The fourth consists of painful, irritable and bleeding cracks or fissures around the edge of the foreskin; they are best treated by the application of the following ointment:

Citrine Ointment................................One Dram.

Lard.................................................Seven Prams.

Mix, and apply night and morning.

Treatment Of Primary Syphilis

It seems to be pretty well established that if a chancre lasts for a few days only there will be no fear of secondary symptoms, and no need to administer Mercury. It is therefore of importance to get rid of the chancre as soon as possible; and this may be accomplished by touching it as soon as discovered with Caustic. Then take an aperient, keep strictly to low diet with rest,and wrap the penis in rag dipped in warm water, to prevent inflammation. But, if the sore has lasted more than a week, the Lunar Caustic will not act deeply enough to destroy it effectually, and the Caustic Potash (Potassa fusa) or strong Nitric Acid must be employed instead.

But the foregoing plan cannot be adopted with safety if the chancre presents a well-marked, hardened lump, or if the penis is swelled or inflamed, and the patient feverish, or if there is any swelling or tenderness in the groin. When this is the case, the local applications should consist of some liquid capable of chemically decomposing the poisonous secretions of the sore, and of a strength proportioned to the existing irritation. Black Wash, a very weak solution of common salt, or a lotion composed of one dram of Tannic Acid and two drams of Tincture of Catechu to half a pint of water. If there is very much irritation, the penis should be enveloped in a poultice of boiled Chamomile Flowers. If there is much hardness the sore may be dressed with Calomel Ointment. Afterwards, during the indolent and granulating stages, the sore may be treated with any astringent lotion,and be touched occasionally with Lunar Caustic or Blue Vitriol.

Constitutional Treatment

If there are none of the reasons to the contrary which will be mentioned presently, the patient should take Mercury. (At least this is recommended by a large majority of the most experienced members of the medical profession.) Not because it is absolutely necessary in all cases, but because it hastens the cure of the primary sores, and affords a more decided security against secondary symptoms. But, before doing so, it will be right to open the bowels with Blue Pill and Black Draught, and to confine the patient to low living, rest, and febrifuge medicines, till local pain and inflammation and any general disorder of the system have been removed, A warm bath or two may be useful.

Then the object is to induce a gentle mercurial action, and to main tain it long enough. Five grains of Blue Pill should be taken every night and morning; and if no effect on the mouth is produced by the fourth day, the dose at night should be doubled. This will rarely fail, in another day or two, to produce a very slight soreness and sponginess of the gums, with a slight increase of saliva; which is all that is wanted; for the only use of salivation is to show that the system is affected. The mercurial influence should be steadily maintained for four or five weeks, and until the sore has healed and all hardness of the scar has vanished. If the mouth become too sore the dose should be lessened; and if the soreness subside too soon, it may be increased; or two or three doses of Calomel may be added. Meanwhile the patient should live regularly, but not too low: he should avoid all excess of food or wine, acids of all kinds, and every thing likely to disorder the bowels; his clothing should be warm, and above all, he should particularly avoid fatigue, exposure to cold, or wet, or night air.

The strong Mercurial Ointment is not so likely to disorder the bowels as the Blue Pill, but it is more troublesome, and might fatigue a feeble patient injuriously. The proper quantity is a piece about the size of a nut, to be rubbed in daily upon the inside of the arms or thighs till it disappears. The morning is the best time for doing it, as the skin is then softer; it should be rubbed on different limbs successively, the patient wearing the same drawers both by night and day. If the skin becomes irritated it should be well washed and bathed. If the patient is too weak to rub in the ointment himself, it must be done by some one else, whose hands should be protected by a pig's bladder, well softened in oil and tied round the wrist.

If Calomel is preferred, two or three grains, may be taken every night, combined with a quarter of a grain of Opium: but it is more apt to purge, and should be used only with strong, robust people, who would be unaffected with milder means.

The ill effects of Mercury that require to be guarded against are the following: First, griping and purging, which are to be obviated by combining a small quantity of Opium or Extract of Henbane with the Blue Pill, and giving occasionally the following draught:

Powdered Rhubarb........................Twenty Grains.

Tincture of Rhubarb......................One Dram.

Laudanum...................................Twenty Drops.

Peppermint Water........................One Ounce.

It is far from uncommon for a slight attack of Dysentery to occur, especially about the time that salivation commences; there being sickness and severe griping, with frequent straining, and ineffectual attempts to go to stool. This should be treated by the draughts prescribed above, followed by an injection of gruel con-taing forty drops of Laudanum, and by a warm bath, the Mercury being omitted for the time.

Secondly. Sore throat; redness of the whole throat, and sloughing or ulceration of the tonsils, with fever. In this case the Mercury must be discontinued, till leeches, gargles and aperients have set the throat to rights; and then it may be resumed in smaller doses.