Opium should be given to allay pain. Quinine, mineral acids, iron, codliver oil, a liberal diet, exercise in the open air, and change of scene, are the indications to aid recovery.

CHANCROIDAL BUBO.

A bubo is an inflammation of a lymphatic vessel or gland, from any cause, but it is commonly restricted to the inflammation of the inguinal glands which accompanies a venereal sore or gonorrhoea.

A chancroidal bubo is an enlargement of the lymphatic glands of the groin, and is the result of the transference of the virus of the original sore to the groin; it may arise during the existence of a chancroid, from the absorption of its poison, and is likely to suppurate quickly.

Inflammation of the glands of the groin is a common occurrence, either after the local application of a poison capable of being absorbed, or after inflammation of the skin or mucous membrane, or without any special local cause, during a period of constitutional cachexia.

The chancroidal bubo is usually limited to one or, at most, two glands. Bubo depending on true chancre is likely to be multiple and indolent.

The bubo usually occurs on the same side as the primary sore; when the chancroid is situated near the mesial line a bubo may be developed in each groin.

Acute bubo pursues the course of acute abscess, with its attendant symptoms, shivering, pain, tenderness, swelling; the skin becomes red and thin, then matter points and is discharged; when the disease assumes this form, it usually runs its course rapidly, and is accompanied by severe constitutional disturbance. When the contents of the abscess is discharged, it is then called an open or ulcerating bubo, and the opening will be in the neighborhood of Poupart's ligament, either above or below, or partly above and partly below.

Indolent bubo occurs in persons of a weak and scrofulous constitution; after having made a certain amount of progress, it may remain stationary for some time, neither advancing nor receding.

Treatment. In from two to three weeks after the appearance of a chancroid, in the proportion of about one case in four, a single lymphatic gland in the groin becomes swollen, painful and tender; the overlying skin becomes red, oedematous, hot, swollen and inflamed; a soft spot appears upon the swelling, and after a little while there is decided fluctuation, and an abscess is formed in the gland. As soon as the gland begins to swell and becomes tender, charge a syringe with the

solution of corrosive

sublimate, or with a three per cent.. solution of carbolic acid, and inject a few drops into the gland, and repeat this in different portions of the diseased structure until fifteen or twenty drops of the solution have been introduced. If this does not arrest the formation of pus, it will be necessary to wait, and when the pus is formed lay the abscess freely open. In making the incision it must be carried parallel with the long axis of the body. The patient being under the influence of an anesthetic, clean out the cavity thoroughly, and touch the surface with cotton which has been saturated with impure carbolic acid. Then apply to the part an antiseptic poultice or the hot corrosive sublimate solution.

If there is much inflammation, put the patient to bed, purge him and place him on the mildest diet. Wrap the parts up, and lay over the bubo a hot solution of acetate of lead and opium.

Should phimosis supervene, inject underneath the prepuce every two hours, first cleaning out the parts by syringing with hot water, an injection of Goulard's extract twenty drops, alcohol thirty drops and water one ounce; or carbolic acid twenty drops, glycerine ten drops, water one ounce, If the syringe cannot be passed under the prepuce, or if gangrene is threatened, put the patient under the influence of an anesthetic, and slit up the prepuce as far as the corona glandis, being careful to treat the parts antiseptically both before and after the operation.

SYPHILIS.

Definitions. "Syphilis is an infectious, contagious and inoculable disease, of slow evolution; it first manifests itself by an indurated or infecting chancre, afterward by eruptions of the skin and mucous membranes, later by chronic inflammations of the cellulo-vascular tissue and bones, and finally by special productions in the form of small tumors or nodules, which have received the name of gummata."-V. Cornil.

"The term syphilis is applied to a disease which, commencing in the genital organs, in the form of a sore of a specific character, invades the lymphatic glands of the groin, the cutaneous and mucous tissues, and finally also the bones, cartilages, fibrous membranes and viscera, leaving upon each and all of them, as well as upon the system at large, a peculiar and distinctive impress."-Gross's System of Surgery.

"Syphilis is a constitutional contagious disorder which may be acquired or inherited, the first manifestation of which, unless it be inherited, is a chancre."-Prof. S. W. Gross.

This disease is due to the introduction of a specific poison or virus from

an infected person into the body of a healthy person, in which individual the poison is disseminated by the blood and gives rise to certain inflammatory lesions and new formations. It is usually transmitted by the secretions of a chancre, during impure sexual congress. An individual laboring under secondary syphilis can transmit the disease as readily as one affected with primary syphilis; the blood of a person laboring under secondary syphilis is inoculable; the flesh is likewise poisoned.

The secretion of what is known as the mucous patch is inoculable; it gives rise to chancre. If a female labor under secondary syphilis, any discharge which she may pour out from her uterus or vagina will give syphilis to a man having connection with her. Syphilis may be transmitted by other means than impure sexual intercourse, as by kissing a child with inherited syphilis, or by infecting the nipple of a nurse when the sucking child has mucous patches, or by smoking a pipe, or using a drinking utensil of an infected person, etc.

The symptoms of syphilis are divided into three stages: primary, secondary and tertiary :—

Primary syphilis is the initial lesion or chancre, with enlargement of the associated lymphatic glands.

Secondary syphilis includes the more superficial inflammatory lesions of the skin, mucous membranes and their appendages.

Tertiary syphilis comprises the destructive inflammation of the skin and mucous membranes and their appendages, as well as lesions of deeply. seated tissues of the various organs of the body.

CHANCRE.

Chancre is the initial lesion of syphilis.

A chancre does not at once appear after a person has been inoculated. The minimum period of incubation of syphilis is ten days; the maximum period is ninety-eight days; the average period is twenty-one days.

Symptoms. A chancroid may not appear until ten days, and a chancre never appears before ten days. In two-thirds of all cases the chancre makes its appearance as the superficial ulcer. It may present itself as a deep, funnel-shaped ulcer, or again as an elevated, hard, desquamating papule or tubercule.

Induration of the base of the ulcer is an important sign. The induration may feel when moved about between the thumb and fingers like thin parchment; or it may be a sore seated upon an indurated base about the size of a split pea; the induration may appear anterior to the sore or vice

versa. This induration is present in ninety-five per cent. of all cases. Whether present or not, if the disease be syphilitic, there will be found in the groin a number of very hard, distinct glands, rolling under the fingers. In addition to being superficial, the ulcer is clearly cut, the edges are perpendicular, not undermined, and look as though made with a scoop. The secretion is serous. The sore is smaller than in chancroid; it is not

attended with pain or inflammation. Its tendency is to heal.

The most common seat of chancre is on the glans penis, dorsal surface of the penis, the meatus, the anus, and lips in the male; and the labia, nymphæ, the entrance to the vagina, the fourchette, and the nipple of the female.

The ulcer will disappear in two or three weeks, leaving an induration which may last several months.

Bubo. A constant concomitant of chancre is bubo.

If the chancre be upon the genitals, the glands of the groin will be found enlarged in ninety-five per cent. of all cases. It will be met with on the same side as the lesion; or if the chancre be seated upon the median line, buboes will be found on both sides. If the chancre be upon the nipple the bubo will be found in the axilla. The bubo of chancre differs from that of chancroid in there being a number of swellings on either side instead of one; they will vary in size from a buckshot to a hazel nut; suppuration occurs in the proportion of one case in every twentyseven; but in chancroid suppuration always takes place. The bubo will present itself in from eleven to fourteen days after the appearance of the initial lesion.

Treatment.-If an individual present himself soon after impure connection, with a slight abrasion or sore upon the penis, wash the part carefully, dry it with a soft cloth, and then dust it with a powder consisting of equal parts of calomel and finely powdered subnitrate of bismuth, covering it with a thin layer of cotton. Should the chancre show a disposition to heal, apply any mild stimulating solution, as the red wash, nitric acid lotion, or a five- or ten-grain solution of nitrate of silver.

Never give mercury in the initial lesion of syphilis.

Local baths, either simple or medicated, are highly recommended. After bathing, the best local application is a moderately strong solution of acetate of lead, combined, or not, with opium, applied on soft lint or cotton wool, and covered with oiled silk. An elm poultice may be substituted. Should phagedena present itself, it must be treated upon the same principles as would be observed in the disease occurring in any other ulcer.

Destroy the sore by means of deliquescent carbolic acid. If the chancre be at the meatus keep the parts soft by a constant application of a mixture composed of melted mercurial ointment one part, white wax three parts.

SECONDARY SYPHILIS.

Secondary syphilis is that group of morbid phenomena which present themselves the first two years after the occurrence of an attack of primary syphilis.

Secondary syphilis is always preceded by chancre, and it may come on before the initial lesion has disappeared.

It is usually ushered in by well-marked constitutional phenomena; the patient feels uncomfortable and unwell; is irritable and desponding; countenance has a dull, muddy aspect; limbs and joints are sore and stiff; his appetite is impaired; his urine is scanty and high colored; is easily fatigued; has headache and disturbed sleep.

After a few days he is seized with rigors, followed by high fever, or by fever and profuse sweats.

The attack is called syphilitic fever, and is an effort of the system to eliminate the poison.

The skin and mucous membrane, with the posterior cervical glands, are the parts most liable to attack.

Affections of the Skin. Of these there are six varieties, viz.: the exanthematous, scaly, vesicular, papular, pustular and tubercular.

Syphilitic eruptions are generally chronic; in form more or less circular, and usually copper colored; after having existed for some time they become of a grayish muddy, or bronze appearance; usually appearing on the forehead, nose, cheek, back and shoulder; they are accompanied or followed by grayish, hard and thick scales, greenish scabs, narrow cracks, or well-defined ulcers.

In the exanthematous form the spots are pinkish, reddish, or of a pale copper color; they are most prominent on the trunk and extremities, and usually pass off with a slight desquamation of the cuticle. This eruption will make its appearance between the sixth and twelfth week after the appearance of the initial lesion.

As the eruption fades it loses its reddish tint, and assumes a dingy, dusky aspect. Duration from ten days to six weeks.

The scaly variety, or psoriasis, comes on from two to six months after the primary disease; it is always chronic, and is often associated with ulceration of the throat and palate, iritis, affections of the bones and joints.