to along with diseases of blood vessels.

[Illustration: FIG. 42.--Tertiary Syphilitic Ulceration in region of
Knee and on both Thumbs of woman aet. 37.]

_Treatment._--The most valuable drugs for the treatment of the
manifestations of the tertiary period are the arsenical preparations and
the iodides of sodium and potassium. On account of their depressing
effects, the latter are frequently prescribed along with carbonate of
ammonium. The dose is usually a matter of experiment in each individual
case; 5 grains three times a day may suffice, or it may be necessary to
increase each dose to 20 or 25 grains. The symptoms of iodism which may
follow from the smaller doses usually disappear on giving a larger
amount of the drug. It should be taken after meals, with abundant water
or other fluid, especially if given in tablet form. It is advisable to
continue the iodides for from one to three months after the lesions for
which they are given have cleared up. If the potassium salt is not
tolerated, it may be replaced by the ammonium or sodium iodide.

_Local Treatment._--The absorption of a subcutaneous gumma is often
hastened by the application of a fly-blister. When a gumma has broken on
the surface and caused an ulcer, this is treated on general principles,
with a preference, however, for applications containing mercury or
iodine, or both. If a wet dressing is required to cleanse the ulcer,
black wash may be used; if a powder to promote dryness, one containing
iodoform; if an ointment is indicated, the choice lies between the red
oxide of mercury or the dilute nitrate of mercury ointment, and one
consisting of equal parts of lanolin and vaselin with 2 per cent. of
iodine. Deep ulcers, and obstinate lesions of the bones, larynx, and
other parts may be treated by excision or scraping with the sharp spoon.

#Second Attacks of Syphilis.#--Instances of re-infection of syphilis
have been recorded with greater frequency since the more general
introduction of arsenical treatment. A remarkable feature in such cases
is the shortness of the interval between the original infection and the
alleged re-infection; in a recent series of twenty-eight cases, this
interval was less than a year. Another feature of interest is that when
patients in the tertiary stage of syphilis are inoculated with the virus
from lesions from these in the primary and secondary stage lesions of
the tertiary type are produced.

Reference may be made to the #rela