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 #relapsing false indurated chancre#, described by Hutchinson and by Fournier, as it may be the source of difficulty in diagnosis.  A patient who has had an infecting chancre one or more years before, may present a slightly raised induration on the penis at or close to the site of his original sore.  This relapsed induration is often so like that of a primary chancre that it is impossible to distinguish between them, except by the history.  If there has been a recent exposure to venereal infection, it is liable to be regarded as the primary lesion of a second attack of syphilis, but the further progress shows that neither bullet-buboes nor secondary manifestations develop.  These facts, together with the disappearance of the induration under treatment, make it very likely that the lesion is really gummatous in character.

INHERITED SYPHILIS

One of the most striking features of syphilis is that it may be transmitted from infected parents to their offspring, the children exhibiting the manifestations that characterise the acquired form of the disease.

The more recent the syphilis in the parent, the greater is the risk of the disease being communicated to the offspring; so that if either parent suffers from secondary syphilis the infection is almost inevitably transmitted.

While it is certain that either parent may be responsible for transmitting the disease to the next generation, the method of transmission is not known.  In the case of a syphilitic mother it is most probable that the infection is conveyed to the foetus by the placental circulation.  In the case of a syphilitic father, it is commonly believed that the infection is conveyed to the ovum through the seminal fluid at the moment of conception.  If a series of children, one after the other, suffer from inherited syphilis, it is almost invariably the case that the mother has been infected.