782 CHRONIC INFECTIOUS DISEASES. 



also become apparent why I have spoken of the customary formulary 

 of indications as inexact, although right on the whole. When an in- 

 dividual, sooner or later after his recovery from an indurated chancre, 

 begins to suffer from condylomata or from eruptions, I do not hesitate 

 to prescribe mercury, either by inunction with blue ointment, or in the 

 form of calomel, to be taken internally, without regard to whether the 

 indurated ulcer has already been treated by mercury or not, for at this 

 period it very seldom happens that, owing to the state of the patient's 

 general health, or to the form of the syphilitic outbreak (then usually 

 a lupus or an affection of the bones), or from both the causes combined, 

 the constitution of the patient has suffered much either from the effects 

 of mercury or from the disease itself. It is only in these very excep- 

 tional instances that I consider a mercurial treatment contraindicated 

 at the period when signs of constitutional infection first appear, for we 

 may be almost certain that, if the syphilis cannot be successfully eradi- 

 cated by means of mercury, its next attack will be of a most pernicious 

 character. On the other hand, where the constitution is still unim- 

 paired, the good effect of mercury in allaying secondary symptoms is 

 most striking. The condylomata, exanthemata, and sore throat, dis- 

 appear much more rapidly than an indurated ulcer does, when treated 

 by mercury, and it often happens that not only are the immediate 

 symptoms allayed, but a permanent cure is effected. There are other 

 cases, however, in which the disease only becomes latent and not ex- 

 tinct ; and where it reappears some time after the subsidence of the 

 first set of symptoms, or relapses, to use the common expression. The 

 management of these relapses varies greatly, according to their character. 

 When the disorder is slight, as when plaques muqueuses appear upon 

 the tongue, or when a few scattered pustules form upon the scalp, the 

 attack is manifestly of a less serious character than the previous mani- 

 festations have been, and it is not advisable to renew the mercurials. 

 Syphilis never subsides suddenly, but usually dies out slowly and 

 gradually, and we may always hope for this favorable termination 

 when the new symptoms are of a less serious nature than their prede- 

 cessors. Although I do not advise a repetition of the mercurials in 

 such cases, yet the patient should be most carefully watched, kept 

 upon a reduced diet, and preserved as far as possible from all other 

 noxious influences, until the last traces of the disease have disappeared. 

 The "privation-cure" (" Entziehungs-cur"), and even the Zittmanrts 

 decoction, are suitable remedies for such cases. At the height of the 

 disease, the action of these methods of treatment is merely palliative, 

 but when it is beginning to decline, they really seem to accelerate its 

 complete disappearance. On the other hand, when the relapse shows 

 that the disease has not assumed a milder character, if the new mani- 



