CHAPTER XVIII.

GENERAL OBSERVATIONS ON THE TREATMENT OF SYPHILITIC DISEASES.

THE deep-rooted prejudice in favour of the specific powers of mercury, in the treatment of all the varieties of syphilitic diseases, having now (except in the minds of a few individuals whose early predilections counterbalance a more matured experience) been extirpated by an overwhelming mass of well authenticated evidence arrayed against that antiquated and unphilosophic doctrine, a writer at the present day is spared the labour of collecting from statistical records materials to form the foundation of an opinion now so universally conceded. The reports of the Army Medical Board, the subsequent united testimony of the surgical staff of the British army, the investigations of Carmichael, Rose, Guthrie, Hennen, Ricord, Bacot, Green, Mayo, together with a host of others, are now so familiar to professional readers, that further allusion to these particular researches would be deemed superfluous.

More recently, however, Dr. Graves has undertaken the laborious task of collating the opinions of German practitioners, including the results of both methods of treatment in the great hospitals of Hamburgh, Berlin, and Vienna. The returns from the hospital at Hamburgh, under the superintendance of Dr. Fricke, were accurately tabulated by his assistant Dr. Günther, and the following facts were elicited. As regards the time occupied in the cure of these affections, under the mercurial and non-mercurial modes of treatment, the precise relative proportion could not be satisfactorily ascertained; but the balance was stated to be in favour of the latter. It was likewise proved that in those patients where mercury had been employed for the cure of the primary sores, nearly one-third were attacked with secondary symptoms. On the other hand, the results of the simple treatment without mercury (which consisted in attention to cleanliness, rest, a restricted diet, and, in plethoric subjects, general blood-letting), are reported to have exceeded Dr. Fricke's most sanguine expectations. A cure was effected in a much shorter period than when mercury had been used; the patients left the hospital with much healthier looks; and when relapses took place, the symptoms were of a much milder description than those which presented in individuals who had been originally subjected to the influence of mercury. When constitutional symptoms supervened, they were speedily cured

by a decoction of woods and nitric acid. Caries of the bones was never observed to occur as a complication, where the patient had been treated without mercury; but in cases where a contrary line of practice had been adopted, caries of the nasal, palatine, maxillary, sternal, and tibial bones was frequently met with.

In the Charité hospital at Berlin, where Dr. Struntz treated seventy-four cases of primary disease, all recovered without the use of mercury, and in none did constitutional symptoms follow. A cure under those circumstances was accomplished two, and sometimes even four weeks sooner than when mercury had been employed. Again, in the great hospital at Vienna, all primary affections are treated without mercury; secondary symptoms of a mild form occur in one out of every nineteen cases; the phagedenic varieties of syphilis, either in their primary or secondary forms, are seldom met with; and caries of the bones is a disease quite unknown. Here, however, it will be necessary to observe that a vast proportion of the so called primary affections alluded to were condylomata-growths which, we have previously seen, are more amenable to local than general treatment. This fact, to the minds of English surgeons, will more satisfactorily account for the rarity of constitutional symptoms, than the deductions drawn by German practitioners founded upon the nonmercurial treatment.

From 1831-4, 5,271 patients had been treated in the Strasburg hospital under M. Kayser; for the most part, on the non-mercurial plan. The number of relapses and secondary affections, in which cases only mercury was administered, was very small; in no instance was caries met with.

From the observations of M. Desruelles, made at the Val de Grace, extending over a period of ten years, and instituted upon 8,810 patients, he has come to the conclusion that the simple treatment should form the basis of all rational practice; but should the ulcers exist for the space of twenty or thirty days without showing any disposition to heal, mercury may then be had recourse to in order to effect a cure.

Dr. Roe has drawn up a return of the venereal patients treated in the 38th Regimental Hospital, from the 11th of June, 1836, to the 15th of November, 1837; and out of 231 individuals under his care, of whom 87 had chancres and 36 bubo, there was only one case of secondary syphilis. The treatment was of the simplest description, consisting of rest in the recumbent posture; the free use of purgatives; the application of lint, constantly moistened with a solution of sulphate of copper, to the primary sore; and restriction to a milk diet. The average time required for the cure of the patients under Dr. Roe's charge was a little over fifteen days. No mercury was employed. These results are particularly valuable, as they are at

tested by Dr. Graves, who had an opportunity of watching the effects of this special line of treat

ment.

It would be easy to multiply evidence to demonstrate the curability of all the varieties of syphilitic affections without the aid of mercury; but the foregoing references to researches of modern date will, I trust, suffice to establish the authenticity of the fact. To the testimony of others I would only add, that I have fully satisfied my own mind on this subject in the wards of our Lock Hospital.

We, therefore, accord our thanks to those army and continental surgeons, who, by their indefatigable and scientific exertions, have assisted in wresting from the grasp of the charlatan a class of diseases so indigenous to every country, and so prevalent in every climate,-diseases, too, which in their origin and progress recognise no distinction as regards age, sex, or temperament; causing the death of the fœtus while yet in the womb of its mother; exhibiting their characteristic marks in the early months of infantile existence; infusing their poisonous qualities into the blood of the adult, whether male or female; and stereotyping with indelible characters the closing scene of the veteran in debauchery. We perceive that a revolution has been effected, which to an almost incredible extent must redound to the sanatory condition of the nation, and consequently prolong the term of human life. We acknowledge that these