Of these pills or powders, two may be taken after each meal until there is evidence of mercurial action upon the gums. At the very first suspicion of salivation, however, the quantity must be diminished to four, three, or even two pills or powders per diem. The degree of tolerance of mercury varies with different patients, and it is frequently necessary to skirmish for a few weeks, increasing or diminishing the quantity until the appropriate dose is ascertained. When this is determined it should be continued without interruption, if possible, for at least eighteen months. That this is frequently possible, we know by experience; that it desirable we are fully convinced. At the end of this time, if the patient has had no syphilitic symptoms other than those for which he first came under treatment, or if he has been for a considerable time without specific manifestations, all medication may be abandoned, in the hope that the disease has been completely eradicated. In a considerable proportion of cases this hope is not an unreasonable one. This prolonged mercurial treatment is of course not to be thought of unless the diagnosis of syphilitic chancre is absolute. In cases of doubt as to the nature of the sore, it is better to wait for the development of secondary symptoms. When these appear the course just mentioned should be at once adopted, and faithfully followed up for the period mentioned with as few interruptions as possible. If there be mucous patches or other lesions about the mouth, the trituration is to be preferred to the pill, insomuch as the finely divided drug is thus brought into immediate contact with the lesions themselves, and by its local action hastens their removal. The continued use of mercury, as here recommended, is possible and practicable in a certain number of cases. In others, however, it cannot be strictly carried out. The causes of failure are usually due either to negligence on the part of the patient, or to too large doses of the drug in the beginning. A great many patients, especially those of the lower classes, abandon all treatment as soon as the manifestations for which they sought relief have disappeared. The almost inevitable result is, sooner or later, a relapse. This is again relieved by temporary treatment followed by another relapse, until actual symptoms of the tertiary period appear in such a form as to demand the use of iodide of potassium or other agents for their relief. On the other hand, if mercury is pushed too freely at the start, mercurial symptoms about the mouth and even decided salivation may suddenly develop. This state of affairs is to be greatly deprecated, because, in the first place, it necessitates interruption of the treatment, and, in the second place, salivation is a positive evil, besides being a source of great annoyance to the patient. If salivation should occur, the mercury must be absolutely withdrawn, and sulphur in small doses, frequently repeated, is to be substituted. In addition, the mouth should be frequently washed with tepid water to which a little chlorate of potash and tincture of myrrh have been added. Belladonna and its alkaloid are also of service. Under the use of these means the salivation will usually cease in a few days and buccal irritation gradually subside. The mercury should not, however, be immediately resumed. It is better to give some form of iron for a short time. Ferrum redactum, or some of the protosalts, are to be preferred to other preparations of this metal. When the general condition has been restored by the tonic properties of the iron, the mercury is to be cautiously resumed, and continued in such a way as not to bring about a repetition of the former trouble. The regulation of the dose of mercury appropriate to each particular case cannot receive too much attention at the hands of the physician. The effort should be to give the largest amount that can be borne, without the production of gastric, buccal, or other irritation; in other words, to overwhelm the disease without detriment to the general condition of the patient. Besides the grosser signs of excess just mentioned, the patient's spirits, strength, and weight will form useful data for the estimation of the proper amount to be given. If, under a mercurial course, mental depression and debility, which are frequent accompaniments of syphilis, are diminished or relieved, the drug is doing good. On the other hand, if they are increased, something is wrong, and the probability is that the dose is too large. In cases of doubt it is safer to err on the side of small doses than risk the larger. In the former case, recovery may be a little retarded, but no positive injury inflicted; in the latter, recovery will be equally retarded, with positive injury in addition. As the same dose is not suitable in all cases, and as there are no positive data by which it can be determined in advance, its proper adjustment necessitates close observation, experience, and judgment.

It will be noticed that thus far there has been no employment of the iodide of potassium.

During the past eight or nine years we have followed substantially the treatment above described in all cases that have come to us early in the disease, and in but a single instance (except in those in which the iodide had been previously given) have we found it necessary to employ it. In general, after the disappearance of the lesions for which the patient has come under treatment, subsequent developments have been trifling and unimportant, such as a few scattered papules upon the body or scalp, and milk-spots and superficial erosions about the mouth. In no case, so far as our notes and recollection serve, have iritis, pustular or ulcerative lesions occurred.

Although the protoiodide is the only preparation of mercury of which we have yet spoken, it must not be supposed that it is the only one that is of service in early syphilis; on the contrary, it may be replaced, and frequently to advantage, by calomel, or protoxide of mercury, or by the metal