tion); at the commencement this is attributed to cold, and seldom attended to until the eruption appears. In the interim, however, the child's health is much affected, and without any obvious reason. It has no bowel complaint, and is not undergoing dentition, but yet wastes away, and is feverish, fretful, and pallid. In about a fortnight an eruption comes out rather suddenly, at first upon the lower extremities and buttocks, and subsequently upon the face and body; * * * first in the form of copper-coloured blotches, about the size of a split pea, and slightly raised above the level of the skin. These are, in a slight degree, moist upon the surface, and in situations exposed to the air they soon become scaly, and subsequently are converted into dark-yellowish scabs. Where portions of skin are naturally in contact, as between the buttocks, in the wrinkles of the neck, &c., scales are not formed, but raised condylomatous sores. As the disease advances, the skin in the intervals of the scabs becomes throughout of a copper colour, and perpendicular fissures are formed in the lips, giving the mouth a very peculiar and characteristic appearance, which cannot be verbally described, but to those familiar with the disease, is in itself diagnostic of its real nature. The voice at this period becomes feeble and stridulous; the inside of the mouth often covered with aphtha; extreme emaciation attends, and, if medical aid be not afforded, the child is reduced to a state of excessive debility, and lies covered with disgusting scabs and ulcerations." (EVANSON and MAUNSELL.) In addition to these, LAWRENCE mentions that he has seen two cases of iritis as symptoms of syphilis in infants; and that sometimes there are ulcers pretty much indurated, that is, with a superficial edge, and rather indurated base, about the anus. The diagnosis is to be derived partly from its history, but in investigating this the greatest caution is required, as a hint of any suspicion upon the subject might, in many instances, be productive of the most unhappy domestic results.*** The snuffles of syphilis having nothing at first to distinguish them from those of common catarrh, the disease with which the eruption is most likely to be confounded is common itch, which in the delicate skin of the child may assume a frightfully severe form. It is to be known from syphilis by its pustular character, by the itchiness which it occasions, and by the absence of the copper colour of the skin, and the peculiar fissured appearance of the mouth. Itch is also commonly communicated to the attendants. *** The prog‐ nosis is always favourable when the case is seen early and properly treated, few diseases being more under the influence of medicine. If left to itself, however, Syphilis infantum is certainly fatal. "The treatment is exceedingly simple-mercury being always required, and, when judiciously exhibited, seldom failing to produce a beneficial effect. *** Administer from one to two grains of hydragyrum cum cretȧ two or three times a day (according to the age) until the eruption and snuffles disappear. The child usually fattens under this treatment; and salivation is never produced, at least we have never seen it, in a child under three years of age. Should the mercury affect the bowels, which some times happens, we must combine with each dose from half a grain to a grain of Dover's powder, or of the powder of chalk and opium. The time required for treatment is from six weeks to two or three months, and the medicine should always be continued for two or three weeks after every symptom has disappeared; even when this precaution has been observed, the disease may return and the mercurial treatment must be again and again resumed." Black wash or dilute citrine ointment may be applied to the sores, and when they become indolent they may be stimulated with nitrate of silver or sulphate of copper. Giving mercury to the nurse so as indirectly to affect the child is insufficient for the cure of the disease in the latter. "When the mother is suckling her own child it will be well to treat her with alteratives, as for example, sarsaparilia; but unless she labours under actual syphilitic symptoms the giving of mercury to her should not be thought of until the child is weaned, as by affecting her general health it would be likely to deteriorate her qualities as a nurse." (EVANSON and MAUNSELL) Some practitioners make use of corrosive sublimate in treating syphilitic infants; but it is objected to both by SWEDIAUR and BACOT as likely to disagree and produce violent griping. In connexion with this subject one very important question may be here adverted to, namely, whether syphilis can be communicated by co-habitation, if the husband labour only under secondary symptoms. HEY is of opinion that the wife may be so infected, although he is not able to state any positive facts supporting it. LAWRENCE also says that the same is the impression on his mind from circumstances that have come under his own observation; and TODD's case of the grandmother already men tioned might be brought in support of these views, as in her case as well as in those of married people, the only conceivable way of the infection being communicated is, the application of the secretion of the secondary sores to the surface of the healthy party. It must not, however, be forgotten that HUNTER, from experiment, asserted that the secretion of secondary sores is not infectious, and RICORD says that his own experiments on the same point have confirmed HUNTER's statement. The possibility of infection from secondary syphilis would therefore seem more than doubtful; and I am rather disposed to believe, that in cases where it is said to take place, that the male patient purposely deceives his medical attendant with a false history of his ailment or of the correctness of his moral conduct after marriage, than that two so able and attentive observers as JOHN HUNTER and RICORD should be in error. Be this however as it may, the consequences to the female and her children are so distressing and so serious, that in my opinion an infected person ought not to be allowed intercourse with his wife; or should at least be warned of the results which, according to the opinions of some able and experienced Surgeons, might by possibility accrue from such intercourse.-J. F. S.] HEY, WILLIAM, Facts illustrating the effects of the Venereal Disease on the Child in utero; in Med.-Chir. Trans., vol. vii. p. 541. 8vo. EVANSON, RICHARD, T., M.D. and MAUNSELL, HENRY, M.D., A Practical Treatise on the Management and Diseases of Children. Dublin, 1838. Second Edit. LAWRENCE, WILLIAM, Lectures on Surgery; in Lancet, 1829-30, vol. i. BACOT, JOHN, A Treatise on Syphilis. COLLES, A., M.D., On the Venereal Disease, London, 1837. 8vo. BEATTY, M.D., A Letter from, on a species of Premature Labour, &c.; in Transactions of the Dublin College of Physicians, vol. iv. p. 31. VIII.-OF THE MERCURIAL DISEASE. ALLEY, G., Essay on a peculiar Eruptive Disease arising from the exhibition of Mercury. Dublin, 1804. MORIARTY, Description of the Mercurial Lepra. Dublin, 1804. SPENS and Mc MULLIN; in Edinburgh Med. and Surg. Journ., No. I. and V. PEARSON, JOHN, On the Effects of various Articles of the Materia Medica in the Cure of Lues Venerea. London, 1809. MATHIAS, A., The Mercurial Disease. London, 1819. CARMICHAEL, RICHARD, An Essay on Venereal Diseases. Dublin, 1825. 8vo. Second Edition. BACOT, JOHN, A Treatise on Syphilis. London, 1829. 8vo. BATEMAN, THOMAS, M.D., A Practical Synopsis of Cutaneous Diseases. London, 1813. 8vo. Second Edition. LAWRENCE, WILLIAM, Lectures on Surgery in Lancet, 1829-30. vol. i. WENDT, S. C. W., De abusâ Hydrargyri. Hafniæ, 1823. HEIM, E. M. A., Inaug. Abhandl. über die Mercurial Krankheit. Erlangen, 1835. DIETRICH, G. L., Die mercurial Krankheit in allen ihnen Formen, geschichtlich, pathologisch, diagnostisch, und therapeutisch dargestellt. Leipzig, 1837. 859. The immoderate and too long continued use of mercury, especially with improper dietetic treatment, and catching cold, produces a peculiar cachexy, which has been first well described within the last thirty years, as the Morbus Mercurialis (1), Erethismus Mercurialis (2), Erythema, and Exanthema Mercuriale, &c. This disease has various stages, and appears, 1. As an eruption which generally occurs on suddenly catching cold, during the use of mercury; it is preceded by a feeling of great debility, oppressive sensation at the pit of the stomach, and frequent horripilations, followed by increased heat, quick pulse, head-ache, nausea, and thirst; then pale, or dusky-red vesicles, rarely a purple-red eruption without vesicles, or similar to nettle-rash, appear most commonly first on the purse, on the insides of the thighs or fore-arms, and gradually spread over the whole body. After a shorter or longer time, the cuticle is shed in thin whitish scales; but if the ailment be left to itself, a large quantity of vesicles or pustules arise which contain an acrid, stinking, very irritating fluid, and on their bursting more or less thick crusts are formed by the drying of the fluid (3). 2. As ulcers in the throat and mouth which are characterized, not merely by their grayish-white and flabby appearance, but also by their whole external form, which is more easily distinguishable by the eye than to be described by words. Pain and tension arise in the soft palate, and in the tonsils, with heat and a peculiar sensation of dragging of the palate towards the hinder part of the nostrils; much excoriation on the soft palate, the uvula, and tonsils, and actual ulcers, having the appearance of whitish discoloured spots, especially on the hinder wall of the pharynx (4). A peculiar characteristic is the disposition the ulcer shows to change its place. Even true syphilitic sores may, by the too long continued use of mercury, degenerate into mercurial sores. As the disease proceeds the pendulous palate is destroyed, and ozana, caries of the nose-bones, pains in the bones, (wanting, however, the nightly exacerbation,) enlargement of the bones, and caries occur. Upon the varied appearances and degrees of the mercurial cachexy, see the beforementioned excellent Paper of DIETRICH. [(1) CARMICHAEL does not hold with the notion of a mercurial disease. He says:"In ascribing those symptoms (mercurial chancres, ulcers, pains, &c.) to mercury, we have entirely overlooked this obvious circumstance, that that medicine, when exhibited even to profusion for liver, or any disease which is not venereal, has never in any one instance produced those results. With respect to the deteriorating influence of mercury, I am perfectly willing to allow, that when it does not altogether supersede the actions of a morbid poison, it may so far alter or modify its symptoms, as to change, in a great measure the appearance and natural progress of the disease; but this is essentially different from an admission, that the remedy will produce symptoms which can scarcely be distinguished from those of the poison itself." (p. 46.) LAWRENCE observes:-" Among the prejudicial effects of mercury, are enumerated, by those who are unfavourable to its use, eruptions, iritis, affections of the nose, affec tions of the bones, and affections of the joints, that is, a considerable portion of those symptoms which we know are secondary symptoms of syphilis. It has been contended by those who in modern times have been the great advocates for the treatment of syphilis without mercury, that a great portion of those symptoms ordinarily described as secondary, are really owing to the action of the remedies employed to counteract the syphilis. Now, in the first place, we may observe that all these symptoms may be produced without the employment of mercury; we know perfectly well that each of them is seen in individuals who have taken no mercury at all. We have, therefore, clear evidence that all these effects may be produced by the disease. We have not the same evidence that they may be produced on the contrary, by the employment of mercury. Mercury is given in many cases besides those of syphilis; it is given to a very considerable extent in other cases, but in no instance where it is given in other diseases do we find it produce eruptions like syphilitic eruptions; in no such instance, do we find it produce iritis, swelling of the nose, or of the bones, or of the periosteum. The effects then, in question can be produced by pox without mercury, but we have not the same evidence that they can be produced by mercury without pox; now, it is true, that mercury and pox acting together may produce a something that neither would produce singly. I can readily admit that the injudicious use of mercury; that the employment of it in cases in which it ought not to be used; that persevering in the employment of it in cases where it exerts one or other of its noxious effects, may aggravate the symptoms, may tend to produce their return more, readily make them more difficult of cure; and thus, I think, we can have no difficulty in admitting that the employment of mercury, under such circumstances, may add to the difficulties which may attach to the disease itself. I cannot, however, for my own part, see any evidence that mercury is capable of pro ducing those effects which we are in the habit of observing from syphilitic poisons in cases where no mercury has been used." (pp. 731, 732.) To the same effect, also, TRAVERS (a) observes, in speaking of syphilitic cachexia:"Mercury, it may be said, has much to do with the production of this cachexia; as an aggravant, I do not deny this to be frequently the case, but not as an element." (p. 87.) (2) The Erethismus mercurialis, as it was named by JOHN PEARSON, differs from either of the two forms of mercurial affections mentioned by CHELIUS, as from it results no local manifestations, but merely disturbance, severe enough indeed, of the constitutional powers. PEARSON's attention appears to have been directed to this formidable complaint, by having "observed that in almost every year one, and sometimes two instances of sudden death occurred among the patients admitted into the Lock Hospital; that these accidents could not be traced to any evident cause, and that the subjects were commonly men who had nearly, and sometimes entirely, completed their mercurial course." (p. 154.) He obtained ro satisfactory information by inquiring of his colleagues as to the cause of these fatal cases; but after having given "a constant and minute attention to the operation of mercury on the constitution in general, as well as to its effects on the disease for which it was administered, and after some time had elapsed, I ascertained," says he, that these sinister events were to be ascribed to mercury acting as a poison on the system, quite unconnected with its agency as a remedy, and that its deleterious qualities were neither in proportion to the inflammation of the mouth, nor to the actual quantity of the mineral absorbed into the body. The morbid condition of the system which supervenes on these occasions during a mercurial course, and which tends to a fatal issue, is a state which I have denominated Erethismus (b); and is characterized by great depression of strength, a sense of anxiety about the pracordia, irregular action of the heart, frequent sighing, trembling partial or universal, a small, quick, and sometimes an intermitting pulse, occasional vomiting, a pale contracted countenance, a sense of coldness, but the tongue is seldom furred, nor are the vital or natural functions much disordered. [What then are to be considered the symptoms just mentioned.-J. F. s.] When these, or the greater part of these symptoms are present, a sudden and violent exertion of the animal power will sometimes prove fatal; for instance, walking hastily across the ward; rising up suddenly in the bed to take food or drink; or slightly struggling with some of their fellow patients, are among the circumstances which have commonly preceded the sudden death of those afflicted with the mercurial erethismus." (p. 155-57.) BURDER says (c):-" This peculiar irritation may arise from the administration of mercury in any form, and may occur during any period of a mercurial course, though most commonly at its commencement. The exact circumstances which favour its occurrence in the particular individuals attacked have not hitherto been ascertained. While resident medical officer of the Lock Hospital he has seen it produced by the inunction of a single drachm of mercurial ointment, and reproduced in the same individual after the discontinuance of the medicine for a whole month, by three frictions, each consisting of only one drachm of the ointment. It is remarkable, however, that in the greater number of instances, a full and adequate course of mercury has been afterwards borne without any recurrence of erethismus, by the very persons who had suffered from it during the commencement of the course." (p. 105.) The seeming rarity of this disease, even "in public institutions where the atmosphere of the wards was actually loaded with the remedy," (mercury,) "would," as BACOT has very justly observed, "be a very imperfect mode of estimating the frequency of the occurrence of erethismus; because although few die, very many persons have been affected by it in an inferior degree, without, in fact, being at all aware of the cause of their sufferings." (p. 272.) To this I would, however, add, that this violent degree of constitutional disturbance is now rarely if ever seen even in hospitals, not only because their syphilitic wards are no longer polluted by a mercurial atmosphere, but because Surgeons, using mercury in the treatment of syphilis, take especial care to suspend or give up its use, when the constitutional symptoms show that the mercury is beginning to do mischief, and if persisted in would excite the irritable condition above described. The relation of Dr. BATEMAN's own case by himself (d) is probably the best account of this disease. Being the subject of amaurosis, he rubbed in a drachm of strong mercurial ointment nightly; on the seventh day his gums were a little tender, and he had slight fever at night; on the eighth he was languid and feverish, and the gums reddish (a) A further Inquiry concerning Constitutional Irritation, &c. London, 1835. 8vo. (b) Principles of Surgery. London, 1788. 8vo. pædia of Practical Medicine, vol. ii.-article, Erethismus Mercurialis. (d) Notes of a Case of Mercurial Erethism; in Med.-Chir. Trans. vol. ix. p. 220. and spongy; on the following day he had violent and irregular action of the heart, which did not yield to laudanum or stimulants, but went off suddenly in the afternoon; on the next two days he was severely griped and purged; on the tenth day, the mouth being sore, and the irregularity of the circulation continuing, the mercury was omitted, but as he was more comfortable on the following day, it was resumed, but the palpitation returned, and continuing on the twelfth day, the mercury was abandoned. During the whole of the following month the symptoms of irregular action of the heart, of extreme debility, and a strong tendency to syncope, accompanied with cough, evidently proceeding from a deranged stomach, and attended with violent retchings, continued to increase in severity, and his condition became very precarious. No solid food could be taken without an alarming increase of the feelings of oppression and faintness; and stimulants, as brandy in small quantities, ammonia, and ather, were principally bene ficial. Among the most curious circumstances of this case, was the impossibility of attaining sleep even for a very short period, without bringing on the most painful sense of suffocation and distress, so that he was obliged to be removed immediately into a current of fresh air. These attacks were so violent, and recurred so frequently, as to entirely banish sleep. He recovered, but for more than a twelvemonth after, complained of a hurried circulation, want of strength, and lassitude." PEARSON speaks of a Cachexia syphiloidea, of which he says, he has not yet attained to that complete and satisfactory knowledge which would authorize him to obtrude a publication on the subject; but," observes, “the experience I have already had in the treatment of that multiform disease, has taught me that it may appear under the following different circumstances:-1. Where the syphilitic virus has lately existed in the constitution, and the patient has employed the accustomed course of mercury; 2. Where the patient has been repeatedly diseased with syphilis, and has used several courses of mercury; 3. Where a great length of time, from three to twelve, and sometimes twenty years, has elapsed since the patient has been exposed to the agency of the disease and its remedy!! 4. After the gonorrhea, where small quantities of mercury have been used; 5. Where no venereal complaints, general nor local, have preceded the appearance of the Cachexia syphiloidea, and where the patient has never been exposed to the hazard of contracting that disease, nor has laboured under complaints requiring the aid of mercury." (pp. liv., v.) This is all he says upon the subject, and why he should prefer applying the term Cachexia syphiloidea to Cachexia mercurialis, which the disorder undoubtedly is, does not appear very satisfactory. No more reasonable is BACOT's persistance in using the same title, under which he well enumerates the symptoms which occur in this affection, to wit, " emaciation, long-continued, and severe nocturnal pains and enlargement of the bones; severe and extensive ulcerations, fever, profuse perspiration, followed not unfrequently by hectic fever and death. The most usual history which a case of this kind affords, is that of a patient, who, perhaps for some common sore of no great extent or severity, has employed mercury until his health has given way, and until symptoms have arisen of so equivocal a nature as to lead to the belief that the original disease is making inroads into the constitution; it is under this conviction that the patient either devotes himself to a fresh course of mercury, or his Surgeon, if a decided mercurialist, advocates the same plan; from that moment the disease becomes complicated; bone generally becomes affected, fresh attacks of nocturnal pains, new and unobserved forms of eruption make their appearance, and are all referred to the original poison, until perhaps a severe form of fever is excited, or some local mischief obliges a discontinuance of the treatment. Then it is that the patient rallies, the constitution appears daily to acquire strength; but, as in this condition it is not unusual for the osteopic pains to be renewed, and partial relapses to take place, the fatal misapprehension is again renewed, until another exhibition of mercury effectually overpowers the efforts of nature, and the patient sinks under the exhausting influence of the remedy." (pp. 276, 77.) "The mercurial cachexia," says TRAVERS, "is characterized by irritable circalstion, extreme pallor and emaciation, an acute and rapid hectic, and an almost invariable termination in phthisis, the utter destruction of the palate, extensive cicatrices, eruptions, or ulcers of an anomalous character in various parts of the body, and large cranial exfoliations are seen in combination with it." (p. 87.) (3) This disease is called Eczema rubrum by WILLAN and BATEMAN, who state that it is not exclusively occasioned by mercury, either in its general or more partial attacks; it has been observed to follow exposure to cold, and to recur in the same individual at irregular intervals, sometimes without any obvious or adequate cause." (p 254.) "The quantity of this ichorous discharge," say these distinguished writers, "is very considerable, and it gradually becomes thicker and more adhesive, stiffening the linen |