THE 
Importance of Local 
Mercurial Treatment in Syphilis. 
BY 
A. H. Ohmann-Dumesnil, A. M„ M. D, 
Pi of essay of Dermatology and Syphilis. SL Louis College of Physicians and Surgeons 
Reprinted from the St. Louin Medical and Surgical Journal, June, 1885. 
ST. LOUIS: 
MEDICAL JOURNAL PUBLISHING COMPANY 
2622 Washington Avenue. 
1885. The Importance of Local Mercurial Treatment in Syphilis.* 
It is rather a safe assertion to make that there is hardly a 
physician who does not regard himself as perfectly competentto 
take charge of a case of syphilis. Since the time when the 
French called it the " Neapolitan disease," we have historical 
proof that mercury has been employed in its treatment and it 
stands to-day as the "sheet anchor" of the physician when deal- 
ing with this widespread disease. Not many years ago, it was the 
almost universal custom to require patients to employ mercurial 
inunctions. Latterly, however, since the advent of a numerous 
crop of manufacturers of pharmaceutical preparations, every drug 
of the materia medica has been converted into a more pleasant and 
palatable shape. The public in general has not been slow to learn 
this and the result has been a marked one in the manner of their 
administration. For the treatment of syphilis there have been 
prepared small pills or parvules, containing accurately measured 
amounts of the different mercurialsand of an elegant appearance. 
So that when a patient is to be prescribed for one of his first re- 
quests being to have the medicine in pill form, if possible, as it is 
so convenient, these preparations are ordered. It is on this ac- 
count and, of course, on account of other reasons that, of late, 
syphilis has been to a large extent treated almost exclusively by 
means of internal medication. 
Wo know that syphilis is a so-called constitutional disease, in- 
fecting the system at large, and that all the lesions which make 
their appearance are but the outward manifestations of a cause at 
work internally. It is good logic to argue that if the cause be 
removed, the symptoms produced by it will also take their depar- 
ture. But, clinically, we find that although this is true, it is at- 
tended by one disadvantage which is, that a greater length of time 
* Read before the Missouri State Medical Association, May 13th, 1885. 4 
is expended and a larger amount of medicine employed than if the 
treatment was also local. 
It is a matter of daily observation, almost, to see cases of 
syphilis, treated by competent men, where the patients become 
discouraged simply because they perceive no improvement in the 
local lesions. They not only become discouraged but ofttimes 
life becomes a veritable burden from the fact that they carry upon 
visible portions of their bodies the imprint of their disgrace and 
imagine, not without some cause, that every one they meet sus- 
pects the presence of the trouble with which they are afflicted. 
The natural result in such a case is, that they apply to some one 
else and either improve under the use of local applications or, re- 
ceiving the same treatment as before, seek out some new phy- 
sician or go to some vaunted resort for the treatment of such 
cases and there, under high doses internally and vigorous exter- 
nal applications, improve temporarily and thus add fame and 
renown to a locality but little deserving of them. 
This state of affairs is not to be attributed so much to the ig- 
norance of physicians as to the fact that, of late years, writers 
and teachers, prominent in the profession, when speaking of the 
treatment of individual cases or of syphilis in general, seem to 
have taken it for granted that even the merest tyro in medicine 
is acquainted with the treatment of the pox ; and it would be 
difficult to find one who would be willing to acknowledge that he 
was not. Basing themselves upon this, their descriptions of treat- 
ment have been but hasty generalized sketches, the details 
being omitted and no especial stress laid upon the local applica- 
tions. From this has gradually grown the idea that mercurials 
administered internally are not only all that is necessary, but 
that they are as efficient as if accompanied by local mercurial 
treatment, a fallacy which is susceptible of being controverted by 
a single experiment. 
This subject of local mercurial applications in syphilis is to- 
day attracting more attantion than it has done heretofore and a 
great deal of light has been thrown upon it, in consequence of 
this. Numerous experiments have been made with various pre- 
parations of mercury and both the endermic and hypodermic 
methods have been resorted to. Ointments of various salts of 
mercury have all acted favorably; some more so than others, 
either by producing less local irritation or by acting more rapidly. 
And it is the testimony of many that one of the best endermic 5 
preparations is the freshly made grey ointment. Calomel oint- 
ment also has its ad vocates, whilst the oleate of the oxide of mer- 
cury is considered irritating to quite a considerable degree. The 
best preparation, as well as the most cleanly for this purpose, is 
the oleate of mercury in which the excess of oleic acid has been 
removed. By combining it with olive oil, in the required strength, 
a preparation is obtained which, for efficiency and ease of appli- 
cation combined with cleanliness, is unequalled. It further has 
the advantage of being unnoticed, attracting no attention by its 
presence as it is sufficiently transparent to permit the skin to 
show its proper color. In regard to the local hypodermics, 
various preparations have been employed, corrosive sublimate 
being perhaps in the front rank in regard to the frequency of use. 
Prof. Kobner, of Berlin, speaks highly of formamide of mercury, 
whilst others are equally as high in their praise of the tannate. 
Zeissl, Lewin and a number of others seem to be well satisfied 
with the bichloride, a number of French observers are enthusi- 
astic over the good effects observed in the use of the albuminate, 
and there really seems to be but very little choice in the selection 
of these different forms. In.regard to lotions of corrosive subli- 
mate, of the formamide, of the tannate or of other salts, little is to 
be said as such a limited quantity of the drug comes in contact 
with the lesions as to affect them only to a small degree. Be- 
sides this, there is a lesser probability of absorption than when 
combined with more fixed agents such as the ointments or oils. 
For very light lesions and as a general detersive agent in the 
eyphilodermata, (Ertel's mercurial soap can be employed. The 
benefit to be derived from it, in a therapeutical point of view, is 
but small; yet, as soap must be used whatever advantage is 
gained from this particular kind is so much in the patient's favor. 
J. D. Stiefel's sublimate soap contains one-half per cent, of the 
bichloride, in accordance with the suggestions of Prof. Bergman, 
of Berlin, and is perfectly odorless, and acts in the same manner. 
Of course, one of the interesting questions in connection with 
the subject is, in what cases or to what lesions should these ap- 
plications be made? And it may be answered, in general terms, 
that they are applicable to all the forms of the syphilodermata 
as well as to the initial lesion. Should the chancre be recognized as 
such and present no unusual appearances, it is hardly necessary 
to use any but simple detergent measures. Should it, however, 
take on a form or process inclined to be destructive, the local use 6 
of mercury will not only limit this process but it will also hasten 
repair. The eruptions accompanying the secondary stage are all 
troublesome to a greater or lesser degree, with the exception of 
the roseola or erythematous syphiloderm. This latter is gener- 
ally so light in character that the patient will have but little or 
no concern respecting it and frequently be entirely ignorant of 
its presence unless his attention be particularly directed to it. 
Authors, as a rule, recommend us not to make local applica- 
tions to this form, as the internal use of mercury is sufficient to 
cause it to disappear. But, although this may appear to be a very 
valid reason, the external use of some m'brcurial preparation has 
this advantage, viz., that it prevents tire subsequent pigmentation 
or diminishes its intensity considerably. In the papular, tuber- 
cular, squamous, and ulcerative forms we have a valuable adju- 
vant to the internal medication in the use of local mercurials. 
And not only in these but even in gummatagood results are fre- 
quently seen ; whilst in the moist papules or condylomata it will 
often happen that these lesions will become intractable and not 
amenable to the most energetic internal treatment whilst they 
speedily yield to local medication. It is unnecessary to enter 
here into a detailed account of the various manners in which to 
employ these local measures, nor would it be within the province 
of such a limited paper to give minute descriptions of the differ- 
ent local conditions requiring such treatment, and in what parti- 
cular stages it would prove most beneficial. . V 
There is one point, however, which ought not to be omitted 
and that is a mention of the fact that these limited local applica- 
tions exert their influence, not by virtue of being absorbed and 
disseminated through the system at large, but because they act 
locally and within a very limited area. This fact has been dem- 
onstrated again and again. It has been found that local troubles 
existing upon the arms will not yield to local medication applied 
to the soles and feet, and yet lesions of the leg were benefitted to 
a considerable extent. In cases of condylomata only those, in 
whose immediate neighborhood hypodermic injections were made, 
dried and disappeared, others at comparatively remote points re- 
maining until treated in a similar manner. I have found that, 
in suppurating tubercular lesions, only those to which the appli- 
cations were made yielded and others had to be submitted to the 
same process before any amelioration took place. 
It may not bo out of place here to mention the fact that fro- 7 
quently indurated or even enlarged lymphatic glands will be 
considerably reduced, even to their normal size and consistency, 
by the local use of mercurials. The same is true of the pigmen- 
tation caused by syphilitic eruptions. Although this latter will 
not always yield to the topical use of mercury, it will very fre- 
quently diminish and the intensity of the color, which is often so 
distressing to the patient, will be toned down to a much lighter 
shade. 
In conclusion, the writer would state that no attempt at ori- 
ginality has been made. That the object of the paper is merely 
to draw a little more attention to one of the details of the tech- 
nique of the treatment of syphilis, an operation which, the more 
it is studied, the more complex it appears. To reduce our art to 
a science is what we are striving to attain and the only method 
to arrive at this much-to-be-desired result is by the study and 
observance of the minor details.