SUR 
with opium, and corrosive sublimate, are 
less frequent modes of exhibiting mercury. 
Lastly, mercurial fumigations have been 
employed, by exposing the patient naked, 
in a wooden box, to the fumes of the pul- 
yis hydrarg. cinereus, thrown on a heated 
iron. The effect of mercury on the salivary 
secretion and gums, is considered as the 
criterion of its action on the system at 
large ; this should not be allowed to be- 
come considerable, as the effects on the 
constitution are very pernicious. A very 
slight affection of the gums, continued from 
six to twelve weeks, will be adequate to 
the cure of most venereal complaints. The 
action of the remedy is usually maintained 
for a fortnight after the symptoms have dis- 
appeared, for the sake of security. Vio- 
lent and long continued salivation often 
aggravates the complaint, and becomes the 
source of other disorders. Decoction of 
sarsaparilla, mezereon, guaiacum, &c. nitrons 
acid, opium, and other remedies, have been 
employed in venereal cases j but the most 
that can be said of them is, that they are 
useful restoratives after the long employ- 
ment of mercury. This is particularly the 
case with the nitrous acid. 
. There is not much to be said on the local 
treatment of the different venereal symp- 
toms. Chancres, when very small, have 
been destroyed by lunar caustic, or exci- 
sion ; they may be dressed with mercurial 
ointment, or any solution of metallic salts ; 
or with solution of opium if irritable. Bu- 
boes may be poulticed, if painful. 
AFFECTIONS OF JOINTS. 
White swelling attacks the larger articula- 
tions most frequently. It consists in an 
indolent tumour of the part, without affec- 
tion of the skin, impairing the motions of 
thejoint ; arising from a diseased state of the 
bones and ligaments, which causes a general 
thickening of the superincumbent parts. 
The enlargement proceeds, the joint be- 
comes painful, and abscesses form j the pa- 
tient at last dying hectic. The treatment 
consists in subduing completely all increased 
action in the part by leeches, cupping, cold 
washes, &c. continued while there is any 
remains of pain or heat ; and afterwards 
in keeping up a drain from the skin by 
means of caustic issues, or, what seems to 
he more advantageous, by Mr. Crowther’s 
plan of blistering, and dressing the surface 
with imguentum sabina;. These drains 
should be continued for six, twelve, or 
eighteen months. Perfect rest is indispeu- 
sible. The constitution of the patient which 
is frequently of the scrofulous kind demand.^ 
the greatest care : bark, sea-air, &c. are 
therefore particularly proper in such cases. 
Where thejoint is too tliorpnghly diseased, 
and the constitution is sinking, amputation 
must be performed. 
Loose cartilaginous substances are most 
frequent in the knee, where they excite in- 
flammation, and are very troublesome, when 
they get between the ends of the bones. 
They must be removed by means of an in- 
cision over the inner surface of the internal 
condyle, where they can be easily fixed by 
an assistant; the wound should be closed 
instantly, and every attention paid to keep 
olf inflammation. 
Hydrops articuli occurs after inflamma- 
tion or injury, and may he dispersed by 
blisters and savine ointment ; or by friction 
with camphorated liniments or mercurial 
ointment, united with mercurial purges. 
DISEASES OP BONES. 
Necrosis is the death of the whole of a 
bony cylinder, excepting its articular por- 
tions ; and is most frequent in the thigh and 
tibia. The periosteum separates from the 
affected hones, becomes thickened and vas- 
cular, and forms a new Case surrounding 
the old bone, and at last absorbing it. This 
process occupies many years ; is attended 
with great pain and swelling of the limb at 
first, and subsequently with abscesses, which 
lead down to the old bone, and afford issue 
to copious fetid suppurations. In some in- 
stances the old bone, which is called the se- 
questra, has been removed by a surgical 
operation, particularly in the tibia. Where 
this cannot he admitted, blisters dressed 
with savine, or issues, will remedy the inita-: 
tion, and prevent suppuration, while the ab- 
sorption of the old bone is going on. Leeches, 
cupping, &c. may he required, if inflamma- 
tory symptoms manifest themselves. Some- 
times amputation is necessary, pai ticularly 
in poor persons, whose circumstances will 
not admit of delay. 
Exfoliation is the term applied to the 
death of a small portion of bone ; in which 
generally the surgeon must wait until nature 
has separated the dead part. 
Caries is a disease of the substance of a 
bone, causing foul, ill-conditioned ulcers, 
and attended with occasional exfoliations. 
Means which reduce inflammation are pro- 
per at first ; followed by counter irritation. 
Rickets is a disorder consisting in a flexi- 
bility of the bones, and, consequently, a de- 
formity of the part affected, occurring ge,( , 
