CONSTITUTIONAL SYPHILIS. 777 



duce a decided impression upon the system. That the one effect, 

 namely, the salivation, is almost always accompanied by another, the 

 improvement of the syphilitic lesion, follows even from the erroneous 

 belief entertained by many old physicians, that salivation is a beneficial 

 crisis. Notwithstanding that I regard salivation as a valuable guide in 

 the treatment of syphilis by mercury, just as I regard dilatation of the 

 pupil as valuable in treatment of epilepsy by atropin, showing that 

 the dose administered is sufficient, and although I do not regard the 

 appearance of slight traces of salivation as an objection to such method 

 of cure, yet I consider it extremely unsafe when we have not the op- 

 portunity to suspend the treatment before the salivation has made any 

 considerable progress. Salivation has no curative effect whatever, and 

 I always seek to allay it by administration of chlorate of potash, either 

 in solution ( 3 j to water ij), a tablespoonful of it to be taken every 

 two hours, or else in the form of pastilles. If, when in doubt whether 

 to continue the cure or to discontinue it, we decide to give one or two 

 more doses of calomel, corrosive sublimate, or iodide of mercury, we 

 run far less risk, by so doing, of producing a severe sore mouth, than 

 if we rub in another half drachm of mercurial ointment. 



The great objection to the inunction treatment, that in it we 

 cannot say how much of the mercury enters the body, does not 

 exist in using subcutaneous injections of corrosive sublimate. In 

 this treatment, which of late has run a strong opposition to the 

 inunction treatment, and has to some extent supplanted it, we may 

 even more certainly control the dose than we can in internal adminis- 

 tration, and we save the gastric and intestinal mucous membrane just 

 as completely as we do by the inunction treatment. 



I acknowledge that I began the employment of subcutaneous 

 Injections of corrosive sublimate with a certain distrust, and that I did 

 not resort to it till it had been urgently recommended to me by 

 various persons. I feared that the pain and inflammations, with 

 partial necrosis of the skin that it must cause, would be out of 

 proportion to any possible benefits arising from its use ; indeed, it 

 seemed doubtful to me if this inflammation and necrosis of the skin 

 would not interfere with or entirely prevent the absorption of the 

 remedy. Experience soon taught me better. If sufficiently dilute 

 solutions are employed, the pains are perfectly bearable and of short 

 duration ; by the same precaution, severe inflammations and necrosis 

 of the skin may be avoided. The absorption of corrosive sublimate 

 appears to follow subcutaneous injection just as quickly as that of 

 morphine does ; in short, the advantages seem to outweigh the objec- 

 tions so much, that any practitioner, who has treated his syphilitic 

 patients for a short time with subcutaneous injections of corrosive 



