Syphilitic Necrosis. 30'5 



part of the glands ; that he had also been affected with buboes in the 

 groins, and subsequently with ulceration of the throat, cutaneous eruptions, 

 and exfoliation of spiculse of bone from the nostrils ; that he had laboured 

 under the disease for three or four years, had been under the care of 

 various practitioners, and had used much mercury, besides other remedies. 

 " He was now, I found, using the decoction of sarsaparilla under the 

 direction of Dr Kennedy, which I desired him to continue ; and after 

 consulting with Dr Kennedy we agreed to prescribe the Plumnier's Pills, 

 of which he was directed to take three daily along with the decoction. 

 Under this course a rapid amendment took place ; the incrustations 

 dropped off from his skin ; he recovered his looks and flesh, and in short 

 complained of nothing but an offensive discharge from the nostrils. His 

 spirits got up, and he seemed to entertain sanguine hopes of recovery. In 

 this state he came over from the Old Town to my house late one evening 

 in the month of July, during the prevalence of a cold easterly wind ; he 

 complained of having caught cold, was exceedingly hoarse, and upon 

 inspection the palate and fauces were found considerably inflamed. On 

 enquiry I ascertained that of late he had been repeatedly out at night, 

 and had been living altogether in a very irregular and dissipated manner. 

 I ordered him home instantly, desired him to confine himself entirely to 

 the house, to lay aside the use of the Plummer's Pills, to take a dose of 

 salts, and to go into the warm bath ; which directions, with the exception 

 of the confinement, I have reason to believe he complied with. 



"Soon after this an ulcer broke out in the palate immediately behiml 

 the incisors — the velum palate and tonsils also became ulcerated — the- 

 offensive discharge from the nostrils increased — pieces of the inferior 

 spongy bone exfoliated — the teeth dropped from their sockets — and 

 though mercury in every form had for some time been laid aside, a 

 copious salivation now commenced, owing to the irritation from the 

 diseased state of his mouth affecting the salivary ducts and glands. He 

 was unable to take almost anything in the shape either of food or medi- 

 cine. Of the latter nothing was recommended to him but bark, 

 laudanum, laxations, and an alum gargle. He continued to linger for 

 several Aveeks, and expired about the beginning of November, greatly 

 emaciated, aiid exhausted by hectic fever. 



" On examining the exterior surface of the cranium, a 

 circular portion of the right parietal bone, about the size of a 

 shilling, may be observed flattened and somewhat rough ; from 

 this an exfoliation had taken place previous to the patient's 

 coming under my care. On the interior surface of the bone 

 opposite to this spot the impressions of numerous small 

 vessels are to be seen deeply indented into the bone, and 

 giving it a rough scabrous feel. 



" On the internal aspect of the frontal bone two circular 

 U 



