Wasting and exhaustion mark the onward course of the disease, to which the withered aspect, giving the appearance of old age, the bloodless state of the conjunctiva, and the yellow hue of the skin, are all accompaniments.

Prognosis. The earlier the disease appears the more unfavorable the prognosis. A very large number of the children attacked with hereditary syphilis die within a few months after birth; yet under appropriate and persistent treatment recovery often occurs.

Pathological research has discovered certain organic affections of the viscera occurring in hereditary syphilis to which the fatal termination of the disease is, in some manner, to be attributed. These are, briefly, suppuration of the thymus gland, the formation of small indurated nodules throughout the lungs passing rapidly into a state of suppuration, also albuminoid degeneration and enlargement of the liver.

In the Med. and Surg. Reporter, vol. 44, p. 615, we find that from 1847 to 1853, syphilis destroyed in England and Wales an annual average of 565 infants under one year of age, in each million of births; in 1878 the deaths under this head had risen to 1851 per one million. An increased accuracy in diagnosis would probably account for a part of this increase.

Treatment. It is an undoubted fact that great benefit may be derived from the administration of internal remedies to the pregnant woman, for the purpose of correcting the results of constitutional taints transmitted to the children through the maternal circulation. This rule has no exception in the disease before us. The persistent and continuous administration to the mother of a remedy corresponding to the manifestations of the disease present during gestation, or to the disease picture as a whole, if at the time of conception the symptoms of the disease may be dormant, will do very much to modify and control the outbreak of the same in the child.

Numerous remedies have been suggested in our school for the general syphilitic manifestations. A few of these drugs are invaluable, while the majority are worthless, and their recommendation, unsupported by fact or reason, is only calculated to mislead. Of all the remedies recommended for syphilis, in nearly all its

forms, acquired or hereditary, Mercury in its various preparations stands at the head of the list. I know that many authorities oppose the use of this drug as liable to injure rather than to help, but this result comes from the abuse of the drug by large doses., Dr. Keyes, in a monograph on the TREATMENT OF SYPHILIS, very ably sustains the advantages to be derived from the steady use of this drug, given in moderate doses. When the disease is cured or modified by internal treatment, Mercury is the remedy that must do it. Merc. corr. is the preparation preferred by most authorities, and its use in the lower triturations recommended. It is adapted to the ulcerated conditions, no matter on what part of the mucous membrane they may occur. The erythematous congestion of the mucous membrane, the inflamed condition of the eyes and eyelids, the discolored skin of the face, and the acrid discharges, are all additional indications, proving the marked similarity between the disease and the drug. For the eruptions in the acquired form, Dr. Baehr prefers the Merc. viv., and it might be well to occasionally alternate the two preparations. The compound preparations of Iodine and Mercury are also frequently used. They are to be thought of when the glands are involved. Under the red iodide we have superficial ulcers and patches in the throat; ulcers on the skin with inflamed bases. In the yellow iodide the patches of ulceration are more easily detached, and we have fine bright eruptions over the body. The tonsils are involved under both drugs, but in the former, the left is the one most affected, in the latter, the right.

Hepar sulph. has been used for the soft, spongy, eating ulcer, without reaching to the bone. Dr. Wm. Peach, of Allegheny, claims to have checked with Hepar sulph." the progress of a foul ulcer with cheesy discharges, involving part of the cheek and nose. The patient was a boy eleven years of age, and the disease had been present for four years-the mother was syphilitic. The disease had been steadily progressing, but had not received any treatment for one year. When last seen the ulcer had nearly healed. The

throat was not affected.

Nitric acid is recommended by Dr. Hedges, of Chicago, for the ulceration following previous constitutional symptoms; for primary

ulceration it is of little use. We know the use of this drug in the acquired form for those cases which have been treated with an excess of Mercury, and is it not possible that this drug may have retarded the manifestations of the disease in the children, and thus the indication for Nitric acid be the more marked? In the sloughing, eating ulcer, its use externally is also to be thought of. A general rule in the choice of Mercury and Nitric acid would seem to be, that the former is more applicable the earlier the ulcerated condition appears.

Iodide of potash is applicable to the trouble when the osseous system becomes affected.

I would call attention to the possible beneficial result to be obtained by the use of Hecla lava in cases of swellings or nodes about the bones of the face. In the tertiary stage of acquired syphilis in a young woman, where the nasal bones became enlarged and nodular, this remedy, given by Dr. C. C. Rinehart, of Pittsburgh, removed the trouble promptly; two years after there had been no return.

Asafoetida is another remedy to be studied when the osseous system is involved.

I believe this list contains all the reliable remedies for this disease, and of these Merc. corr. and Iodide of potash are the ones best adapted to radically remove the disease, provided they are given persistently and in low attenuations.

INFANTILE SYPHILIS.

BY W. H. JENNEY, M.D.

Etiology.-Infantile syphilis comprises two classes, namely, congenital and acquired; the former arising from hereditary impressions by one or both parents, the latter from contact with the genital parts of the mother at birth, or later from contact of the lips from kissing, from the nipples in the act of suckling, from the poisoned milk of the nursing woman, or from impure vaccine

matter.

If the calamity result from the infection of both parents, the foetus perishes between the fourth and eighth month of intrauterine life. If directly from the father alone (which is the more frequent of the two), the offspring may exhibit no symptoms at birth, owing to the healthy blood of the mother as the direct nourishment during gestation, but evidences of contamination may appear about the second or third month, and almost invariably within one year. If direct from the mother alone, the infant is rarely born unscathed, or if such be the case, it generally becomes apparent toward the close of the first month of independent being.

Symptoms.-The effects of this poison upon the growth of the foetus and the health of the infant are many and varied. According to Trousseau it is a chief cause of habitual abortion in syphilitic mothers, particularly when occurring about the sixth month, and almost positively indicating involvement of the placenta, thus strongly tending to such result.

The body of the foetus usually presents a macerated appearance, portions of the cuticle being detached or papulated and containing a puriform liquid; the amniotic secretion is also abnormal, being greenish and offensive.

The evidences of syphilitic taint in the new born are likewise multiform, and embracing: 1st. A shriveled form and saddened visage, with a weak and stifled cry. 2d. A peculiar, dull, sooty hue of the skin, most apparent on the forehead and face, and con

sidered by M. Diday unmistakable evidences of syphilis. 3d. An eruption, of marked copper color, upon the extremities, sometimes consisting of blebs, (onyxcis,) as described by Bonchut, with inflamed borders-which degenerate into ulcerations and are denominated pemphigus neonatorum, most commonly seen upon the fingers and toes; this eruption sets in by a violet hue of the part beneath which a turbid, watery fluid collects; if present at birth, it has been considered precursory of death; it is, however, to be differentiated from non-specific pemphigus, which mainly attacks the neck and body. 4th. Obstinate ozæna, with excoriating discharge, thickening of the nasal membrane and snuffling respiration, which more or less interferes with nursing. 5th. Condylomatous of sycotic growths, chiefly around the genitals or anus. 6th. Mucous patches, the location of which is at the outlet of the mucous canals, or upon the arches of the fauces; they present an appearance as if the skin had been softened by water. 7th. Roseola, or rose tinted irregular eruptions, selecting by preference the neck and the belly, or the inner surface of the extremities. 8th. Periostitis, especially of the clavicle, ribs and long bones, with circumscribed enlargement, mostly of the beginning of the union epiphysis and diaphysis; softening at the epiphysis is not unfrequent; these conditions are usually developed during the first weeks of infantile life. 9th. Acne or Impetigo, according to Diday, and Germinata according to Sebert, are occasionally noted in this form of syphilis; the former are diagnosed from the simple variety by their copper colored areola. 10th. Infiltration of the liver and hypertrophy of the spleen are more remote and less frequent complications. Sir James Simpson considered foetal peritonitis a cause of death.

Finally, Mr. Hutchinson, of London, has demonstrated an important condition in many latent cases, observed about the fourth year of life, namely, a dwarfing of the central incisor teeth, particularly of the upper jaw, with a notched up chipping of their free borders; and this is perhaps more general than might at first be conceded.

Prognosis. This is of necessity conditional and mainly dependent upon the constitutional state, the younger the infant and the deeper the dyscrasia, the less hopeful the diagnosis will be.