CHRONIC INFECTIOUS DISEASES. 



capable of doing; and I know of no objection to it, excepting that 

 salivation sometimes occurs more suddenly and with greater severity 

 in this than in other cures. As a rule, I follow the directions laid 

 down by Sigmund for this mode of treatment (which, compared with 

 the notorious and dangerous "grand inunction-cure" of Louvrier, 

 scarcely deserves the name of inunction), but I do not pedantically 

 hold myself strictly to Sigmuntfs precepts. The patient having taken 

 several daily warm baths, I cause a half drachm of blue ointment to be 

 rubbed into the skin, and, where there seems to be danger from delay, 

 I rub in a whole drachm. Upon the first day I apply it to the legs, 

 the second to the thighs, the third to the arms, the fourth to the back, 

 the fifth to the legs again, and so on. The precise order in which the 

 rubbings succeed one another is of course unimportant. At points 

 within the patient's reach he can rub the ointment in for himself; at 

 others, an attendant must do it. Each inunction should continue from 

 ten minutes to a quarter of an hour, and, before rubbing again, the 

 surface previously rubbed is to be washed with soap and water. The 

 temperature of the room should not be above sixty-five or seventy de- 

 grees Fahrenheit, and must be ventilated daily. There is no objec- 

 tion to the patient's changing his linen. It is useless to combine the 

 hunger-cure with the inunction-cure ; and it may even do harm. As 

 soon as the least trace of salivation shows itself, the treatment must 

 be suspended ; and any of the ointment still adherent to the skin 

 should be carefully removed by a bath, or by a thorough washing. 

 Should the healing of the ulcer or resolution of the induration come to 

 a stand-still after cessation of the salivation, or, in cases of secondary 

 disease, should the improvement not continue after the salivation 

 abates, I recommence the mercurial frictions, one or two of which then 

 almost always perfect the cure. I observe the rule of always suspend- 

 ing the treatment upon the occurrence of salivation, not only when the 

 mercury is employed in the form of ointment, but in all other forms of 

 mercurial treatment, and simply because I regard salivation as a sign 

 that a sufficient quantity of the mineral has been absorbed. It mat- 

 ters not whether the mercury be applied upon the skin, or to the in- 

 testines ; in either case a part only of what is administered is absorbed, 

 and the rest either remains upon the skin or else is expelled in the 

 stools. Hence, even if we could tell how large an amount of it must 

 be introduced into the system in order to effect a cure of a syphilitic 

 affection, we should still be ignorant of the number of inunctions of 

 ointment, or of internal doses of calomel, corrosive sublimate, or iodide 

 of mercury, requisite to produce the desired result. Salivation, of 

 course, affords no criterion of the amount of mercury absorbed, but it 

 certainly indicates that enough of the drug has been taken up to pro- 



