Thirdly. Violent salivation. This may be caused by a too liberal use of the remedy; or by a sudden check to perspiration by cold and damp; or by loss of blood, or anything that lowers the system. It is, however, very common to meet with persons who are salivated by the smallest quantities conceivable; and that is a matter that requires inquiry and consideration. The symptoms of severe salivation are, swelling and inflammation of the salivary glands, cheeks, tongue and throat, with a flow of peculiarly fetid saliva and ulceration or even sloughing of the gums. The best local applications for this state are, gargles of Brandy and Water, to which a little of the solution of Chloride of Lime or of Tannic Acid may be added. The bowels should be cleared by mild aperients; and as soon as fever has abated, the patient should have a good diet and tonics, and change of air. If the salivation is very obstinate repeated blisters should be applied behind the ears, and to the throat. Dr. Macleod mentions two cases of stupor following the sudden cessation of salivation; one fatal; the other cured by reproducing it.

Fourth. Mercurial eruption, consists of patches of redness and inflammation, which appear first in the groins, armpits, and flexures of the limbs, and then spread over the trunk. These patches are covered with minute vesicles, which soon burst, discharging a thin, acrimonious fluid, and leaving the surface excoriated, and exceedingly painful and tender. The discharge often becomes profuse and fetid, and the affected parts much swollen and fissured. It generally lasts for ten days, but may remain for many weeks.

Treatment

Warm bathing; mild and unctuous applications, aperients to open the bowels; Dover's Powder at bedtime to produce perspiration; Bromide of Potash if the rest is disturbed, and the Fever Mixture No. 9 three or four times a day: these during the early stages; subsequently, Quinine in one or two grain doses, with six' minims of Diluted Nitric Acid, three times a day. Dr. Colles has described another and less severe form of eruption, which resembled the itch, except that the intervals between the fingers are free from it; the treatment is the same. When a patient who is disposed to these affections resorts to the use of Mercury, the doses should be small, combined with Henbane, and he should carefully avoid heat, violent exercise, and everything else that excites the cutaneous circulation.

Fifth. In some cases there is a tendency to palsy of the heart. The symptoms are great depression of strength, anxiety, shortness of breath, frequent sighing, weak and tumultuous action of the heart, frequent sense of suffocation, disturbed sleep, and faintness upon any exertion; which faintness may prove fatal. Treatment-Removal to a fresh atmosphere; stimulants and antispasmodics, especially Musk, which may be takes in ten grain doses, or Castor in the same doses, with tonics and good living.

If during the mercurial course any feverish or inflammatory attack arises, it is a general rule to discontinue it until such a state has been removed. And if the patient should become thin and feeble; losing his appetite and strength; complaining of disturbed sleep, night sweats, cough, or any other symptoms indicative of debility, his diet must be generous, and tonics must be liberally administered; and if these symptoms continue, notwithstanding the Mercury is given in diminished doses, it must be relinquished altogether.

There are some patients whom it is scarcely advisable to subject to a mercurial course, viz.: those naturally labouring under, or strongly disposed to, Consumption or Scrofula.

For these and other cases in which Mercury is unadvisable, the Iodide of Potash has been proposed as a substitute; in doses of from one to three grains a day.

Bubo signifies an inflamed lymphatic vessel or gland leading from a venereal ulcer.

Any local irritation will, in certain habits, cause inflammation of the lymphatics; in Gonorrhoea, for instance, the glands in the groin are apt to swell. But the genuine syphilitic bubo arises from absorption of the poisonous secretions of a chancre; and the ordinary time of its appearance is just as the ulcerative stage of the chancre is ceasing.

Acute bubo at the groin generally affects only one gland, and pursues the course of an ordinary acute abscess.

Indolent or chronic bubo very commonly affects more than one gland. It occurs in weak, scrofulous habits, and especially in persons worn out by the improper administration of Mercury. The glands slowly enlarge; suppuration is slow and imperfect, and commences at several points. The skin is long before it inflames, but when it does so, a large tract of it becomes of a dusky bluish tint; the matter spreads widely; and at last large portions of the skin perish by ulceration or sloughing, leaving an extensive sore that may be months in healing.

If a bubo at the groin affects one gland only, it is most probably caused by chancre on the penis, provided there be one. But, if many glands are swelled the swelling is probably caused by mere irritation.

Treatment

The acute bubo is to be prevented from suppurating if possible. For this reason three or four leeches are to be applied, and they may be repeated on the following day, if the inflammation has not subsided. The patient must keep quite quiet, and abstain from stimulants of all kinds. And he may take the Fever Mixture No. 9; and take a gentle Cathartic. The application to the chancre should be soothing, and Mercury, if being administered, should be at once given up.

In treating the indolent bubo, the general health must be amended by every possible means; the patient may try the various tonic mixtures recommended in this work, particularly the Citrate of Iron and Quinine, and his diet must be light and nourishing: boiled mutton, boiled chicken, and things of that kind. Leeches may be applied occasionally, and cold poultices, to relieve the inflammation; and he may take ten grains of Bromide of Potash at bedtime. If these measures fail, and matter forms, and the skin is becoming bluish and thin, a blister may be applied; or the diseased skin may be rubbed with Caustic; but if the matter continues to increase the swelling must be opened either with Caustic or with the lancet.