Case 4.

A child, two years old, of syphilitic constitution, had a similar otorrhoea; marasmus, with enlarged liver, ensued. Syphilitic amyloid degeneration was diagnosed, and duly proved at the autopsy, soon after.

Case 5.

This was a babe, whose parentage was suspicious. The mother denied syphilis, (had been a ballet dancer.) The father, a machinist, neither admitted nor denied the taint. No lesions of the skin at birth, or afterwards, showed its existence. After about three weeks, it seemed to have caught cold-an obstinate, stuffy coryza, just such as used to be called "strumous" came on, causing great distress. It went on, under non-anti-syphilitic treatment, from bad to worse. Some taint, scrofulous, psoric, or what not, seemed probable, but treatment for these availed nothing. The child doubtless suffered all this for the want of the absolute and prompt recognition of its syphilitic origin. The similimum was Kali hydriodicum, but the father became hostile on the diagnosis being arrived at, and withdrew his "patronage." No "scrofula" was observable in either parent.

Case 6.

A consultation case. A newly born babe; several predecessors had died soon after birth, undoubtedly syphilitic, and the parents were very desirous of saving this one. The symptoms were similar to case 5. The child presented no other evidence of syphilis, but only that very white, delicate complexion, debility, etc., which have so often been held up as signs of a strumous constitution. Advised Kali hydriodicum as the regular (anti-syphilitic) remedy ; and if required, for debility, an occasional dose of Arsenicum album, which, in my experience, is also eminently adapted to this dyscrasia. Under this treatment rapid recovery took place, for which event the parents were duly grateful.

The syphilitic foundation of many so-called scrofulous (and psoric") conditions has of late years become so probable, and the specific treatment has yielded so good returns, that some pathologists

and surgeons do not hesitate to insist upon it with earnestness. The late Dr. F. F. Maury, one of the most noted of Philadelphia's syphilologists, was in the habit, in his clinical lectures, of giving to all the group of scrofuloid surgical diseases the name "quaternary syphilis." In Paris we find Dr. Parrot, in a clinical lecture, asserting the syphilitic nature of another of the scrofulides, viz., Rachitis, (see U. S. Med. Invest., Oct. 15, 1880); also Dr. Gee, (Med. Invest., March, 1880). Per contra, see Dr. R. W. Taylor's "Syphilitic Diseases of the Osseous System in Infants," etc.

In view of all the theoretical and clinical reasons here adduced, we may well consider how far both scrofula and the psoric miasm, and perhaps the sycotic also, are also explainable by reference to this one monstrous cause; yet, not forgetting to note each differentiation, adapting our practice in chronic diseases more than ever to the rule of individualization, according to the tenets of Samuel Hahnemann; with a new understanding and with well founded veneration for this crowning work of his ripened intellect and age.

The relation of tuberculosis to scrofulosis is widely regarded as one of community of origin, with differentiation in the restricted sense only. Microscopically, the original structure of both series of lesions is strikingly similar, and consists chiefly of a delicate stroma of connective tissue, destitute of vessels, but infiltrated with lymphoid corpuscles; giant cells being also present as the probable result of fusion of cell walls. Syphilitic new formations are described in nearly similar terms, excepting that they are merely "poor in vessels," (Wagner,) and giant cells are not characteristic. Sarcoma, leprosy, etc., may be profitably studied from this same point of view.

Thus, the microscope interposes no objection, but rather confirms the claim of a possible common origin for all of the dyscrasiæ.

Practically, the recognition of their ultimate origin, single or otherwise, is the first step towards the rescue of helpless and otherwise hapless infancy from a sad inheritance. Theory must here, as always, pave the way from observation to knowledge. May we soon find the sure way from knowledge to cure, and to the final eradication of all taint from human nature!

THE TREATMENT OF INFANTILE

SYPHILIS.

BY AMBROSE S. EVERETT, M.D.

The treatment of infantile syphilis should be commenced early, and should be both prophylactic and curative. The prophylactic treatment consists in bringing the mother under the influence of medication, when she is known to be syphilitic, in the hope of protecting the unborn child from the contaminating influences of her blood. The power of medicine to do this is now well understood and universally recognized. That this ante-natal treatment enables the child to reach its full growth, and the mother to attain the full period of gestation, is now the opinion of all, or nearly all who have had an extended experience with the treatment of pregnant syphilitic women.

My convictions upon the subject are so strong, and the plan that I adopt so simple and unirritating, and so devoid of any injurious influence upon either the mother or the fœtus, that I employ it without hesitancy. Even in cases where the mother is only suspected of laboring under this constitutional taint; if she has had two or three miscarriages or abortions consecutively; if she is infirm in health, has an eruption on the skin, a copious leucorrhoeal discharge, and an ulcerated condition of the neck of the uterus, I suspect syphilis, and put her upon a syphilitic treatment as the surest way of preventing abortion, of improving her general health, and of protecting the unborn child.

The treatment I employ is a combined Mercurial and Kali hydroiodic one. It consists in giving four grain powders of the second trituration of one of our preparations of Mercury twice a day, usually the biniodide or the bichloride.

An hour after breakfast I give one of these powders, and an hour after supper I give the other. An hour after dinner I give a four grain powder of the second trituration of Kali hydroiodicum

and another of the same size on retiring at night. In this way my patient gets four powders a day, two of Mercury, and two of Kali hydroiodicum. I have no doubt but that Mercury alone would be a sufficient prophylactic agent, but my experience has taught me that the efficiency of Mercury in syphilitic affections is greatly enhanced by the addition of Kali iodum. I know that the administration of Mercury to a pregnant woman has been seriously questioned on the ground that it possesses the power of exciting abortion. For a time it was held, and the position zealously defended, that the death and expulsion of the fœtus was more frequently due to the administration of this mineral than to the disease itself. But modern investigation in this field of medical research has been so exhaustive and complete, that this fear has been proven to be chimerical and that Mercury has no direct action on the uterus, and therefore has no inherent power of producing abortion.

Its power to produce abortion is an indirect one, and lies through the gastro-intestinal canal; any medicinal agent which so irritates the stomach as to produce vomiting, or the bowels as to produce purgation, is as liable to excite abortion as Mercury. The tendency to abort is no more pronounced in the tenesmus produced by Mercury than in that excited by another powerful irritant of the lower bowel.

This being the case, and the liability to miscarry lying in the sympathy between the uterus and the gastro-intestinal tract, it is perfectly safe to administer Mercury to a pregnant woman, provided it is done in such a manner as to avoid any irritation of the stomach or bowels. This the old school physician accomplishes by mercurial inunction, and the homoeopath by minute doses of the mineral internally administered. The amount of Mercury which an old school surgeon can administer by inunction, and the extent to which he can impress the system with the mineral without irritating the gastro-intestinal canal sufficiently to excite abortion, is perfectly wonderful. No one who has witnessed the

energetic treatment of the old school, in a case of this kind, can any longer believe that the period of gestation in syphilitic women contra indicates the use of Mercury, provided it be administered by the skin.

They push their treatment to the point of touching the gums, and yet it does not awaken any disturbance of the stomach or bowels. If in their hands, and by such heroic exhibitions of the mineral, they can prolong gestation to full term and afford protection to the infant after birth, what will it do in our hands where the treatment is mild, of a chronic nature, and in conformity with the course of the malady itself?

Syphilis is a disease which cannot be taken by storm; we must lay siege to it, and seek to accomplish a certain amount of good each day until the implacable foe is effectually expelled from the system. The thing to be sought is regularity and perseverance rather than a display of strength or heroism. The doses of Mercury and Kali hydroiodicum which I employ are so exceedingly minute, and the time of giving them so remote from any liability to irritate the stomach and bowels, that they can both be used with great regularity and perseverance, and without a moment's intermission from the very commencement of pregnancy to the hour of delivery. I have never yet known it to disagree with the patient, or produce a single unfavorable symptom, and my employment of it has extended over the last five years of my practice, and in a very large number of cases.

Upon the other hand, I have known it to immensely benefit, in a very short time, very bad cases. I have on more than one occasion prevented threatened abortion by its timely exhibition, and that, too, where the uterine and abdominal pains were so severe that the patient could not rest. But the good effects of the treatment do not stop here. They are far more far-reaching, and exercise a salutary influence on all the other lesions of the disease. I have seen it restore mothers whose bodies were deformed and racked by pain, to health and usefulness. In my experience no other treatment exercises so happy an influence on both secondary and tertiary syphilis. In these forms of the disease, and especially during the period of gestation, it is the treatment par excellence. It seems also to relieve the distressing and annoying symptoms incident to pregnancy, and which have no relation to the syphilitic contamination whatever, except perhaps to increase their force.

The improvement under this mild and simple treatment is rapid