NOTE 
• ON THE 
TREATMENT OF SYPHILIS 
BY THE 
HYPODERMATIC INJECTION OF CALOMEL. 
PY 
J. C. WILSON, M.D., 
ATTENDING PHYSICIAN TO THE PHILADELPHIA HOSPITAL AND TO THE 
HOSPITAL OF THE JEFFERSON COLLEGE OF PHILADELPHIA. 
FROM 
THE MEDICAL NEWS, 
June 2, 1888. [Reprinted from The Medical News, June 2. 1888.] 
NOTE ON THE TREATMENT OF SYPHILIS BY THE 
HYPODERMATIC INJECTION OF CALOMEL} 
BY J. C. WILSON, M.D., 
ATTENDING PHYSICIAN TO THE PHILADELPHIA HOSPITAL AND TO THE 
HOSPITAL OF THE JEFFERSON COLLEGE OF PHILADELPHIA. 
The treatment of syphilis by the intramuscular 
injection of calomel, as first practised by Scarenzio, 
in 1864, was prominently brought to 'the notice of 
the profession in Germany by Neisser, in September, 
1885. Since that time a large number of communi- 
cations upon this subject have appeared in the 
German, and more recently in the French journals. 
It is a remarkable fact, however, that this method of 
treatment has received but little notice among Eng- 
lish and American physicians. Two papers only, 
those of Bloom and Morrow, have thus far appeared 
in American literature. Neither of these has em- 
bodied any extended clinical observations, a fact 
that is more noteworthy in view of the multiplying 
reports of the growth of this method of treating 
syphilis on the Continent, and especially in Ger- 
many. 
1 Read before the College of Physicians of Philadelphia, April 4, 
1888. 2 
WILSON, 
The object of the present communication is to 
call attention to the details of this treatment as 
practised by the writer, and its results in a limited 
series of cases. The method is the natural outcome 
of efforts to render the treatment of syphilis more 
exact, and to keep it more completely within the 
control of the physician by the administration of 
specific remedies hypodermatically. It marks a step 
in the advance of the therapeutics of syphilis beyond 
the hypodermatic use of the soluble salts of mercury, 
as the bichloride, formerly advocated, and still occa- 
sionally employed in cases in which it is necessary 
to obtain the full effect of mercury rapidly. The 
difference between the therapeutic effects of the 
soluble and the insoluble mercurial salts hypoder- 
matically injected is, however, an important one. 
In the case of the former, absorption readily occurs, 
and the effects of the drug are manifested with great 
promptitude; thus, Hutchinson quotes Bloxam as 
saying that one-third of a grain of bichloride of 
mercury dissolved in twenty drops of water and 
repeated hypodermatically on three consecutive 
days, will usually salivate freely; whereas the insol- 
uble salts, introduced by the hypodermatic method, 
undergo chemical changes in the presence of the 
fluids of the tissues with comparative slowness, thus 
keeping up a prolonged and relatively mild influence 
until their chemical conversion and absorption are 
completed. The gradual nature of this process is 
shown by the fact that, in one of my cases, slight 
ptyalism occurred on the ninth day after the injection 
of one grain of calomel. Much difference of opinion THE TREATMENT OF SYPHILIS. 
3 
has been expressed as regards the relative advan- 
tages of the mode of treatment under consideration ; 
the greater number, however, of those who have 
published their observations regard it as possessing 
certain positive advantages over the methods hitherto 
practised. Among these advantages may be named 
the following: 
A. As over the administration of the preparations 
of mercury by the mouth : 
1. The absence of any directly unfavorable influ- 
ence upon the digestive apparatus (nausea, loss of 
appetite, colic, diarrhoea), especially in cases where 
mercury in sufficient doses is not well borne. 
2. Precision of dosage. 
3. Control of the administration by the physician, 
and, therefore, better opportunity, especially in pri- 
vate practice, to observe the effect of the drug, as 
well as the general condition of the patient, at fixed 
intervals. 
4. Simplification of the treatment as regards the 
patient himself, and diminution of the liability of his 
condition becoming known. 
5. Promptness of action. 
6. Diminished risks of salivation. 
B. As over treatment by inunction, in addition to 
the above advantages, we have: 
1. Absolute cleanliness. This point is of much 
importance in private practice. Mercurial inunc- 
tions are not acceptable to the better class of patients, 
and are feasible only in cases where the symptoms 
are urgent, and the patient fully realizes the gravity 
of the situation. 4 
WILSON, 
2. Convenience of administration in all respects. 
C. As over the treatment by fumigation, etc., in 
addition to the above, we have: 
1. Comparative safety of the method of treatment. 
2. Absence of the necessity for attendants, and 
for the use of apparatus of any form on the part of 
the patient. 
D. As over other forms of treatment in ordinary 
use, the fact that stubbornly rebellious symptoms 
often yield with promptness to hypodermatic injec- 
tions of the insoluble salts. 
The disadvantages of this treatment, as compared 
with the methods in general use, are: 
1. Pain. 
2. Danger of the formation of abscesses. 
It may be said at this point that both of these dis- 
advantages are reduced to a minimum by attention 
to the details of the little operation, and especially 
by the observance of the rule to introduce the medic- 
ament deeply into the substance of the muscle. 
Some degree of burning pain is, however, pro- 
duced by almost every injection. It is, as a rule, 
moderate, and comes to an end in the course of a 
few minutes. It is, on the contrary, however, some- 
times quite severe. Exceptionally, the injection has 
caused no pain whatever beyond the mere prick of 
the needle. 
The danger of the formation of abscesses is very 
slight when the injection is properly performed. 
Antisepsis must be complete as regards the material 
injected, the syringe, and the patient’s skin at the 
point of puncture, and the calomel must be thrown THE TREATMENT OF SYPHILIS. 
5 
deeply into the muscular substance, the needle being 
entered perpendicularly to the plane of the surface. 
The most convenient site is the lateral aspect of the 
gluteal region in the fossa behind the great trochanter. 
Smirnoff and Sofiantini state that calomel injections 
in this region are never followed by abscesses. 
Shadek says “abscesses never occur after deep intra- 
muscular injections of the quicksilver preparations ; 
coagulations—that is to say, nodes and induration at 
the point of injection—are rarely seen.” Watra- 
zewski saw only 4 abscesses follow 257 calomel injec- 
tions. In my own private practice, in thirty-two 
injections in six patients once only slight fluctuation 
occurred at the seat of puncture. It disappeared in 
the course of a few days. In the cases treated at the 
Philadelphia Hospital, several small, superficial ab- 
scesses developed at the point of injection. These 
were among the earlier cases, and the procedure was 
practised without due regard to antisepsis. 
On the other hand, Kopp and Chotzen counted 
48 abscesses after 768 injections of o. 1 of a gramme 
(1.5 grains) of calomel. Krecke caused suppuration 
of the subcutaneous tissue in 21 instances out of 171 
injections, while Monti, Bockhardt, and others, have 
abandoned the treatment on account of this danger. 
There can be no doubt, in view of these varying 
results, that the occasional formation of abscesses is 
due to faults in technique. It is, therefore, largely, 
if not indeed wholly, avoidable, and constitutes no 
real objection to the treatment. 
Two of the insoluble salts of mercury have been 
used, calomel and the yellow oxide. My own ob- 6 
WILSON, 
servations have been made with calomel alone. 
Neisser suspended the calomel in water with a little 
gum Arabic. The original formula was 
Calomel, 
Sodii chlorat aa 5.0. 
Aquae dest. ..... 50.0. 
Mucilag. acacias . . . . 2.5. 
The formula given by Bloom is, 
Calomel by vapor . . .5.0 0iv). 
Sodii chloridi . . v" . 1.25 0j). 
Aquae dest 50.00 (f 3xiijss). 
It is obvious that this mixture defeats the object 
of the treatment in view of the rapid chemical 
changes by which bichloride of mercury and metallic 
mercury are formed at the expense of the calomel. 
After some experience, calomel was administered by 
various observers in suspension in liquid vaseline, 
by others, in pure olive oil. One of the difficulties 
of the injection of calomel is found in the liability 
of the needle of the ordinary hypodermatic syringe 
to become clogged. For this reason both the vase- 
line and oil are objectionable. My own injections, 
after a few early trials with the above substances, 
have been made with glycerine, as suggested by 
Smirnoff, and in order to secure greater accuracy of 
the dose and to overcome the tendency of the 
calomel to settle at the bottom of the vial, I order 
the doses from the apothecary, separately, in drachm 
vials, each containing 
Calomel by vapor .... grain 1.25 
Glycerine (pure) . . . . tt\, xv. THE TREATMENT OF SYPHILIS. 
7 
A number of these vials are ordered at once, and 
are protected from the light. At the time of using, 
the cork is removed and a few minims of recently- 
boiled water are forcibly injected from the needle of 
the syringe into the bottle in order to displace the 
calomel that has settled. The bottle is then thor- 
oughly shaken until the calomel is suspended. The 
mixture is next poured into a little conical porcelain 
capsule, and quickly taken up through the nozzle of 
the syringe. The needle is then adjusted, the air 
expelled, and the operation performed in such a 
manner that the drug is thrown into the muscular 
mass. A grain of calomel, approximately, is the 
usual dose. The formula calls for one and a quarter 
grain for the reason that notwithstanding the greatest 
promptness, a certain amount of the calomel remains 
at the bottom of the capsule, and a little in the 
syringe itself. 
The antiseptic precautions consist in thorough 
disinfection of the apparatus employed immediately 
before each injection by means of water boiled for 
some minutes in a test-tube, and in the careful 
cleansing of the skin at the point of puncture, by a 
solution of corrosive sublimate i : 1000. Burning 
pain usually follows, lasting for some minutes, and 
the circumscribed deep infiltration, which may be 
detected after the injection, becomes the seat of 
moderate tenderness, and more or less induration, 
lasting for some days, or even a week or two. . 
When we come to consider the transformations 
which the insoluble mercurial salts undergo when thus 
injected, we enter a field as yet but little investigated. 8 
WILSON, 
It is probable that to a slight extent chemical reac- 
tions take place with certain organic principles, nota- 
bly albumen, with the formation of albuminate of 
mercury, but that the greater part of the calomel 
undergoes in the constant presence of the alkaline 
fluids of the tissues gradual conversion into a double 
chloride of mercury and sodium. In this respect it 
follows the course of mercury introduced into the 
economy by way of the alimentary canal. 
The following cases were treated in the Philadel- 
phia Hospital, and the notes are condensed from 
the ward histories taken by Dr. Hutchinson, Resi- 
dent Physician. 
Case I.—J. A., male, set. forty-eight; admitted 
September 23, 1887, to Medical Ward 2, bed 10; 
Irish, a store-porter, moderate drinker. No hered- 
itary tendency to disease of the nervous system. 
Chancre in 1861 or 1862 ; lymphatic enlargement; 
stubborn faucial and buccal symptoms; no recollec- 
tion of a rash; prolonged treatment by mercury. 
In 1867, spinal symptoms, staggering gait, dizziness, 
and difficulty in holding his water. Systematic 
treatment for two years, with complete recovery. 
He then married; wife’s first pregnancy resulted in 
miscarriage. The second child was healthy, and is 
Still living. Four children born subsequently died 
in early infancy from “marasmus.” In 1875 there 
was recurrence of the spinal symptoms ; he then was 
treated in the Orthopaedic Hospital; states that 
recovery rapidly took place under strychnia and in- 
creasing doses of iodide of potassium; continued 
well until the spring of 1887, when spinal symptoms 
recurred, together with loss of sexual power and THE TREATMENT OF SYPHILIS. 
9 
desire, marked ataxia, burning sensations and numb- 
ness, especially in the limbs and feet. Knee-jerk 
much exaggerated in both legs. Examination of the 
eyes by Dr. de Schweinitz showed insufficiency of 
the internal recti, oval disks distinctly gray in the 
second layer, and distention of the lymph sheaths 
along the arteries and veins; no distinct retinal 
changes except haziness. Diagnosis as to eyes, 
probable early gray degeneration of the optic nerve. 
Hypodermatic treatment from Nov. 11, 1887, to Feb. 
1 7, 1888; total number of injections, seven ; result, 
very decided improvement. Patient transferred to 
the surgical ward, for the treatment of cystitis. 
Case II.—G. M., male, mt. thirty-seven ; admitted 
to Medical Ward 2, bed 2, September 28, 1887. 
Primary sore occurred in 1876; secondary lesions of 
the mouth and throat, with falling of the hair; no 
recollection of a rash. Two years later, symmetrical, 
circumscribed ulcers of the shoulders and thighs, the 
scars of which remain. In 1879, sharp pains in the 
knees and ankles, lasting for some months, and dis- 
appearing under treatment. In 1886, acute pain 
and swelling of the knees and ankles, always aggra- 
vated at night, kept him in bed for eleven months. 
Upon admission to the Hospital, there was well- 
marked periostitis of the clavicles, tibiae, and radii. 
Slight improvement only under large doses of iodide 
of potassium. On December 11, 1887, other medi- 
cation having been stopped, he was given calomel 
hypodermatically, and had in all five injections at 
intervals of a fortnight. Very decided improvement. 
He was subsequently treated by Dr. Bruen with 
hypodermatic injections of bichloride of mercury. 
Case III.—J. J., male, set. thirty-seven, Italian 
laborer, admitted to Medical Ward 8, bed 9, Decem- 
ber 24, 1887, complaining of vague pains in various 10 
WILSO N, 
parts of the body and constant headache. The 
initial lesion occurred five weeks prior to admission. 
Lesions of the tonsils and throat. About January 16, 
1S88, well-characterized macular eruptipn appeared 
over the whole body ; enlargement of the superficial 
lymphatic glands. January 17th, hypodermatic treat- 
ment begun, and he received in all eight injections. 
On March 23d, the following note was made : “ The 
patient better in every respect; the eruption has 
disappeared ; the superficial lymphatics have under- 
gone resolution ; the patient free from pain and 
feels perfectly well. He has had at no time any 
stomatitis or diarrhoea.” This patient received on 
one occasion two grains of calomel by hypodermatic 
injection. A superficial abscess occurred at the site 
of one of the injections. 
Case IV.—C. McG., male, aged twenty-eight, 
Irish, blacksmith, admitted to Medical Ward 8, bed 
10, January 27, 1888. The initial lesion occurred 
October 1, 1887. He suffered with severe pains in 
the head, arms, and body ; considerable induration 
about the point of the chancre on the dorsal aspect 
of the penis in the sulcus. Inguinal'lymphatics 
much enlarged, also the post-cervical* and epi- 
trochlear glands. A profuse papular eruption cov- 
ered the whole body. The treatment by calomel, 
hypodermatically, commenced January 28th, and 
he had in all nine injections. During the course of 
the treatment an abscess formed at the side of the 
neck, and two or three small abscesses formed in 
the gluteal region at the site of the injection. There 
was no stomatitis or diarrhoea. Within two months 
of the beginning of the treatment the sore on the 
penis had healed, the glands had undergone reso- 
lution to a considerable extent, and the eruption 
had disappeared, with the exception of a few scaly THE TREATMENT OF SYPHILIS. 
11 
papules in the region of the lips, the lower part of 
the abdomen, and the thighs. March 15th, the 
patient was still doing well. 
Case V.—L. S., male, set. twenty-five, roofer 
by occupation, American, admitted to Medical 
Ward 2, bed 18, February 25, 1888. He first ob- 
served the initial lesion some time during the 
autumn of 1887. There was phimosis, for which 
circumcision was performed. Secondary symptoms, 
sore throat, constant headache, enlargement of the 
superficial lymphatics, uniform papular rash over 
the body and legs. Treatment was commenced 
February 26th. In all six injections were given up 
to March 15th, when it was noted that the glands 
were undergoing resolution, that the rash had, to 
some extent, faded, that the headache had disap- 
peared, and that his general condition was improv- 
ing. There were no abscesses, no sore mouth, and 
no diarrhoea. 
Case VI.—J. F., jet. twenty-five, Irish, admitted 
to Medical Ward 8, bed 24, October 20, 1887. 
The initial lesion occurred fifteen months before 
admission, and was followed by non-suppurating 
enlargement of the glands of the groin. He had 
suffered with iritis in both eyes, but not at the same 
time. Severe periosteal and articular pains. Treat- 
ment by hypodermatic injections of calomel was 
commenced in January, 1888. Alter the second 
injection the patient refused to continue the treat- 
ment on account of the pain attending it. 
The following cases were treated in private prac- 
tice : 
Case VII.—X., male, set. forty-five, a man of 
leisure, had the initial lesion in 1873. Intense and 
protracted secondary lesions affected the mucous 12 
WILSON, 
membrane of the mouth and the cutaneous surface; 
prolonged mercurial treatment. A period of about 
five years passed without symptoms of any kind. 
In 1881 there appeared extensive, stubborn ulcera- 
tion of the tongue, very little modified by treatment 
by mercurials and iodides, and local treatment with 
nitric acid. He came under my observation in 
1882. There was deep serpiginous ulceration of the 
left border of the tongue, with extensive cicatrices 
of the right border; scaly eruption of the palms of 
both hands, not symmetrical, with deep, linear, fis- 
sured ulcers of the flexures; thick, scaly patches 
upon the soles and borders of both feet, with con- 
siderable thickening of the skin ; a large, scaly patch 
on the left side of the scrotum. Decided improve- 
ment under alternating courses of iodide of potas- 
sium and protiodide of mercury, with frequent 
applications of nitrate of silver to the lingual ulcers. 
The latter in the course of a few months had healed, 
and since have only occasionally, and for short in- 
tervals, given trouble. The scaly patches have 
undergone occasional improvement, but never dis- 
appeared, notwithstanding the fact that the patient 
has been steadily under observation to this date, and 
for most of the time under treatment. Mercurial 
inunctions, although frequently proposed, have never 
been practised, owing to the patient’s unwillingness 
to subject himself to the inconvenience. Treatment 
by hypodermatic injections commenced November 
4, 1887, and was continued somewhat irregularly 
until the end of February, 1888, five injections in 
all having been administered. After the second in- 
jection, the scaly patches upon the hands, feet, and 
scrotum absolutely disappeared. On the ninth day 
after the first injection slight salivation was noted. THE TREATMENT OF SYPHILIS. 
13 
Case VIII.—F. H., male, aet. thirty-two, a travel- 
ling salesman, came under observation with the 
initial lesion in April, 1886. I had the opportunity 
of seeing the female from whom the disease was con- 
tracted, then suffering from intense secondary symp- 
toms. F. H. developed in due course of time 
superficial ulcers of both tonsils, mucous patches,, 
macular rash, and enlargement of the superficial 
lymphatics; none of these symptoms, however, being 
intense. The general health continued good. After 
a year of systematic treatment with protiodide of 
mercury, with occasional brief intermissions, the 
patient still presented a few reddish, scaly papules 
upon the forehead at the edge of the hair, upon the 
fingers and the legs; these lesions, however, not 
being symmetrical. In March, 1887, iodide of po- 
tassium was given in moderate doses, and continued 
until November, 1887, with the effect of modifying 
but not curing the cutaneous lesions. 
Hypodermatic treatment commenced December 
10, 1887. It was interrupted by the absence of the 
patient from the city until February 16, 1888, when 
the second injection was administered. The patient 
was unable to return until March 10th. He then 
stated that after the second injection a very decided 
improvement in his symptoms had occurred, and 
requested that the treatment should be regularly 
continued. From that day until the present time 
he has received four injections at intervals of a week, 
making six injections in all. The lesions have en- 
tirely disappeared. 
Case IX.—Mrs. R., widow, aet. thirty-eight, was 
sent to me from the central part of Pennsylvania, 
by a medical friend, February 10, 1888. She had 
been ill three years with a teaming cough, attended 
by scanty expectoration, occasional night-sweats, 14 
WILSON, 
but without loss of flesh. She had consulted a num- 
ber of physicians without benefit. The appetite was 
fairly good; the temperature as taken in the mouth 
at 4 p.m. was normal. There was dulness over the 
right lung anteriorly in the mammary region, with 
abundant subcrepitant and crepitant rales heard in 
the infra-scapular area and extending down the ante- 
rior border of the lung. Percussion elsewhere yields 
good resonance, and especially is this noted in the 
supra-clavicular region on both sides; examination 
of the sputum showed no bacilli. 
February 27. The signs not having changed and 
the patient having a normal evening temperature, 
the history was carefully investigated. There was no 
hereditary tendency to phthisis. The patient mar- 
ried twelve years ago, a man somewhat younger than 
herself, whose occupation compelled him to be much 
absent from home. Within a year the wife miscar- 
ried at the sixth month. Two years later a child 
was born apparently healthy. It developed snuffles 
when one month old and died at the age of four 
months of “marasmus.” The husband complained 
from the time of marriage of frequent severe head- 
ache. The attacks of headache after a time became 
so violent that he was obliged to discontinue his oc- 
cupation for periods of several days together. Later 
the headaches were followed by confusion. There 
is no history of any special condition of the eyes 
nor of paralysis until about three years before his 
death. At this time he was seized with unconscious- 
ness and irregular palsies. This attack was not fol- 
lowed by recovery; on the contrary, his mental 
condition became progressively feeble, he lost the 
power of locomotion and died paralytic one year 
ago. 
Mrs. R., his widow, informs me that shortly after THE TREATMENT OF SYPHILIS. 
15 
her marriage she had sore throat which lasted for 
more than a year despite treatment, and that at that 
time she almost wholly lost her hair, which, how- 
ever, afterward grew in; does not recall any erup- 
tion. 
29th. Treatment by hypodermatic injections was 
commenced and has been continued up to the 
present time, five injections having thus far been ad- 
ministered. The area of percussion dulness is much 
less extensive, the subcrepitant rales are not heard, 
and a few crepitant rales only can be elicited on 
forced inspiration after efforts of coughing. The 
diagnosis in this case is not, perhaps, positive, but 
there is warrant for the assumption that these symp- 
toms and signs are due to gummatous infiltration of 
the lung. 
Case X.—Mrs. S., set. fifty-six, has suffered for 
many years with intense paroxysmal headaches ac- 
companied by disturbance of hearing and hallucina- 
tions, followed by deep stupor at intervals of from 
six weeks to three months. These attacks last from 
two or three to six or eight days. In the intervals 
there is a feeling of confusion and dull headache, 
easily excited by mental or physical effort General 
nutrition good. The eye grounds have been exam- 
ined by the late Dr. Little and by Dr. William 
Thomson with negative results. The urine has never 
been albuminous. There is no cardiac disease. No 
history whatever is to be obtained in this case. The 
patient’s husband presents no indications of having 
suffered from syphilis; there are three grown-up 
daughters all in good health. The oldest, however, 
has, to a well-marked degree, the physiognomy of 
hereditary syphilis with characteristic narrowing and 
notching of the upper central incisors. This de- 
formity was so conspicuous that she had the teeth 16 
WILSON, 
removed and replaced by artificial pivoted teeth. 
The other daughters show nothing characteristic. 
The symptoms of this patient never improved under 
mercurial treatment by the mouth or under iodide 
of potassium. On several occasions, mercurial in- 
unctions have been followed by a cessation of the 
headaches for a period of some months, and a miti- 
gation of the severity of the paroxysms upon their 
recurrence. On more than one occasion she has 
been ptyalized as a result of this treatment. Treat- 
ment by the hypodermatic injection of calomel was 
commenced November 20, 1887, and continued at 
intervals of, at first, a week and later two weeks 
until the present time. Eleven injections in all have 
been administered. From the time of the com- 
mencement of this treatment, the patient, although 
suffering from occasional dull headache and the old 
sense of confusion, has had no recurrence of her 
attacks. 
Case XI.—N. S., female, set. seventeen, the 
third child of syphilitic parents; with the typical 
facies of hereditary syphilis, prominent frontal 
bosses, sunken nose, and notched teeth, developed, 
at the age of fifteen, interstitial keratitis with 
double iritis resulting in total blindness. She was 
successfully treated by Dr. Charles S. Turnbull, 
improvement gradually taking place under frequently 
repeated small doses of biniodide of mercury. 
Within a year there has appeared a copious, thick- 
set, acneform eruption, most copious over the sides 
of the face, the shoulders, and the thighs. This 
eruption has the color of lean ham ; is papular and 
occasionally pustular. The hypodermatic treatment 
was commenced March 2, 1888, and has been re- 
peated at intervals of ten days, three injections in 
all having been administered up to the present time. THE TREATMENT OF SYPHILIS. 
17 
Under this treatment the eruption has rapidly im- 
proved, a large proportion of the papules have en- 
tirely disappeared, and those which remain have lost 
their vivid copper-red color. 
Case XII.—B., set. forty-one, was seen in consul- 
tation December 31, 1887, with Drs. C. M. Wilson 
and Murray Cheston. The details of the history 
were not known further than that he had been under 
the care of an ophthalmic surgeon for serious syphi- 
litic eye trouble, which had improved under specific 
treatment. The patient had been disinclined to 
take care of himself, or to follow the directions given 
by his medical adviser. The day before he came 
under observation he had complained of unusually 
severe headache upon the left side, and had gradu- 
ally lost power of the right arm and leg. When 
seen he was completely aphasic; the intelligence 
was clear. Two hypodermatic injections of calomel 
were administered, but in view of the gravity of the 
case and lack of experience in regard to this treat- 
ment, it was abandoned for mercurial inunctions, 
under which the patient rapidly regained his speech, 
and, to a certain extent, the use of the paralyzed 
side. The treatment is now being conducted by a 
female evangelist of the “faith-cure,” under whose 
care the patient had been for some weeks prior to 
the attack in which I saw him. 
Whole number of patients treated, twelve ; injec- 
tions, sixty-nine. 
My thanks are due to Dr. Hutchinson, Resident 
Physician at the Philadelphia Hospital, for his inter- 
ested pains taken in this clinical study, and to my 
colleagues, Drs. Bruen and Steinbach, for courtesies 18 
WILSON, 
in regard to the observation of cases transferred, 
under the rules of the Hospital, to their wards. 
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19 
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