milk, for the Artificial Digestion of Milk, etc. Ulus. 
" The author has avoided the not uncommon error of writing a 
book on general medicine and labeling it ' Diseases of Children,' 
but has steadily kept in view the diseases which seemed to be 
incidental to childhood, or such points in disease as appear to be so 
peculiar to or pronounced in children as to justify insistence upon 
them. * * * A safe and reliable guide, and in many ways 
admirably adapted to the wants of the student and practitioner."- 
American Journal of Medical Science. 
Price of each Book, Cloth, $3.00 : Leather, $3.50. THE NEW SERIES OF MANUALS. 
No. 6. Goodhart and Starr :-Continued. 
" Thoroughly individual, original and earnest, the work evi- 
dently of a close observer and an independent thinker, this book, 
though small, as a handbook or compendium is by no means made 
up of bare outlines or standard facts."- The Therapeutic Ga- 
zette. 
" As it is said of some men, so it might be said of some books, 
that they are ' born to greatness.' This new volume has, we 
believe, a mission, particularly in the hands of the younger 
members of the profession. In these days of prolixity in medical 
literature, it is refreshing to meet with an author who knows both 
what to say and when he has said it. The work of Dr. Goodhart 
(admirably conformed, by Dr. Starr, to meet American require- 
ments) is the nearest approach to clinical teaching without the 
actual presence of clinical material that we have yet seen."-New 
York Medical Record. 
No. 7. PRACTICAL THERAPEUTICS. 
FOURTH EDITION, WITH AN INDEX OF DISEASES. 
Practical Therapeutics, considered with reference to 
Articles of the Materia Medica. Containing, also, an 
Index of Diseases, with a list of the Medicines 
applicable as Remedies. By Edward John Waring, 
m.d., f.r.c.p. Fourth Edition. Rewritten and Re- 
vised by Dudley W. Buxton, m.d., Asst, to the Prof, 
of Medicine at University College Hospital. 
" We wish a copy could be put in the hands of every Student or 
Practitioner in the country. In our estimation, it is the best book 
of the kind ever written."-N. Y. Medical Journal. 
No. 8. MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 
NEW, REVISED AND ENLARGED EDITION. 
By John J. Reese, M.D., Professor of Medical Jurispru- 
dence and Toxicology in the University of Pennsyl- 
vania ; President of the Medical Jurisprudence Society 
of Phila.; 2d Edition, Revised and Enlarged. 
" This admirable text-book."-Amer. Jour, of Med. Sciences. 
" We lay this volume aside, after a careful perusal of its pages, 
with the profound impression that it should be in the hands of every 
doctor and lawyer. It fully meets the wants of all students 
He has succeeded in admirably condensing into a handy volume all 
the essential points."-Cincinnati Lancet and Clinic. 
Price of each Book, Cloth, $3,00; Leather, $3.50. 
5 6 
STUDENTS' TEXT-BOOKS AND MANUALS. 
ANATOMY. 
Macalister's Human Anatomy. 816 Illustrations. A new 
Text-book for Students and Practitioners, Systematic and Topo- 
graphical, including the Embryology, Histology and Morphology 
of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 
Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations, 
izmo. Cloth, 1.00; Interleaved for notes, 1.25 
Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. Cloth, 5.00; Leather, 6.00 
Bound in Oilcloth, for the Dissecting Room, $4.50. 
"No student of Anatomy can take up this book without being 
pleased and instructed. Its Diagrams are original, striking and 
suggestive, giving more at a glance than pages of text description. 
* * * The text matches the illustrations in directness of prac- 
tical application and clearness of detail."-New York Medical 
Record. 
Holden's Human Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the 
Muscles. The General and Microscopical Structure of Bone and 
its Development. With Lithographic Plates and Numerous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 
Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 
Heath's Practical Anatomy. Sixth London Edition. 24 Col- 
ored Plates, and nearly 300 other Illustrations. Cloth, 5.00 
Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. 
Cloth, 1.00; Interleaved for Notes, 1.25 
CHEMISTRY. 
Bartley's Medical Chemistry. Second Edition. A text-book 
prepared specially for Medical, Pharmaceutical and Dental Stu- 
dents. With 50 Illustrations, Plate of Absorption Spectra and 
Glossary ofChemicalTerms. Revised and Enlarged. Cloth, 2.50 
Trimble. Practical and Analytical Chemistry. A Course in 
Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- 
istry in the Phila. College of Pharmacy. Illustrated. Third 
Edition. 8vo. Cloth, 1.50 
HSf See pages 2 to 5 for list of Students' Manuals. STUDENTS' TEXT-BOOKS AND MANUALS. 
Chemistry :-Continued. 
Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
Seventh Edition. Enlarged and Rewritten. 330 Illustrations. 
Cloth, 4.50; Leather, 5.50 
Richter's Inorganic Chemistry. A text-book for Students. 
Third American, from Fifth German Edition. Translated by 
Prof. Edgar F. Smith, ph.d. 89 Wood Engravings and Colored 
Plate of Spectra. Cloth, 2.00 
Richter's Organic Chemistry, or Chemistry of the Carbon 
Compounds. Illustrated. Cloth, 3.00; Leather, 3.50 
Symonds. Manual of Chemistry, for the special use of Medi- 
cal Students. By Brandreth Symonds, a.m., m.d.. Asst. 
Physician Roosevelt Hospital, Out-Patient Department; Attend- 
ing Physician Northwestern Dispensary, New York. I2mo. 
Cloth, 2.00; Interleaved for Notes, 2.40 
Tidy. Modern Chemistry. 2d Ed. Cloth, 5.50 
Leffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition. Revised. 
Cloth, x.oo; Interleaved for Notes, r.25 
Leffmann and Beam. Progressive Exercises in Practical 
Chemistry. i2mo. Illustrated. Cloth, 1.00 
Muter. Practical and Analytical Chemistry. Second Edi- 
tion. Revised and Illustrated. Cloth, 2.00 
Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. 3d 
Edition, Enlarged. Illustrated. Cloth, 1.00 
Van Niiys. Urine Analysis. Ulus. Cloth, 2.00 
Wolff's Applied Medical Chemistry. By Lawrence Wolff, 
m.d., Dem. of Chemistry in Jefferson Medical College. Clo., 1.00 
CHILDREN. 
Goodhart and Starr. The Diseases of Children. Second 
Edition. By J. F. Goodhart, m.d., Physician to the Evelina 
Hospital for Children; Assistant Physician to Guy's Hospital, 
London. Revised and Edited by Louis Starr, m.d., Clinical 
Professor of Diseases of-Children in the Hospital of the Univer- 
sity of Pennsylvania; Physician to the Children's Hospital, 
Philadelphia. Containing many Prescriptions and Formulae, 
conforming to the U. S. Pharmacopoeia, Directions for making 
Artificial Human Milk, for the Artificial Digestion of Milk, etc. 
Illustrated. Cloth, 3.00; Leather, 3.50 
Hatfield. Diseases of Children. By M. P. Hatfield, m.d., 
Professor of Diseases of Children, Chicago Medical College, 
izmo. Cloth, 1.00; Interleaved, 1.25 
Day. On Children. A Practical and Systematic Treatise. 
Second Edition. 8vo. 752 pages. Cloth, 3.00; Leather, 4.00 
4®* See pages 14 and 15 for list of ? Quiz-Compends ? 
7 8 
STUDENTS' TEXT-BOOKS AND MANUALS. 
Children:- Continued. 
Meigs and Pepper. The Diseases of Children. Seventh 
Edition. 8vo. Cloth, 5.00; Leather, 6.00 
Starr. Diseases of the Digestive Organs in Infancy and 
Childhood. With chapters on the Investigation of Disease, 
and on the General Management of Children. By Louis Starr, 
m.d., Clinical Professor of Diseases of Children in the Univer- 
sity of Pennsylvania. Illus. Cloth, 2.50 
DENTISTRY. 
Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 
Flagg's Plastics and Plastic Filling. 3d Ed. Preparing. 
Gorgas. Dental Medicine. A Manual of Materia Medica and 
Therapeutics. Third Edition. Cloth, 3.50 
Harris. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery 
and Mechanism. Twelfth Edition. Revised and enlarged by 
Professor Gorgas. 1028 Illustrations. Cloth, 7.00; Leather, 8.00 
Richardson's Mechanical Dentistry. Fifth Edition. 569 
Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 
SewilL Dental Surgery. 200 Illustrations. Third Edition. 
Stocken's Dental Materia Medica. Third Edition. Cloth, 2.50 
Taft's Operative Dentistry. Dental Students and Practitioners. 
Fourth Edition. 100 Illustrations. Cloth, 4.25 ; Leather, 5.00 
Talbot. Irregularities of the Teeth, and their Treatment. 
Illustrated. 8vo. Second Edition. Cloth, 3.00 
Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. Revised. 292 Ulus. 
772 Pages. Cloth, 5.00 
Warren. Compend of Dental Pathology and Dental Medi- 
cine. Illustrated. Cloth, 1.00; Interleaved, 1.25 
DICTIONARIES. 
Gould's New Medical Dictionary. Containing the Definition 
and Pronunciation of all words in Medicine, with many useful 
Tables etc. % Dark Leather, 3.25 ; Mor., Thumb Index 4.25 
Cleaveland's Pocket Medical Lexicon. 31st Edition. Giving 
correct Pronunciation and Definition. Very small pocket size. 
Cloth, red edges .75 ; pocket-book style, 1.00 
Longley's Pocket Dictionary. The Student's Medical Lexicon, 
giving Definition and Pronunciation of all Terms used in Medi- 
cine, with an Appendix giving Poisons and Their Antidotes, 
Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 
24mo. Cloth, x.oo; pocket-book style, 1.25 
See pages a to 5 for list of Students' Manuals. STUDENTS' TEXT-BOOKS AND MANUALS. 
EYE. 
Arlt. Diseases of the Eye. Including those of the Conjunc- 
tiva, Cornea, Sclerotic, Iris and Ciliary Body. By Prof. Von 
Arlt. Translated by Dr. Lyman Ware. Ulus. 8vo. Cloth, 2.50 
Hartridge on Refraction. 4th Ed. Cloth, 2.00 
Meyer. Diseases of the Eye. A complete Manual for Stu- 
dents and Physicians. 270 Illustrations and two Colored Plates. 
8vo. Cloth, 4.50; Leather, 5.50 
Fox and Gould. Compend of Diseases of the Eye and 
Refraction. 2d Ed. Enlarged. 71 Ulus. 39 Formulae. 
Cloth, 1.00; Interleaved for Notes, x.25 
ELECTRICITY. 
Mason's Compend of Medical and Surgical Electricity. 
With numerous Illustrations. i2mo. Cloth, 1.00 
HYGIENE. 
Parkes' (Ed. A.) Practical Hygiene. Seventh Edition, en- 
larged. Illustrated. 8vo. Cloth, 4.50 
Parkes' (L. C.) Manual of Hygiene and Public Health. 
i2mo. Cloth, 2.50 
Wilson's Handbook of Hygiene and Sanitary Science. 
Sixth Edition. Revised and Illustrated. Cloth, 2.75 
MATERIA MEDICA AND THERAPEUTICS. 
Potter's Compend of Materia Medica, Therapeutics and 
Prescription Writing. Fifth Edition, revised and improved. 
Cloth, 1.00; Interleaved for Notes, 1.25 
Biddle's Materia Medica. Eleventh Edition. By the late 
John B. Biddle, m.d., Professor of Materia Medica in Jefferson 
Medical College, Philadelphia. Revised, and rewritten, by 
Clement Biddle, m.d., Assist. Surgeon, U. S. N., assisted by 
Henry Morris, m.d. 8vo., illustrated. Cloth, 4.25; Leather, 5.00 
Headland's Action of Medicines. 9th Ed. 8vo. Cloth, 3.00 
Potter. Materia Medica, Pharmacy and Therapeutics. 
Including Action of Medicines, Special Therapeutics, Pharma- 
cology, etc. Second Edition. Cloth, 4.00; Leather, 5,00 
Starr, Walker and Powell. Synopsis of Physiological 
Action of Medicines,based upon Prof. H. C. Wood's " Materia 
Medica and Therapeutics." 3d Ed. Enlarged. Cloth, .75 
Waring. Therapeutics. With an Index of Diseases and 
Remedies. 4th Edition. Revised. Cloth, 3.00; Leather, 3.50 
See pages 14 and 15 for list of ? Quiz-Comp ends ? 
9 10 
STUDENTS' TEXT-BOOKS AND MANUALS. 
MEDICAL JURISPRUDENCE. 
Reese. A Text-book of Medical Jurisprudence and Toxi- 
cology. By John J. Reese, m.d., Professor of Medical Juris- 
prudence and Toxicology in the Medical Department of the 
University of Pennsylvania; President of the Medical Juris- 
prudence Society of Philadelphia; Physician to St. Joseph's 
Hospital; Corresponding Member of The New York Medico- 
legal Society. 2d Edition. Cloth, 3.00; Leather, 3.50 
Woodman and Tidy's Medical Jurisprudence and Toxi- 
cology. Chromo-Lithographic Plates and 1x6 Wood engravings. 
Cloth, 7.50; Leather, 8.50 
OBSTETRICS AND GYNAECOLOGY. 
Byford. Diseases of Women. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to 
Women. By W. H. Byford, a.m., m.d., Professor of Gynaecology 
in Rush Medical College and of Obstetrics in the Woman's Med- 
ical College, etc., and Henry T. Byford, m.d., Surgeon to the 
Woman's Hospital of Chicago ; Gynaecologist to St. Luke's 
Hospital, etc. Fourth Edition. Revised, Rewritten and En- 
larged. With 306 Illustrations, over xoo of which are original. 
Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 
Cazeaux and Tarnier's Midwifery. With Appendix, by 
Munde. The Theory and Practice of Obstetrics ; including the 
Diseases of Pregnancy and Parturition, Obstetrical Operations, 
etc. By P. Cazeaux. Remodeled and rearranged, with revi- 
sions and additions, by S. Tarnier, m.d., Professor of Obstetrics 
and Diseases of Women and Children in the Faculty of Medicine 
of Paris. Eighth American, from the Eighth French and First 
Italian Edition. Edited by Robert J. Hess, m.d., Physician to 
the Northern Dispensary, Philadelphia, with an appendix by 
Paul F. Munde, m.d., Professor of Gynaecology at the N. Y. 
Polyclinic. Illustrated by Chromo-Lithographs, Lithographs, 
and other Full-page Plates, seven of which are beautifully colored, 
and numerous Wood Engravings. Students' Edition. One 
Vol., 8vo. Cloth, 5.00; Leather, 6.00 
Lewers' Diseases of Women. A Practical Text-Book. 139 
Illustrations. Second Edition. Cloth, 2.50 
Parvin's Winckel's Diseases of Women. Second Edition. 
Including a Section on Diseases of the Bladder and Urethra. 
150 Illustrations. Revised. See page 3. 
Cloth, 3.00 ; Leather, 3.50 
Morris. Compend of Gynaecology. Illustrated. In Press. 
Winckel's Obstetrics. A Text-book on Midwifery, includ- 
ing the Diseases of Childbed. By Dr. F. Winckel, Professor 
of Gynaecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J. Clifton 
Edgar, m.d., Lecturer on Obstetrics, University Medical Col- 
lege, New York, with nearly 200 handsome illustrations, the 
majority of which are original with this work. Octavo. 
Cloth, 6.00 ; Leather, 7.00 
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Galabin's Midwifery. By A. Lewis Galabin, m.d., h.r.c.f. 
227 Illustrations. See page 3. Cloth, 3.00; Leather, 3.50 
Glisan's Modern Midwifery. 2d Edition. Cloth, 3.00 
Rigby's Obstetric Memoranda. 4th Edition. Cloth, .50 
Meadows' Manual of Midwifery. Including the Signs and 
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Swayne's Obstetric Aphorisms. For the use of Students 
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PATHOLOGY. HISTOLOGY. BIOLOGY. 
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Students. 135 Illustrations. 12010. Cloth, 2.00 
Davis' Elementary Biology. Illustrated. Cloth, 4.00 
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PHYSIOLOGY. 
Yeo's Physiology. Fourth Edition. The most Popular Stu- 
dents' Book. By Gerald F. Yeo, m.d., f.r.c.s., Professor of 
Physiology in King's College, London. Small Octavo. 758 
pages. 321 carefully printed Illustrations. With a Full 
Glossary and Index. See Page 3. Cloth, 3.00; Leather, 3.50 
Brubaker's Compend of Physiology. Illustrated. Fifth 
Edition. Cloth, 1.00; Interleaved for Notes, x.25 
Stirling. Practical Physiology, including Chemical and Ex- 
perimental Physiology. 142 Illustrations. Cloth, 2.25 
Kirke's Physiology. New 12th Ed. Thoroughly Revised and 
Enlarged. 502 Illustrations. Cloth, 4.00; Leather, 5.00 
Landois' Human Physiology. Including Histology and Micro- 
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cine. Third Edition. Translated and Edited by Prof. Stirling. 
692 Illustrations. Cloth, 6.50; Leather, 7.50 
" With this Text-book at his command, no student could fail in 
his examination."-Lancet. 
Sanderson's Physiological Laboratory. Being Practical Ex- 
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Tyson's Cell Doctrine. Its History and Present State. Illus- 
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11 12 
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PRACTICE. 
Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
Hospital, London; Physician to Evelina Hospital for Sick Chil- 
dren, and Examiner in Materia Medica and Pharmaceutical 
Chemistry, University of London. Cloth, 4.00 
Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d. ; m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50 ; Sheep, 6.50 
Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 
Part x.-Continued, Eruptive and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc., and General Diseases, etc. 
Part ix.--Diseases of the Respiratory System, Circulatory 
System and Nervous System; Diseases of the Blood, etc. 
Physician's Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index, x vol. Full Morocco, Gilt, 2.50 
Tanner's Index of Diseases, and Their Treatment. Cloth, 3.00 
PRESCRIPTION BOOKS. 
Wythe's Dose and Symptom Book. Containing the Doses 
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Seventeenth Edition. Completely Revised and Rewritten. Just 
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Pereira's Physician's Prescription Book. Containing Lists 
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PHARMACY. 
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Text-Book of Pharmacy. Second Edition, Revised. 
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SKIN DISEASES. 
Anderson, (McCall) Skin Diseases. A complete Text-Book, 
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Just Ready. Cloth, 4.50 ; Leather, 5.50 
Van Harlingen on Skin Diseases. A Handbook of the Dis- 
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betically). By Arthur Van Harlingen, m.d., Clinical Lecturer 
on Dermatology, Jefferson Medical College; Prof, of Diseases of 
the Skin in the Philadelphia Polyclinic. 2d Edition. Enlarged. 
With colored and other plates and illustrations. i2mo. Cloth, 2.50 
Bulkley. The Skin in Health and Disease. By L. Duncan 
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SURGERY. 
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geons Royal Infirmary. With over 200 Illustrations. 400 pages. 
Pocket size. Leather covers, 2.50 
Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students and Hospital Surgeons. By W. H. A. 
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pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 
Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
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Horwitz's Compend of Surgery, Minor Surgery and 
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Walsham. Manual of Practical Surgery. For Students and 
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URINE, URINARY ORGANS, ETC. 
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Thompson. Diseases of the Urinary Organs. Eighth 
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13 NEW AND REVISED EDITIONS. 
?QUIZ-COMPENDS? 
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They form a most complete, practical and exhaustive 
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Cloth, each $1.00. Interleaved for Notes, $1.25. 
No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New 
Tables and 117 other Illustrations. By Samuel O. L. 
Potter, m.a., m.d., late A. A. Surgeon U. S. Army. Professor 
of Practice, Cooper Medical College, San Francisco. 
Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 
Part I.-Continued, Eruptive and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 
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These little books can be regarded as a full set of notes upon 
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No. 4. PHYSIOLOGY, including Embryology. Fifth 
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Penn'a College of Dental Surgery ; Demonstrator of Physiology 
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and Illustrated. 
No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
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Women, in Starling Medical College, Columbus, O. Revised 
Edition. New Illustrations. BLAKISTON'S ? QUIZ-COMPENDS ? 
No. 6. MATERIA MEDICA, THERAPEUTICS AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 
With especial Reference to the Physiological Action of Drugs, 
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Last Revision of the U. S. Pharmacopoeia, and including many 
unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., 
late A. A. Surg. U. S. Army; Prof, of Practice, Cooper Medical 
College, San Francisco. Improved and Enlarged, with Index. 
No. 7. GYNAECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson 
Medical College, Philadelphia. 
No. 8. DISEASES OF THE EYE AND REFRACTION, 
including Treatment and Surgery. By L. Wbbs'ter Fox, m.d., 
Chief Clinical Assistant Ophthalmological Dept., Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulse. Second Enlarged and Improved Edition. Index. 
No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
Dislocations, Sprains, Amputations and other operations ; Inflam- 
mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College. Revised 
and Enlarged. 84 Formulae and 136 Illustrations. 
No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in 
Penn'a College of Dental Surgery, Phila. Third Edition, Revised 
and Rewritten, with Index. 
No. 11. PHARMACY. Based upon " Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph.g., Quiz-Master 
at Philadelphia College of Pharmacy. Second Edition, Revised. 
No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R. Ballou, m.d., Prof, of 
Equine Anatomy at N. Y. College of Veterinary Surgeons. 
No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. By Geo. W. Warren, d.d.s., Clinical 
Chief, Penn'a College of Dental Surgery, Philadelphia. Ulus. 
No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Illustrated. 
Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 
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Descriptive Circular Free. NOW READY. 
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SEND FOR SPECIAL CIRCULAR. A UNIQUE BOOK. 
POTTER'S MATERIA MEDICA, PHARMACY AND THERA- 
PEUTICS. Second Edition. Revised and Enlarged. A Hand- 
book; including the Physiological Action of Drugs, Special Therapeutics 
of Diseases, Official and Extemporaneous Pharmacy, etc. By S. O. L. 
Potter, m.a., m.d., Professor of the Practice of Medicine in Cooper 
Medical College, San Francisco; Late A. A. Surgeon, U. S. Army, etc. 
A new Edition in larger type. Octavo. Cloth, $4.00; Leather, $5.00. 
Dr. Potter has become well known as an able compiler, by his Compends 
of Anatomy, and of Materia Medica, both of which have reached four editions. 
In this book, more elaborate in its design, he has shown his literary abilities to 
much better advantage, and all who examine or use it will agree that he has 
produced a work containing more correct information in a practical, concise 
form than any other publication of the kind. The plan of the work is new, 
and its contents have been combined and arranged in such a way that it offers 
a compact statement of the subject in hand. 
Part I.-Materia Medica and Therapeutics, the drugs being arranged 
in alphabetical order, with the synonym of each first; then the description of 
the plant, its preparations, physiological action, and lastly its Therapeutics. 
This part is preceded by a section on the classification of medicines as follows: 
Agents acting on the Nervous System, Organs of Sense, Respiration, Circu- 
lation, Digestive System, on Metabolism (including Restoratives, Alteratives, 
Astringents, Antipyretics, Antiphlogistics and Antiperiodics, etc.). Agents act- 
ing upon Excretion, the Generative System, the Cutaneous Surfaces, Microbes 
and Ferments, and upon each other. 
Part II.-Pharmacy and Prescription Writing. Written for the use 
of physicians who put up their own prescriptions. It includes-Weights and 
Measures, English and the Metric Systems. Specific Gravity and Volume. 
Prescriptions.-Their principles and combinations; proper methods of writing 
them; abbreviations used, etc. Stock solutions and preparations, such as a 
doctor should have to compound his own prescriptions. Incompatibility, 
Pharmaceutical and Therapeutical. Liquid, Solid and Gaseous Extempo- 
raneous Prescriptions. 
Part III.-Special Therapeutics, an alphabetical List of Diseases-a 
real Index of Diseases-giving the drugs that have been found serviceable 
in each disease, and the authority recommending the use of each; a very im- 
portant feature, as it gives an authoritative character to the book that is unusual 
in works on Therapeutics, and displays an immense amount of research on the 
part of the author. 600 prescriptions are given in this part, many being over 
the names of eminent men. 
The Appendix contains lists of Latin words, phrases and abbreviations, with 
their English equivalents, used in medicine, Genitive Case Endings, etc. 36 
Formulae for Hypodermic Injections; a comparison of 10 Formulae of Chloro- 
dyne; Formulae of prominent patent medicines; Poisonsand their Antidotes; 
Differential Diagnosis; Notes on Temperature in Disease; Obstetrical Memo- 
randa; Clinical Examination of Urine; Medical Ethics; Table of Specific 
Gravities and Volumes; Table showing the number of drops in a fluidrachm 
of various liquids and the weight of one fluidrachm in grains, and a table for 
converting apothecaries' weights and measures into grams. 
A MINE OF WEALTH FOR THE STUDENT. Standard Text-Books. 
LANDOIS' HUMAN PHYSIOLOGY. A Text-Book of Human Physi- 
ology, including Histology and Microscopical Anatomy, with special 
reference to the requirements of Practical Medicine. By Dr. L. 
Landois, Professor of Physiology and Director of the Physiological Insti- 
tute, University of Greifswald. Translated from the Fifth German Edition, 
with additions by Wm. Stirling, m.d., Sc.d., Brackenburg, Professor of 
Physiology and Histology in Owen's College and Victoria University, Man- 
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ford, England. Third Edition, revised and enlarged. 692 Illustrations. 
One Volume. Royal Octavo. Cloth, $6.50; Leather, $7.50. 
" With this Text-book at command, no Student could fail in his examination.''- 
7 zu Lancet. 
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" Unquestionably the most admirable exposition of the relations of Human Physiology to 
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" Landois' Physiology is, without question, the best text-book on the subject that has ever 
been written,''-Nezu York Medical Record. 
CAZEAUX AND TARNIER'S MIDWIFERY. Eighth Revised 
and Enlarged Edition. With Appendix, by Munde. The Theory 
and Practice of Obstetrics; including the Diseases of Pregnancy and 
Parturition, Obstetrical Operations, etc. By P. Cazeaux, Member of 
the Imperial Academy of Medicine. Remodeled and rearranged, with 
revisions and additions, by S. Tarnier, m.d., Prof, of Obstetrics and 
Diseases of Women and Children in the Faculty of Medicine of Paris. 
Eighth American, from the Eighth French and First Italian Editions. 
Edited and Enlarged by Robert J. Hess, m.d., Physician to the Northern 
Dispensary, Phila., etc., with an Appendix by Paul F. MuNDfc, M.D., 
Professor of Gynaecology at the New York Polyclinic, Vice-President 
American Gynaecological Society, etc. With Chromo-Lithographs, Litho- 
graphs, and other Full-page Plates, seven of which are beautifully colored, 
and numerous Wood Engravings. One Volume, octavo. 
Cloth, $5.00; Full Leather, $6.oo. 
MEYER ON DISEASES OF THE EYE. A Manual of Ophthal- 
mology. By Dr. Edouard Meyer, Prof, ft 1'flcole Pratique de la Faculty 
Medecine de Paris; Chevalier of the Legion of Honor, etc. Translated 
from the Third French Edition, with the assistance of the author, by Dr. 
Freeland Fergus, Assistant Surgeon, Glasgow Eye Infirmary. With 267 
Illustrations and three Colored Plates. Prepared under the direction of Dr. 
R. Liebreich. 8vo. Cloth, $4.50; Leather, $5.50. 
The first chapter is an explanation of the best means for examining the eyes, 
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ease is then taken up in its proper order; the anatomy of the part being pre- 
sented first, followed by the diagnosis, causes, progress, prognosis, etiology and 
Jreatment. The arrangement of the work will thus be seen to be systematic, 
commending itself to all physicians and students for the logical and concise 
way in which the facts are given. This English edition makes the eighth 
language into which Meyer's book has been translated. 
P. BLAKISTON, SON & CO., Publishers and Booksellers, 
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HOLDEN'S ANATOMY. A Manual of the Dissections of the Human 
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and Enlarged, specially concerning the Anatomy of the Nervous System 
Organs of Special Sense, etc. By John Langton, f.r.c.s., Surgeon to, 
and Lecturer on Anatomy at, St. Bartholomew's Hospital. 208 Illustrations. 
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these points be emphasized to such as are commencing their studies. The text matches the 
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ANDERSON ON SKIN DISEASES. A complete Treatise on Skin 
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University of Glasgow. With numerous wood engravings and several col- 
ored and steel plates. Octavo. Cloth, $4.50. Leather, #5.50. Just Ready. 
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an extensive experience of nearly twenty-five yean. 
GOWERS' MANUAL OF DISEASES OF THE NERVOUS 
SYSTEM. A Complete Text-book. By William R. Gowers, m.d., 
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National Hospital for the Paralyzed and Epileptic. Comprising over 
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BYFORD. DISEASES OF WOMEN. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to Women. 
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College and of Obstetrics in the Woman's Medical College; Surgeon to 
the Woman's Hospital; Ex-President American Gynaecological Society, 
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