CONSTITUTIONAL SYPHILIS. 781 



in accelerating the heaxing of the primary affection. But, frequently, 

 just as the patient is beginning to recover from his eleven or twenty- 

 two days of fasting, purging, and sweating, the first crop of secondary 

 symptoms begins to develop. 



The preparations of iodine are altogether useless against the pri- 

 mary affections ; although certain physicians, who only practise in the 

 country, or in the smaller towns, and who, rarely having occasion to 

 treat syphilis, have an exaggerated dread of the effects of mercury, 

 place great confidence in iodine. During my practice hi Magdeburg, 

 I remember many cases, where travellers visiting the small towns, and 

 consulting the physician of the place for indurated chancres, afterward 

 came under my hands, suffering from the worst iodine eruptions that I 

 have ever seen. From the recipes which they brought with them, it 

 was often quite evident that the iodic exanthema had been mistaken 

 for a syphilide, and the worse it grew, the larger were the doses of 

 iodine prescribed. 



The secondary and tertiary symptoms of syphilis must always be 

 treated with the utmost circumspection and care, since there is no dis- 

 ease in which therapeutic errors can do such serious harm as in consti- 

 tutional syphilis. Mercurial treatment is nearly always of signal bene- 

 fit in the secondary and tertiary forms of the disease, and frequently 

 not only relieves and allays the symptoms as they arise, but some- 

 times brings about a complete and permanent cure. If, however, it be 

 administered again and again in unsuitable cases, instead of mitigating 

 the malady, it renders it still more pernicious, causing destruction of 

 the bones, degeneration of internal organs, and even endangering life 

 itself. The fact that horrible forms of syphilis are more rare than 

 they used to be, probably is partially because the " grand inunction- 

 cure " and other methods of over-treatment are being banished more 

 and more from the therapeusis of the malady, and that our employ- 

 ment of mercury is now more cautious and restricted. The indications 

 for mercurial treatment of constitutional syphilis have generally been 

 gummed up as follows : The secondary affections alone call for mer- 

 cury, while the tertiary accidents demand the exhibition of iodine. 

 Although this formula is somewhat inexact, yet, upon the whole, it 18 

 perfectly true. Mercurials are indicated in nearly all cases where the 

 affection belongs to the secondary group, while, in cases of a manifestly 

 tertiary character, they are generally contraindicated. To this rule an- 

 other is very properly added, that even in secondary affections mer- 

 cury is contraindicated, when it has already been used repeatedly with- 

 out success. The principles upon which the mercurial treatment of 

 syphilis is based may be deduced from what I have said above, re- 

 garding the course of the disease, and from the same remarks it wilJ 



