CONSTITUTIONAL SYPHILIS. 775 



of the great hospitals, but it is large enough to prove that the mis- 

 chief produced by mercurial treatment has been greatly overestimated. 

 As I have kept most of the patients, whom I have treated for syphilis, 

 under observation for some time afterward, and since, after the marriage 

 of many of them, I have become their family physician, it would have 

 been more difficult for the pernicious effects of a course of mercury to 

 escape my notice, than that of many a chief of a large syphilitic ward, 

 who loses sight of his patients as soon as they are discharged A se- 

 ries of observations, many of them very close ones, and now continued 

 for over eleven years, of a by no means inconsiderable number of per- 

 sons who have undergone a careful mercurial treatment, has converted 

 me from an opponent into a decided advocate of mercury. 



It lies out of the plan of this work to recount all the celebrated 

 modes of treatment by mercury, or to detail the minute directions en- 

 joined in the different methods, the number of pills to be taken daily, 

 the manner of raising and reducing the dose, etc. I admit that I re- 

 gard all sharply-defined routines not only as useless, but as absolutely 

 dangerous, as it induces inexperienced or careless physicians to treat 

 all varieties of constitution by the same formula. Experience has 

 taught that the efficacy of mercury, as a remedy against syphilis, does 

 not depend upon the form in which it is administered, whether as a 

 suboxide, an oxide, a basic salt, a chloride, or an iodide. It is equally 

 immaterial, as regards its efficiency as a remedy, how the mineral enters 

 the blood, whether it be by the intestinal mucous membrane or through 

 the skin. Hence our choice of a preparation of the drug should fall 

 upon one which, while an effective remedy, does the least possible 

 harm to the constitution. Since, however, the pernicious influence 

 which this mineral exerts upon animal life is susceptible only of a par- 

 tial explanation, we can merely diminish or avert the more subordinate 

 mischief to the intestinal mucous membranes, to which the use of mer- 

 curials gives rise, by choosing preparations which are the least irritat- 

 ing to them, or by not introducing the drug through the intestines at 

 all, but through the skin. If we deemed the action of calomel and 

 iodide of mercury upon the intestine, when cautiously administered, to 

 be very great or very pernicious, we should regard the reintroduction 

 of the " inunction-cure " as a most important step in the therapeutics 

 of syphilis; but, believing as we do, that these disadvantages are 

 trifling, and nearly always temporary, we cannot concur in the ecsta* 

 sies of those who see the beginning of a new era in the reestablish- 

 ment of the treatment of syphilis by mercurial inunction. I do not 

 mean by this that I look upon mercurial inunction as an improper 

 method of treating syphilis ; indeed, I very often make use of it myself, 

 especially in clinical practice, for it does all that mercurial treatment is 

 99 



