The symptoms of secondary, or constitutional Syphilis, generally occur about six weeks after the primary symptoms, sometimes a fortnight, sometimes not for months. Before their appearance, the patient generally becomes thin and wan; he looks dispirited; his eyes are heavy; and he complains of want of appetite and sleep, and of rheumatic pains.

The effects of constitutional Syphilis are usually first manifested upon the skin and the mucous membrane of the throat, and then upon the bones.

Syphilitic eruptions vary in degree from the slightest discolouration to the most inveterate ulcers. In the mildest form, the skin is mottled and stained in irregular patches of a brownish red colour; or the skin may be raised in copper-coloured blotches, covered with scales. Or there may be an eruption of pimples, varying in size from a pin's head to a pea.

2. Scaly eruption is an aggravated variety of the preceding. It begins with an eruption of copper-coloured blotches, which become covered with scales of enlarged cuticle; these are succeeded by scabs, and, when they fall off, by shallow ulcers with copper-coloured edges.

3. Vesicular Eruption. Large flattened blisters, filled with liquid, which gradually become purulent, and finally dry into scabs, under which the skin is ulcerated. The ulcers spread under the scabs, and the latter become remarkably thick from suc-cessive additions.

4. Pustular eruption. Large, prominent pustules, with a copper-coloured base, leading to ulcers.

5. Tubercular eruption. Broad, red, copper-coloured tubercles, forming most frequently on the sides of the nose, or on the cheeks. They gradually suppurate, and are succeeded by deep irregular ulcers, terminating in puckered scars.

This form of disease is most unfavourable, and usually appears at a considerable distance of time from the primary symptoms in persons whose constitution is originally weak, or has be en shattered by privation, dissipation, or frequent, unavailing courses of Mercury. A patch of this kind of unhealthy -inflammation is apt to form on the tongue, and after a time an abscess breaks, disclosing a ragged excavation, filled with orange-coloured sloughs, and exuding a copious, fetid discharge. If it occur on the palate the bone will become diseased and give way, leaving a hideous chasm.

In addition to these there is the syphilitic sore throat, and syphilitic ulcerations of the nose and palate, which may occasion the loss of the nose; the disease also frequently affects the bones of the leg, arm, and skull; and death may ensue from irritation of the dura mater, or protrusion of the brain through apertures in the skull.

Treatment-For syphilitic eruptions, the warm, vapour or sulphur baths will be useful. Obstinate patches of pimples may have their removal hastened by dressing them with diluted Citrine Ointment, or white Precipitate Ointment, or Tar Ointment. Itching eruptions may often be relieved by a weak lotion of Corrosive Sub-limate. Ulcers must be treated according to their condition, whether inflamed, irritable or indolent. In general weak mercurial applications, Black Wash, or weak red Precipitate Ointment answer best.

For the sore throat the Permanganate of Potash may be used. The following lotion may be commenced with, and the strength increased by degrees:

Solution of Permanganate of Potash.....Two Ounces.

Water, sufficient to make....................A Pint.

It may be used several times a day.

The pains of the bones are often relieved by blisters; and sometimes it is useful to dress the blistered surfaces with strong Mercurial Ointment and Opium. If, during secondary Syphilis, the nose becomes tender and painful, the greatest benefit will be derived from the application of one or two leeches twice or three times a week to the inside of the affected nostril.

The general treatment must be according to the state of the patient. If there is pain in the chest and other feverish and inflammatory symptoms, it will be necessary to open the bowels, and to restrict the diet and confine the patient to the house. He may take the Fever Mixture No. 9; and the warm bath will be very useful. When the feverish state has departed, if the patient has never taken a course of Mercury (if none of the reasons against it, previously mentioned, exist) and his constitution is sound, he may take Mercury in the manner previously recommended. If, under its use, the strength and general appearance are improved, it will show the treatment is beneficial; but if the patient gets thinner, weaker, and haggard, and suffers from chills and feverishness, the Mercury must be given up.

The Iodide of Potash is the remedy which, next to Mercury, is considered most beneficial in these cases. Mr. B. Hill, Surgeon to the University College Hospital, has lately published some cases, shewing the advantage of Iodide of Ammonia, and Iodide of Soda, in these cases, after the Iodide of Potash, from long administration, had lost its power. He gave the Iodide of Ammonia in eight grain doses, in Infusion of Gentian or Infusion of Cascarilla three times a day. After some time he changed the Iodide of Ammonia for Iodide of Soda.

The patient may take any of the tonics prescribed in this work, and the Bromide of Potash or Bromide of Ammonia in ten or fifteen grain doses at bedtime. The main object is to improve the general look and condition of the patient-to treat symptoms-never to push a remedy if it does manifest harm, under the vague idea that it is a specific, or to attempt to produce sudden benefit by large doses of Mercury, or other violent remedies which may weaken or impair the constitution.

Syphilis In Children

When a man labours under constitutional Syphilis, it is probable that he may communicate it to his wife; but, at all events, if the wife has it, she may communicate it to the fetus. The consequence is sometimes that the infant dies about the fourth or fifth month, and the woman miscarries repeatedly. Sometimes a child is born weakly and shrivelled,with hoarse voice, discharge from the nostrils, and copper-coloured blotches or ulcers, especially about the breech and genitals. Sometimes again, it is born healthy, but these symptoms appear a month afterwards. Lastly a child may be infected with primary Syphilis during its birth.

The parents in these cases should take a course of Mercury, and be treated in other respects for secondary Syphilis. And for the children, the best plan is to rub ten grains of Mercurial Ointment daily into the armpits, or to administer half a grain or a grain of Mercury with Chalk (Gray Powder) every night till the symptoms disappear. Although the symptoms are apt to return once or twice, they are in general easily removed by a short repetition of the remedy.