202 
HINTS TO TRAVELLERS. 
from which, oozes a little watery fluid. The base of the ulcer and the 
skin surrounding it are hard like gristle. The nearest glands, usually 
those of the groin, enlarge and occasionally become tender. Unless 
badly neglected, the original sore gradually heals and the glands 
resume their normal size. Secondary symptoms now make their appear¬ 
ance. These are fairly definite, and comprise (a) A skin rash, consisting 
of numerous irregularly shaped copper-coloured spots, spread over the 
face, upper part of the chest, the loins and the back of the arms. They 
do not itch. ( b ) Moist lumps and warts form in the crutch, around 
the scrotum (purse) and the outlet of the bowel, (c) Ulcerated sore 
throat. Large deep ulcers form on each tonsil, having ragged under¬ 
mined edges. ( d ) Iritis or inflammation of the eye may also occur. 
These symptoms, even if untreated, tend to heal, but always leave more 
or less marked traces behind. 
After an interval of apparent health, lasting perhaps only for a few 
months, but often for a year or two, the tertiary symptoms or “ re¬ 
minders” make their appearance. These take the form of localised 
swellings, which soon break down, forming deep ulcers, and if un¬ 
treated, produce extensive destruction of the part involved, with much 
deformity. 
Treatment .—As soon as the disease is recognised, the treatment must 
be commenced. 
Local treatment.—Keep the sore perfectly clean by washing it with an 
antiseptic solution such as chinosol (1 in 1000). Between the washings, 
dress it with a piece of lint soaked in “ black wash,” or dust it with 
iodoform powder and cover it with a piece of lint smeared with boric 
ointment. 
For the sore throat, use an antiseptic gargle (see Ulceration of Throat, 
p. 170). 
General treatment.—The patient must be put on a course of mercury 
at once. Calomel, one grain twice a day, or grey powder, one grain 
three times a day,' must be administered, and continued until skilled 
advice can be obtained. The effect of the mercury must be carefully 
watched, and if the patient complains of soreness of the gums, a coppery 
taste in the mouth and excessive flow of saliva, the dose must be 
reduced or the administration of the drug stopped until these symptoms 
have disappeared. If the calomel or grey powder causes looseness 
