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1

ON THE

TREATMENT OF SYPHILIS.

ALFKED FOUKNIElt;

ipHTSICIAN TO THE LOtTECINE HOSFITAI., PABIS'.

TRANSLATED BY

R W. TAYLOK, M. D.,

FTTBQEOir TO THE NEW TOBK DISPENSABT, DEPABTMENT OE TENEBEAt AnB BK.IK DISEASES.

. \:REPBINTED from the new tore medical JOmNAL, AUGUST, 1872.3

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D. APPLETON AND COMPANY,

649 '& 661 BROADWAY.

. 1872.

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01^ THE treatment OE SYPHILIS/

PART I.

dN THE NECESSITY OP TREATING SYPHILIS, AND ON THE ACTION OP

MERCURY.

The peculiar opinious which have recently been put forth as to the treatment of syphilis have neither overturned nor even unsettled the results of the observation and laboV of four centuries. The trifling opposition which has . been raised against mercury, and in a more general manner against the methods of treating syphilis, has succeeded only in rallying a small number of converts, and has invoked only very feeble arguments to its aid, so that it will scarcely leave any traces of itself in the history of medicine. Mercury, to speak of it alone, has already encountered much more serious oppo- sition, and much more powerful enemies. In the sixteenth century guaiac, was vaunted against it ; but it failed finally to replace it, although for a time, in consequence of the powerful support of medical and non-medical writers, it did outrank it. In the present century the physiological school, which could not find enough invectives to apply to it, and which pro- claimed its extinction, did succeed in banishing it from use for a few years, but it has survived, and will survive, in con- sequence of the experience and observation of its undeniable virtues ; for, whatever may be said against it, it is a great and beneficial remedy, which cannot be injured by the prejudiced

‘ This article has recently appeared as a clinical lecture in the pages of the Gazette Rel)domadaire de Medecine et de Chirurgie. In its translation it has been found necessary, in consequence of its colloquial style in some places, to slightly alter the diction, and in others to leave out unimportant repetitions ; but every care has been taken to present the full meaning of the author in a clear manner.

4

ON THE TREATMENT OF SYPHILIS,

calilmnies of the one, nor by the unjust but conscientious ac- cusations of the otherSi

Previous to a sketch of the treatment applicable to syphi- lis^ I will consider the qilestion as to whether there is any ne- cessity to treat syphilis, or whether it is well to abandon the disease to its natural course ; and, before explaining the man- ner df using rhercury^ 1 will inquire whether there are any benefits to be derived frpm it^ and whether its introduction into the economy is attended with danger.

Prom what has been recently said and written, it would appear that syphilis was one of the most mild and benign of diseases. According to the Views of certain dontemporary physicians, a person would suppose that the disease cured itself in consequence of an inherent tendency thereto, and that it was only necessary to aid Nature in its spontaneous elimination of the virus by hygienic influences, and that hygiene alonej aided or not by tonics, as the ease might re- quire, would be all-sufl5cient, and that any special treatment, or any specific remedy against the diathesis, was both visionary and superfluous.

This is not at all exaggerated, as will be found by reading the recent discussions upon the subject^ in which statements like the following may be found, some of whiehj' by-the-way, are contradictory : V Syphilis cures itself spontaneously — whatever may be done, it has an inevitable evolution and duration ; the remedies usually prescribed for it tend neither to modify nor shorten its manifestations ; it is even injurious to treat itj for that only disorders it, and retards its natural evolution, and hinders it from running itself out spontaneously ; when left to its natural course, syphilis is mild, and it only occasionally results in serious lesions when an injurious treat- ment has been adopted for it; the tertiary manifestations need not be feared, for, on the one hand, they are very rare, if the physician has the good sense to allow the diathesis to run itself out spontaneously and naturally by its mild secondary manifestations, afid because, on the other hand, we possess a certain specific for them; mercury, the so-called specific excellence for syphilis, is not only inert, as it does not cure either the disease or its lesions, but it is even dangerous, be- cause it acts as a poison upon a system already poisoned ;

ON THE TREATMENT OF SYPHILIS.

5

finally, the expectant treatment pure and simple, aided by suitable hygienic measures, and according to the case by tonics, is the most rational and surest method that we can adopt for primary and secondary syphilis, indeed, even (as one of my colleagues recently said tq me) for tertiary syphilis. All these arguments resolve themselyes practically into this : Is it or is it not necessary to treat a syphilitic patient ? Is it or is it not beneficial that he should be treated ?

In order to answer a proposition thus stated, let us con- sider what risks such a patient runs, by stating his condition clearly, To what dangers, in fact, is he exposed ? Let us set forth his pathological balance-sheet, if I may speak thus — a balance-sheet which, if not certain and inevitable, is at least probable and possible. What can such a patient have ? What lesions is he liable to develop some day or other ? And these lesions, are they of such a character that it will be urgent or advantageous that they should be treated? What he can have are at first lesions without any renl gravity, but which are at least very disagreeable to some, particularly if they are visible; thus he may have cutaneous syphilides of various forms, very annoying syphilides of the mucous membranes, engorgements of the ganglia, alopecia, and onyxis. In the second place, there are more serious lesions, from the fact that some of them are yery painful ; they are — angina, cephalalgia, various pains with nocturnal exac.erbation, in- somnia, myalgia, pain in the joints, inflammation of tendons, periostitis, etc. Would not the possible anticipation of such troubles justify the intervention of treatment ? But we have really a third order of lesions which are much more serious, and which involve and compromise important organs. Only to cite the most common of this group, we will find — affec- tions of the eye, such as iritis, choroiditis, and retinitis, which are capable of impairing or eyen extinguishing vision ; sarco- cele, which may induce disorganization and atrophy of one or both testicles, and thus produce impotence ; gummy tumors, which often perforate and destroy the velum palati, and leave a double and revolting infirmity ; paralyses of the eye and face ; hemiplegia and paraplegia ; inflammations of bone, ca- ries, ozoena, flattening and loss of the nose, without speaking of the possibility of hereditary transmission, and of the introduc-

6

ON THE TREATMENT OF SYPHILIS.

tion of syphilis into the family circle. But this is not all yet. If we consult a manual of pathological anatomy, we shall find there described fatal lesions attributable to syphilis alone. The causes of death in syphilis are many and varied ; death by hepatic lesions, cirrhosis, and hepatitis gummosa ; death by lesions of the meninges ; by cerebral gummata, and syphilitic encephalitis ; by lesions of the spinal cord, which are more common than is generally believed ; by exostoses of the cra- nium or vertebrae ; by lesions of the kidneys, of the larynx, and of the lungs, and more rarely by lesions of the oesophagus and rectum ; death by consumption and progressive cachexia. These are, in short, the possible consequences of syphilis, and such is the perspective offered to a person who contracts this contagion. Dare we call a disease benign which can end thus? Can a disease be called benign which is fraught with such serious accidents, and whose pathological anatomy is so rich and varied ? Dare we tell persons afflicted with this disease to leave it untreated, “ to let things go,” and to wait patiently the possible results of such an infection without warning them of it?

How suppose for an instant, bearing in mind the tableau which I have carefully sketched, a patient recently contami- nated, suppose him on his own account looking the inter- minable series of accidents of syphilis squarely in the face, and then ask him if there was any reason why he should not try by every means to prepare himself for such events, or whether he preferred to await results. What would be his answer ? It would be that he would not under any circumstances think of such a thing as of standing the brunt of such a disease ; that it would be foolhardiness not to endeavor to protect himself ; and that he was firmly resolved to try every medicine and remedy, and every doctor, in order to be cured ; in a word, that he wished to he treated^ and he would be treated.

How, we physicians, who are more enlightened than this patient, as to the nature and consequences of syphilis, would we reason otherwise than he did if we were victims of the dis- ease ? Certainly not. Simple common-sense, which is greater than all systems and all theories, says that, when a person has syphilis, he should get rid of it, and not allow it to remain in his system.

ON THE TREATMENT OF SYPHILIS.

But here some of our adversaries would interpose bj saying : “ Undoubtedly you would be right in fearing and wishing to treat your patients, if syphilis invariably ran the course yop speak of; but there are two forms pf syphilis, the one severe {forte) and grave, the other mild {faihle) and benign. Y ou are right in treating the severer cases, but for the mild cases treatment is wholly unnecessary.” But I will reply : Have you the means of pronouncing ofi-hand {d’em'blee) upon the nature of a case of syphilis ? Do you possess any faculty by which you can form a prognosis as to the future of a given case of syphilis ? Can you assert, at the outset, that one patient will suffer severely by syphilis, and that another will be rela- tively spared * If you are able to make this intuitive {pre-. visionnel) diagnosis upon truly scientihc principles, we would consent not to treat those of our patients for whom you pro- nounced a mild course of syphilis, for we do not treat them for pleasure but for their own benefit, and, before submitting them to the dangers of an expectant treatment, we would de- mand of you something more than tlimsy and theoretical as- sertions ; we would require, in order to be convinced, serious evidence, based upon scientific certainties, and supported by a number of observations, clearly and precisely drawn, other- wise we owe it to our patients and to ourselves to treat them, How, do we possess, in the preseut state of our knowledge, any absolute, or even probable, criterion which enables us to foretell as to the future of syphilis, and which authorizes us in saying positively, such a case will be mild, and such an- other severe? This is the key-note of the question. Some physicians are led to form a prognosis of syphilis by certain characters of the initial lesion, and of the first eruptions which follow it, and they think they are authorized in drawing the following conclusions : A mild syphilis is one which follows the category of secondary lesions, which begins with a super-, ficial erosion only slightly indurated ; and the secondary period of which is ushered in by a mild crop of eruptions, followed by other mild crops, with a long interval between each. .On the contrary, a severe syphilis is to be looked for when it has de- rived its contagion from an initial lesion, which has ulcerated, or is markedly indurated, when the first crop of eruptions is of an ulceratiye and suppurative character, and which is followed

8

ON THE TREATMENT OF SYPHILIS.

by other crops of a similar character at short intervals, hfone of these statements have any real value. ISTone of them warrant the physician in prophesying as to the ultimate evolution of a given case of syphilis, as to whether, it will he mild or severe. Under these circumstances would we be warranted in saying to one patient, It is necessary that yon should be treated, as you are in daqger;” and to another, “it is not necessary to treat you, as you need fear nothing.’^ To say this would be to prophesy q-s to the future, and to promise a patient a mild course of syphilis, and to give him a dangerous consolation, and a security of which he would sorely repent some day ; and to refrain from treating him, and to leave him to the chances of an unknown future, would be to expose him to serious dam gers upon the strength of uncertain statements and visionary assurances. In short, then, We do not possess the elements of certainty, or even of probability, in formulating ah ovo a prog- nosis in a given case of syphilis ; and, as such is the case, prm dence dictates to us to urge in every case a proper treatment, in order to shorten, if possible, the effects of the diathesis for the present and for the future. This is dictated by common:, sense, and is confirmed by observation and experience, in spite of all theories,

The necessity of treatment being thus admitted, its appli- cation remains. To what treatment shall we resort ? What remedies shall we employ ? And especially upon what form of medication shall we place our patients ?

According to past and present experience, mercery is the most valuable remedy for syphilis, and therefore claims our attention first. There are, however, two questions to be answered before we prescribe it •

1. ' Is it deleterious to the patient, and can it in any way become injurious to him?

2. Can it be of benefit to him ?

First Question. — Is it deleterious ? Is it liable, in any way, to aggravate the condition of the patient, and to add another danger to that of syphilis ? This is a very important and very practical question u]ion which you will be asked daily by your patients, and to which it is necessary to give at once an exact, scientific, and peremptory answer, for mercury has a bad repu- tation, and is mistrusted by the public. It is a remedy whose

ON THE TEEATMEKT OF SYPHILIS.

9

name is a terror, and for which all classes of society, the highr est and the lowest, entertain an inherent horror. When you prescribe it for a patient, the following stereotyped questions will immediately arise, as they are in everybody’s mouth: “ But, doctor, you are prescribing mercury for me ! So good-by to my teeth and hair, and will you warrant that my bones don’t 4®cay ? How will you get this mercury out of my system ? ” I will not, again, endeavor to disprove all the calumnies charged against mercury. It will be remembered that it is said to produce loss of the teeth, alopecia, necrosis, nodes, nervous symptoms of various kinds, anaemia, cachexia, and almost all the lesions due to syphilis, particularly the ter- tiary lesions. Certain authors have almost come to the con- clusion that syphilis does not produce any bad results, but that mercury does. These, however, are only exaggerations and absurdities, to which it is unnecessary to reply, as they have been refuted hundreds of times, and I mention them only to stigmatize thenj as ridiculous. It is almost unnecessary to say that mercury, administered in a therapeutic dose, as we prudent physicians do nowadays, never produces the results of which it is accused, It is undoubtedl}" true that even in these doses mercury is liable to produce certain disturbances which are necessary to be understood. We will study these disturb- ances, and endeavor to determine whether they are of suffi- cient gravity' to contraindicate the use of mercury, or to cause it to be discarded in the treatment of syphilis.

There are three classes of phenomena which are to be feared while administering mercury to syphilitic subjects ; they are —

1. Etyalism (stomatitis and salivation).

2. Qastric and intestinal disturbances.

3. Impairment of the nutrition of the body.

1. Ptyalism. — Mercurial stomatitis is a well-known con- dition, sometimes even produced by inunctions or by the in- ternal administration of mercury, but it is a danger which can be easily avoided. It is only necessary to urge watchfulness as to the action of the remedy, and to give it in such doses and iu such forms as not to irritate the teeth, and especially to suspend its use as soon as the mouth becomes slightly sore,

10 ON THE TREATMENT OF SYPHILIS.

for mercurial stomatitis 4oes not burst oi;t on the patient like a thunder-clap ; it announces itself^ and lias a premonitory period of irritation of the gums, in which the physician can take measures to prevent the inflammation, Always' suspend the use of naercury as soon as the mouth becomes tender, and administer chlorate of potassa in time, and you will almost to a certainty save the patient from serious consequences. You may judge of this by observation of my service. We always have here niore than sixty syphilitic women under a mercu- rial treatnaent, and, if mercurial stqmatitis were an inevitable result of mercury, it would occur daily in our wards ; blit it is almost unknown. Undoubtedly you may find, on occasions, some of our patients presenting a slight irritation of the gums ; but we interfere in time, and you will never see here an example of that frightful stomatitis which ulcerates the gums, causes an incessant flow of saliva, and even threatens to disorganize the maxillae, In a word, then, with prudence and watchful/ness (this is the whole secret), we can readily avoid any ptyalizing effects of mercury. Stomatitis is a visionary danger, if we make it our duty to \yatch our patients carefully ; consequently it does not constitute a contraindication to the use of mercury.

2. Gastric and Intestinal Disturbances. — It is certain that, in some cases, mercury is badly borne by the stomach and by the intestines. This is to be noticed more frequently in women than in men, especially in women who have a fair skin and who are delicate, lymphatic, and dyspeptic ; but this in- tolerance is very rare, and can be prevented, ameliorated, and even successfully overcome. In order to do this, it is necessa- ry to suit the dose to the* degree of tolerance of the stomach, or to combine some modifying agent, such as opiuuo, quinine, or bitter tonic, with the mercurial, or even in some oases to change the form of mercurial. Should it be inipossible to ad- minister mercury by the mouth, there remain other methods, such as inunction and subcutaneous injection, by which irrita- tion of the digestive organs is avoided.

The possibility, then, of digestive disturbances is far from being a sufficient reason to contraindicate the use of mercury in syphilis.

Oisr THE TEEATMENT OF SYPHILIS.

11

3, Impairment of the Nutrition of the Body. — It has been said that mercury induces serious nutritive disturbances ; that it causes by its poisonous action a chloro-ansemia, and that it detibrinizes the blood. There is a degree of truth in this, as some patients do experience this debilitating {anemiante) efiect of mercury ; but this is especially (I might almost add only) when we misuse the remedy, when we give it in excessive doses, or when we use it for top long a time. This, however, is not a danger which suddenly overtakes a patient, for we see its development, and it is easy to avoid it, either in suspending the use of the drug, or by substituting some preparation of iodine, or by combining with it tonic remedies and hygienic measures. Moreover, is not this debilitating influence of mer- cury exaggerated? We treat here flve hundred cases every year with mercurials, and out of this number we certainly do not observe more than an average of flve per cent, in whom these disturbances are prqduced. ISTearly all the women in our wards bear mercury admirably ; this is the case with the youngest, and even chil(^en. Almost all of them take the remedy several weeks continuously, sometimes even for months (with necessary precaution, and short interruptions), without experiencing th.e least ill effect upon their health; some even grow fat, and present a very enviable appearance. Do we not see that our private patients, who enjoy a better re- gime and hygiene, undergo a mercurial treatment without ex- periencing the least ill effects, without even hnowing that they take it {fen apercevbir)., as they say, so that they are astonished and have some doubts as to the efficacy of a treatment so mild ? According to some observers, mercury possesses tonic proper- ties, and it has been said to cause rabbits to fatten ; I cannot vouch for this fact, as I have not seen it ; but I can affirm, by experience, that in every case in which it is administered in suitable doses, methodically and watchfully, it is a remedy which is admirably well borne by the economy in the vast majority of cases.

Then this third danger of the disturbances of nutrition by mercury is more theoretical than clinical. This influence shows itself only very rarely, or in cases of careless adminis- tration. Again, we find that this is not an arguipent to pp-

12 ON THE TREATMENT OF SYPHILIS.

pose to a mercurial treatment, seeing that it really possesses advantages which we will consider farther oq.

These, then, are the drawbacks in the use of mercury, and it is only attended with these three inconveniences (for 1 will not call them dangers), which are generally easy to avoid, to treat, and to shorten. Ko other accident, I reiterate, results from its administration prudently instituted, accurately meas- ured, and watched with care, Qught we, theu, as sorqe of our confreres do, to endeavor to exclude n^ercury from our thera- peutics % If that were the case, it >vould be necessary to give up prespribing almost every remedy, for, when improperly used, it can do mischief. In unskilled or ignorant hands, opium, qui- nine, arsenic, nitrate of silver, aqd digitalis, are liable to pro- duce bad results. The same is true of less powerful agents, which, when badly used, are apt to become dangerous. Take, for example, the mild Yichy waters, whiph, when taken in ex- cess and foolishly, becorne poispnous. Elyery year, we hear of persons haying died at Yiphy, in consequenpe of drinking the waters without limit and direction.

Let us, then, reason more intelligently than our adversa- ries, and let us come to this conclusion ; If mercupy can be- come dangerous, it is bepaqse it is active, aqd, if it is active, let us know how to profit by its activity, in such a w«.y as to render it useful ; fqr it would bp foolish to pondemn it from . the simple fact that it possesses virtues which we pan abuse, or that, when if is badly administered, it is capable of doing harm.

The question of the possible injqrious ejects of mercury being answered in the negative, let us consider the second point, which is more delipate ap4 more difficult. The ques- tion is. Can mercury be useful in syphilis 1 Every possible and imaginable answer has been made tq this question. Some resolutely refuse to accord to meroury the least curative power over syphilis, and say that it aggravates rather than cures it ; others go to the other extreme, and cannot indqlge sufficiently in praise and in enthusiastic panegyrics upon merpury, which they claim is a specific. They would make you believe that mercury was an antidote created against syphilis. Their cqur fidence in it is unlimited. According to them, it would sepni

ON THE TR:feAT]VtE]fT OF SYEHILIS.

13

that a pound of this metal, and a quantity of mercurial pills, were sufficient to annihilate syphilis, and forever rid us of this fotmidahle enemy. Let us not be deceived, for these fanatics do more harm to and with mercury than its most violent ene- mies do ; they play the part of the “ dangerous friend ” of the novelistj who does more harm than a wise enemy.” In order to arrive at the truth of these contradictory opinions, let us endeavor to answer the following i:][uestions :

1; Has mercury a real and evident action upon the Visible lesions of syphilis ?

2. Has mercury an immediate and a remote action upon syphilis? Does it shorten its course, and does it lessen the severity ofj or prevent, its later lesions ?

First Point. — Let us consider the first c[uestion: Suppose we have before us a patient presenting various s^hilitic lesions, and that we prescribe nlercury for him. Does this remedy exert any manifest influence over these accidents J does it shorten their course, and cause them to disappear sooner than they would if we gave Un inert femedy, or no remedy at all ? To this, observation replies emphatically in the affirmative, that mercury does exercise an evident iti- fluence upon these lesions, renders them milder, arid causes them to disappear sooner than they would if left alone, and finally cures them iii such a manner as to leaVe no doubt of its action; The adversaries of mercury say this is a delusion, and that We attribute to the influence of mercury what is really the result of timej and of the natural tendency of the disease. They say that syphilitic lesions are not of long dura- tion, and that they disappear sponte sud after a cOrtain time without the least medication, but upon one person they rc’- main a longer time than upon another ; that this is the pecu- liarity of these lesions, and that we do not know why. But they are certaiii that mercury has no influence, and that with it or without it they run their natural course. To this it is easy to reply that the syphilitic lesions, particularly ^le secondary, disappear spontaneously under the influence of time, and the natural course of the disease. We know this from the fact that, in time past) there have been patients who were negligent or unconscious of their disease, and who

14

ON THE TEEATMENT OF SYPHILIS,

have not been treated, and upon whom various syphilitic lesions have disappeared spontaneously. But let us establish a comparison. What time is required, on the one hand, for the lesions of a given case of syphilis to disappear spontane- ously ? And, on the other hand, what is the duration of these lesions when they are treated by mercury ? If they will give us their average, we will give them ours.

Now, this comparison has been made seriously, and the result is, as we should expect it to be, in accordance' with the experience of our fathers, and with the observation of four centuries. It would be useless to present the lull details of the casej so we will take a single illustration : Suppose, by way of comparison of the expectant and mercurial treatments, a well-marked case of lenticular papular syphilide. In what time would it disappear, if left to an expectant treatment? Our opponents would say several months, five to six on the average.

Now, with mercury, this eruption will disappear in from five to six weeks, in two months at the most ; and, more than this, it is wonderful to observe that after a fortnight of treat- ment the influence of the mercury is evident, for the syphilide begins to become paler and to grow smaller* There is another argument in favor of this evident action of mercury, which certainly carries conviction. It sometimes happens that syphi- litic lesions have not been diagnosticated as syphilitic, as, for instance, when a scaling syphilide {syphilide psoriasiforme) is mistaken for a case of dartrous or arthritic psoriasis, or it happens that a neuralgia due to syphilis is regarded as an ordinary neuralgia. Now, what happens in consequence of such an error ? The so-regarded psoriasis is treated for months by arsenic and alkalies, and is not cured ; the neuralgia is treated for a long time by opium, quinine, and the bromides, but still it persists. Why is it, then, that this psoriasis is not cured, and that the neuralgia persists, since it is natural, as our opponents say, for every syphilitic manifestation to disap- pear spontaneously? But this is not all, for, during this time, the physician, having been enlightened by the want of success of his treatment, suspects syphilis as the origin of the troubles, and he prescribes mercury as a touch-stone, when the psoriasis

OlNr THE TEEA.TMEHT OF SYPHILIS;

15

disappears in a few weeks, and tlie neuralgia is ameliorated in a few days.

What is the secret of this sudden and remarkable cure, ot which every physician has seen instances? Time and hlature cannot here be alleged as the cause, for they have had every opportunity before the institution of a mercurial course. Is it simply chance or a coincidence? ISTo one can believe that this chance or coincidence could reproduce itself always under similar conditions. Is itj then, possible to ignore the therapeutic effect, or to deny the manifest curative action of mercury ? To deny this would be to place ourselves in de- tiance of logic and common-sense, and to challenge beforehand and with foregone conclusion the therapeutic action of mer- cury, than which nothing is more manifest and convincing. The action of mercury, then, upon syphilitic manifestations is an acknowledged scientific fact which has been observed by physicians of all countries and of all ages.

Second Point. — Does mercury exert an immediate action upon syphilis ? Does it act upon the diathesis in such a man- ner as to modify it, or to lessen its morbific element, to dilute it, as we say. of poisons, so that it mitigates or prevents the later manifestations ? Let us put the question practically. A syphilitic patient is troubled with various manifestations, and is treated by mercurials. Now, mercury, we know, will act well upon the visible manifestations, but will it do any thing else ? Will it affect the source of the lesions, that is to say, the diseased Will it modify the element of the disease, and does it have the power of controlling the diathesis in its evo- lution, of preventing other lesions, of rendering less severe those which in spite of it will appear ; in a word, of jprotect- ing the future after having relieved the present ?

Now, this present and future action of mercury upon syphilis is a point which is most frequently and most warmly contested. A large number of physicians, while they accept the fact of the undoubted action of this remedy upon the lesions of syphilis, refuse to acknowledge its power in modify- ing the diathesis. “ Yes,” they say, “ mercury does shorten and cure the manifestations of syphilis, but it acts only on the manifestations and does not act upon the disease. It clears

16

OK THE TeHatmeHt 6e syphilM.

off the skin {il hlanchii)^ and that is all. The proof,” they add, “ is, that the manifestations, for which mercury has been given, disappear and are followed by others,” In a word, it does not cure, it is simply a palliative of existing lesioils, it i's not ah antidote or a counter-poison of syphilis.

I believe, on the contrary, that the action of mercury is not limited to the lesions, but that it affects the disease. I believe that it, on the one hand, cures the lesions of syphilis, and, on the other, when administered in a manner which I will describe, it exerts upon the whole disease an influence genei’al, prophylactic, and curative. And my opinidri on this, so essential and impWtant a pointj is not a mere ihapression or conjecture; it is based upon sound clinical arguments; which I will bring forward.

A priori^ I can scarcely QohcCive how it is possible that mercury, which exercises an undoubted action upon all the lesions and symptoms of every tissue, could possess this action, if it had no influence upon their cause, which is the disease. I Can well understand how opium relieves a pain without touching its cause, and how digitalis alleviates affections of the heart without influencing the lesions of the valves ; but my mind absolutely fails to understand how a remedy can modify all the results of a poison, and can follow this pbison in all the tissues in which it lurks, how it caii cure the varied and successive manifestations of a diathesis, without affecting in any degree the poison which is the real cause of all the morbid processes. This, however, may be beyond my com- prehension, so I will seek elsewhere for elements of convic- tion. Now, in clinical observation, we can place side by side cases of Syphilis treated and cases of syphilis not treated. In order, then, to determine the action of mercury, nothing can be more convincing than this comparison, so let us institute it.

In the first place, what do we daily observe upon syphi- litic patients who are treated carefully, strictly, and persever- ingly? What lesions do they present? How does syphilis show itself upon them ?

Syphilis with them is a very slight affair, and I certainly do not exaggerate in stating, after a careful perusal of my notes, that, in ninety-five times out of a hundred at the least.,

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