Hints on the Treatment of Syphilis. 
By FREEMAN J. BUMSTEAD. M. D. 
Professor of Venereal Diseases at the College of Physicians and Surgeons, 
New York. 
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LOUISVILLE, KY Hints on the Treatment of Syphilis. 
By FREEMAN J. BUMSTEAD, M. D. 
Professor of Venereal Diseases at the College of Physicians and Surgeons, 
New York. 
REPRINTED FROM THE AMERICAN PRACTITIONER FOR SEPTEMBER. 
LOUIS VILLE: 
John P. Morion and Company, Publishers. 
1871. HINTS ON THE TREATMENT OF SYPHILIS. 
There is a class of cases to which a specialist in venereal 
diseases is almost daily called in consultation, and which it is 
fair to presume are preeminently the difficult ones met with 
by the general practitioner. Their history is usually some- 
what as follows: the patient contracted a chancre a year or 
more ago, which was followed by secondary symptoms recur- 
ring in a number of successive outbreaks, and to which treat- 
ment afforded temporary but no permanent relief. Gradually 
the syphilitic lesions have assumed a more severe type. The 
secondary stage has merged into the stage of transition, or 
into the full tertiary period. There may be an obstinate 
iritis, an affection of the testicle, ulcerated tubercles upon 
the integument, deep fissures of the tongue, ulceration and 
destruction of the hard or soft palate, periostitis or necrosis, 
or any of the still more formidable late manifestations of 
syphilitic poisoning, as epileptiform convulsions, hemiplegia, 
paraplegia, affections of the viscera, etc. 
The attending physician is not a novice in the treatment 
of venereal diseases. He has been many years in general 
practice, and every year has brought him a number of genuine 
cases of syphilis, in which his efforts have proved successful. 
He has used the same remedies in this case as in the others. 4 
Hints on tJie Treatment of Syphilis. 
He finds that the mode of treatment which he has always 
adopted is sanctioned by high authority, and is that recom- 
mended in his text-books; yet weary months and possibly 
years have dragged along until he, as well as his patient, has 
become disgusted and is fast losing faith in the art of healing. 
Why this discrepancy in the results of his practice? Why 
has he succeeded so often, yet now so signally fails? The 
answer to this question is to be found in the varying degree 
of severity of the disease in different cases, and in the inad- 
equate use of remedies as employed by many practitioners in 
the more obstinate cases. 
Cases of syphilis may be divided into two classes — the 
mild and the severe. In the former the symptoms are often 
of the most insignificant character; the primary sore is super- 
ficial and heals in a few days or weeks, leaving but slight 
induration behind it, and the glands in the groins are only 
moderately enlarged and hard. Unless the patient is care- 
fully watched from time to time, the maculae of an early 
secondary syphilide upon the chest and abdomen will pass 
unnoticed. Rheumatoid neuralgia and a few mucous patches 
in the mouth may pass for the results of a cold and a disor- 
dered stomach. In these cases, and in others approximating 
to them in mildness, it makes but little difference what reme- 
dies are employed. If the patient be of a good constitution, 
and leads a regular life, he is subject to the recurrence of 
some of these slight manifestations for a few times, when the 
disease finally disappears, and his physician has the credit of 
a cure which is really due to the powers of nature. 
Another class of cases presents symptoms of a much more 
noticeable and severe form, and unless properly met threatens 
the integrity of important and even vital organs. This severity 
may be manifest from the first outbreak of secondary symp- 
toms, or only appear in the tertiary period, when the previous 
secondary symptoms have been mild ; for it is a fact not too 
well known that the degree of severity of the secondary mani- Hints on the Treatment of Syphilis. 
5 
festations of syphilis is no test of what the tertiary will be in 
case these should appear. I have repeatedly known patients 
to pass through the secondary stage with safety and with 
little inconvenience, only to break out at some subsequent 
time with tertiary symptoms of the most alarming character. 
Now in this second class of cases it does make a difference, 
and a great difference, what remedies are used, and in what 
manner. Let us inquire what is the course of treatment 
commonly in vogue, and examine how far this treatment will 
account for the obstinacy of the cases referred to at the com- 
mencement of this paper. 
The remedies chiefly employed in the treatment of syphilis 
are only two in number—mercury in some form, and the iodide 
of potassium. As is well known, each of these remedies is 
more particularly adapted to one stage of the disease than 
another; and yet how common it is in practice to see physi- 
cians using them without the slightest discrimination! A 
patient contracts a well-marked chancre, or develops second- 
ary symptoms, and is put upon the iodide of potassium, which 
can have no possible effect in removing the symptoms of this 
stage. Ricord and Grassi’s analyses of the blood have indeed 
shown that iodide of potassium has a decided influence over 
the chloro-anaemia of the secondary period, and may therefore 
be used as a tonic at this time, especially in connection with 
iron ; but it certainly has no direct effect upon the syphilitic 
symptoms themselves. In the later stages of syphilis we find 
the same want of discrimination still more prevalent; and 
we see practitioners, put to their trumps in obstinate cases, 
blindly employing mercury for a few weeks, then resorting to 
the iodide, and repeating this routine an indefinite number of 
times, for months or years, without any clear idea as to which 
remedy is indicated. 
A second serious mistake, which is very generally com- 
mitted, is, as I believe, the selection of corrosive sublimate, 
in preference to all other preparations of mercury, in the 6 
Hints on the Treatment of Syphilis. 
treatment of syphilis; and, I would add, the persistent em- 
ployment of any form of mercury by the mouth, when the 
system rebels against it, to the entire neglect of its external 
use, which has been proved to possess so many advantages. 
Can any one explain how or why the corrosive chloride has 
acquired such a reputation in the treatment of syphilis as it 
has with the mass of the profession ? In syphilis we have a 
blood-poisoning which we wish to reach by some agent active 
enough to control it, and which will find its way into the cir- 
culation with the least irritation to the intestinal canal, and 
the least consequent impairment of the digestive function and 
depression of the vital power; yet of the forms of mercury 
among which we look for such a remedy we select, forsooth, 
the very preparation which is notoriously the least likely to 
affect the general system, and which is known to be the most 
irritant of all, and this too in the most stubborn cases of the 
disease! Moreover, we continue this agent, always by the 
mouth, until the intestinal canal rebels against its further 
administration, and throws it off in frequent stools, while the 
little that is absorbed is about as powerless over syphilis as 
so much water would be. 
The only reason that I can imagine for this preference for 
the corrosive chloride is the slight danger of salivation; yet 
surely salivation can with rare exceptions be avoided by a 
little care, even when employing the stronger preparations 
of mercury; and I myself have used the very strongest pre- 
parations in a practice of many years without meeting with 
this accident half a dozen times. 
My own experience with mercury in the treatment of vene- 
real diseases leads me to conclusions which may be briefly 
stated as follows: 
i. Avoid mercury in all cases of chancroids, also in all 
doubtful cases of venereal sores following exposure, unless 
the failure of other remedies and the danger of destruction 
of important parts leaves no other resource. Such cases Hints on the Treatment of Syphilis. 
7 
are extremely rare. Experience shows that even in well- 
marked cases of true chancre it is better to defer the admin- 
istration of mercury until secondary symptoms appear. We 
are, however, justified in its use in case the chancre, contrary 
to custom, assumes a phagedenic form; in case the patient’s 
relations, as in matrimony, demand that the sore should be 
speedily healed; or in case that he himself is unwilling to 
submit to delay. 
2. Although a true chancre will heal and secondary symp- 
toms will disappear spontaneously, especially when favored 
by attention to hygienic rules, yet mercury is the only 
known agent which has a direct action upon them. In 
tertiary syphilis the iodide of potassium alone has a remark- 
able effect in dissipating the symptoms for a time, but the 
concurrent use of mercury is of great value in preventing 
their return. 
3. When using mercury for syphilis, use it, as the French 
say, coup sur coup—“blow on blow.” In other words, give it 
actively and for short periods, repeated if necessary, rather 
than in small and long-continued doses. Harm is less likely 
to result from the former than the latter course, and another 
advantage is that you have the means of testing the correct- 
ness of the course you are pursuing. If the disease has pro- 
gressed in spite of the first thorough trial, you are probably 
wrong in your indications; if it has yielded but not disap- 
peared under the first hit, you can hit it again! 
4. When a patient for the first time comes under treatment 
for syphilis, mercury is usually well borne, and does its work 
well, given by the mouth. It may therefore be administered 
in this way, and the greater inconvenience of its external use 
be avoided. During the first mercurial course that a syphilitic 
patient undergoes the remedy commonly acts more effectively 
and speedily upon the symptoms than in subsequent courses. 
In the first course also there is greater danger of salivation ; 
so that a patient who at this time has had his gums made 8 
Hints on the Treatment of Syphilis. 
tender by the administration of mercury for a few days may 
in a second or third course be brought under the influence 
of this agent with great difficulty. Hence greater caution is 
requisite in the early treatment of syphilis; and since the 
physiological influence of mercury often rapidly follows the 
therapeutical, it is well to suspend the treatment or diminish 
the dose as soon as a decided effect upon the symptoms is 
apparent. In old cases of syphilis, especially when mercury 
has already been used repeatedly or for a long period, its 
internal administration is found to have less effect upon the 
disease; and although the danger of salivation is slight, yet 
Other ill effects of the mineral—such as irritation of the intes- 
tinal canal, loss of appetite, diarrhea, and general cachexia— 
are more likely to ensue. Hence its external use is now to 
be preferred to its internal. 
5. For reasons already given, the corrosive chloride is the 
least desirable of all the preparations of mercury for internal 
administration. I usually employ in my own practice either 
the pil. hydrargyri or the protiodide, or sometimes the hy- 
drargyrum cum creta. The protiodide is found to be too 
irritating to the bowels of some patients, and in all cases 
should be given half an hour or an hour after meals, and not 
on an empty stomach. The mercury with chalk acts mildly, 
but effectually, when well prepared, and is conveniently com- 
bined with quinine and put up in capsules. I most frequently, 
however, employ the blue mass, made into pills of two or three 
grains each, with the addition of one grain of the dried sul- 
phate of iron; one pill to be given, three or four times a day, 
an hour after eating. These pills rarely act upon the bowels 
or require the addition of opium. 
Of the three methods for the external use of mercury 
more commonly employed—viz., inunction, fumigation, and 
hypodermic injection—I decidedly prefer the first named, for 
which I have given minute directions in the third edition of 
my treatise upon venereal diseases, page 497. Moist mercu- Hints on the Treatment of Syphilis. 
9 
rial fumigation, so strongly recommended by Mr. Langston 
Parker, is indeed less repugnant to sensitive patients; but, 
judging from my own observation, is less efficacious and less 
convenient, and requires more time for each bath than most 
patients can well spare. Moreover, unless the patient take 
the baths in his own room, or the surgeon administers them 
at his office, they must be intrusted to one of our professional 
bath-givers, who, as a class, I am sorry to say, are prone to 
wean the patient from his medical adviser, or to fill his mind 
with ignorant or false notions. It is pretty generally con- 
ceded by those who have made an impartial trial of hypodermic 
injections in the treatment of syphilis that this method is not 
to be recommended for general adoption. (See a review of 
this method by my partner, Dr. F. R. Sturgis, in the American 
Journal of Syphilography and Dermatology, April, 1871; also 
an able article by my friend, Dr. R. W. Taylor, in the Medical 
Gazette for May 13, 1871.) 
Mercurial suppositories introduced into the rectum were 
recommended by Lebert, Berl. Klin. Wochenschrift, No. 14, 
April, 1870. I made a trial of them recently in four cases at 
Charity Hospital, with results so unsatisfactory in controlling 
the disease that I abandoned the experiment. 
Rut to return to the errors too often committed by practi- 
tioners in the treatment of old and obstinate cases of syphilis, 
the most heinous of all is an ignorance of the dose of the 
iodide of potassium requisite to give this agent its full effect 
and to test its power. By many men doses of two, five, or 
seven grains, given three times a day, are regarded as the 
utmost limit, beyond which it is unnecessary to go. If the 
symptoms do not yield to this treatment it is concluded that 
the iodide is not the remedy, and something else is tried! 
To think of a patient suffering with the nocturnal agony of 
periostitis, or threatened with destruction of the palate or of 
the nose, being thus tampered with is almost enough to make 
one’s blood boil. Why, the iodide may be used with safety Hints on the Treatment of Syphilis. 
10 
and must be used, if its full effect is to be attained, with an 
unsparing hand. Relief will be had and important organs 
will be saved by giving one hundred grains a day, when the 
disease only laughs (metaphorically speaking) at fifteen or 
twenty! Patients find this out themselves when you have 
not stinted them in the use of the remedy ; and will tell you, 
as one of my patients with syphilitic necrosis of the ulna 
recently did me, that forty grains three times a day had no 
effect, while fifty three times a day were at once followed by 
a manifest improvement. The iodide of potassium has been 
given with impunity in the quantity of two or three ounces 
in the twenty-four hours for several weeks and even months, 
but. this amount is unnecessarily large. I have never had 
occasion to exceed three drachms a day; and from a drachm 
and a half to two drachms is usually sufficient. 
I remarked above, when speaking of mercury, that this 
agent is of great value, even in tertiary syphilis, in preventing 
a return of the symptoms, as so frequently occurs after the 
employment of iodide of potassium alone; and it is to this 
point that I desire to call special attention with reference to 
the old and obstinate cases of syphilis mentioned at the com- 
mencement of this article. I am convinced by no small ex- 
perience that the iodide of potassium can not be relied upon 
alone for permanent relief in pure cases of tertiary syphilis ; 
and that the judicious use of mercury, especially by inunction, 
concurrently with the iodide, affords a much greater degree of 
security. The “mixed treatment,” administered in the form 
of large doses of iodide of potassium internally and repeated 
courses of mercurial inunction externally, has relieved more 
desperate cases of syphilis than any other mode of practice 
that I know of. The books tell us that mercury and iodide 
of potassium should not be used at the same time for fear 
of severe salivation, through the evolution of the biniodide 
of mercury in the system. Experience, better than books, 
teaches us that this fear is groundless. Hints on the Treatment of Syphilis. 
11 
Whenever, from the unavoidable staining of the linen and 
the consequent danger of exposure of the patient’s secret, or 
from any other cause, inunction can not well be employed, I 
do not hesitate to give half a grain or a grain of the protiodide 
of mercury, combined with two grains of extract of gentian, 
in the form of pill, at noon after eating, and twenty, thirty, or 
fifty grains of the iodide of potassium morning and night; 
but I much prefer to administer the same quantity of the 
iodide three times a day, and to rub about a drachm of mer- 
curial ointment into varying portions of the integument at 
night; at the same time directing the patients not to wash 
off whatever of the salve may remain, and to wear the same 
underclothes night and day. After the lapse of a week or 
ten days the patient is directed to cleanse the whole surface 
of the integument with hot water and soap, and to change 
his linen. The iodide is, however, to be continued, and the 
inunction to be repeated at intervals of a week or a fortnight, 
according to. the exigencies of the case. The iodide of potas- 
sium should be given after meals, largely diluted with water 
(in not less than six or eight ounces of fluid, to which one 
or two drachms of the extract, sarzae fl. comp, of the United 
States Dispensatory may be added). 
I have notes of many cases in which this mode of treat- 
ment has afforded complete relief up to the present date, for 
periods of a number of years, after other means had failed, 
but the relation of one will suffice. 
I was called in the spring of 1866 to see Mrs. W., in con- 
sultation with Dr. C., an old and respected physician of this 
city. Mrs. W. had contracted syphilis from her husband sev- 
eral years before. The disease had progressed to the tertiary 
period, and she was then suffering from syphilitic cachexia 
and necrosis of the nasal and frontal bones. Her nose was 
already sunken to a level with the face, and her forehead 
presented several large ulcers with necrosed bone beneath. 
Her general condition was so poor that her speedy death was 12 
Hints on the Treatment of Syphilis. 
expected by her relatives, and their arrangements were made 
accordingly. 
At the consultation I found the usual routine had been 
followed: the “ bichloride,” in doses of a sixteenth or twelfth 
of a grain, for a while, and then the iodide of potassium, in 
three to five-grain doses, for another while, followed by a 
repetition of the same programme. My advice to Dr. C., after 
our retiring, was to administer the iodide of potassium in 
doses of twenty grains three times a day, gradually increasing 
the dose to forty grains, and to use mercurial inunction to 
the extent of one drachm every night. 
I afterward learned that Dr. C. reported to the patient and 
her friends that “Dr. Bumstead had recommended the same 
remedies which he had employed, only in a little different 
form.” Dr. C., however, had the honesty to carry out the 
plan proposed, with the result that Mrs. W. arose from what 
was supposed to be her death-bed; and after the removal of 
the necrosed fragments of bone she has been able, with the 
assistance of a nose of wax, to adorn Broadway with the re- 
mains of her former beauty, and without a return of her old 
trouble. Of this I speak confidently, since through the death 
of Dr. C. she has been exclusively my patient for the last two 
years. 
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