CEREBRAL SYPHILIS. 
By Henry Alfred Robbins, M. D.t 
Washington, D. C. 
CLINICAL LECTURE DELIVERED AT THE SOUTH WASHINGTON (D. C.) FREE DISPENSARY, JANUARY 4, 1897. 
SEVENTH PAPER. 
Reprinted from the Maryland Medical, Journal, May 1897. 
We shall first call your attention to- 
day to this colored boy, who is twenty 
years old. He presents a picturesque 
appearance, as well as a geometrical 
cast of countenance. The hieroglyph- 
ics of syphilis are stamped upon his 
brow. Before attempting to describe 
this form of syphiloderm, we will ex- 
amine him for other evidences of syphi- 
lis. Dr. Arwine has removed his 
clothing and you notice on the prepuce, 
to the right of the median line, as good 
a representation of the chancre, known 
as Hunterian, as it is possible to be- 
hold. You notice also above Poupart's 
ligament, on either side, a typical bubo. 
The epitrochlear and posterior cervical 
glands are also enlarged and hard. 
To return to his expressive counte- 
nance. You see fantastic shapes, cir- 
cles, figures of eight, segments of cir- 
cles made with almost geometrical pre- 
cision. Perhaps this boy now looks 
like a blooded relative in darkest Af- 
rica, who marks his face with queer 
designs, thinking that it adds to the 
attractiveness of his appearance. Dr. 
Livingstone, in his interesting work, 
" Travels and Researches in South Af- 
rica," alludes to the custom. 
You will find in your text-books this 
syphilide classified among the papular 
forms. Dr. Joseph Zeisler, in Morrow's 
work on Dermatology and Syphilology, 
exhibits an admirable colored litho- 
graph, from a photograph taken by Dr. 
Piffard, with the following remarks : 
" Still another eruptive form, known as 
the stellate syphilide, or the syphilide en 
corymbe, is produced by the circular 
grouping of small papules around a 
large papule as a center. These smaller 
' satellite ' papules, as they are 
termed, are disposed in a system with 
almost geometrical regularity. As a 
rule, they are discrete and separated by 
sound skin; they may, however,become 
confluent, forming a circular nappe of 
infiltration around the central lesion. 
A polycyclic configuration, designated 
as the syphilide en cocarde, may result 
from the development of one or more 
concentric rings encircled by a larger 
ring. The intricate and eccentric forms 
assumed by the papular syphilide from 
the intersection and interfusion of cir- 
cular, semilunar and elliptical patches, 
give to the eruption a most bizarre ap- 
pearance, which is admirably shown in 
the above mentioned picture." The 
patient before us is in the secondary 
stage of syphilis. Generally it is de- 
scribed as a late secondary form. We 
also call your attention to a picture 2 
which adorns our walls. It is taken 
from one of Baretta's wax models, in 
the St. Louis Hospital, Paris. It is 
called a ciricinate papulo-squamous 
syphilide. It is exquisite and looks as 
if the artist might have given free rein 
to his imagination ; but it is an exact 
representation of the patient from whom 
it was taken. We are very proud of 
our picture gallery. These life and 
life-like representations make our clin- 
ics what they ought to be, attractive 
and instructive. 
We presented to you last week a man 
who was recovering from syyhilitic 
hemiplegia, notwithstanding he had not 
carried out our treatment thoroughly. 
Cerebral syphilis is so important and so 
often not suspected, that we propose to 
continue the subject today. In many 
cases it is extremely difficult to obtain 
ahistory of syphilis. Very often to the 
sense of vision the patient is without a 
blemish and he denies ever having had 
the disease. The nocturnal headaches, 
however, are characteristic of syphilis 
and so is vertigo and other symptoms, 
which I hope to explain at some future 
time. Last week we described the pa- 
thological changes in brain syphilis and 
we will continue the subject today, by 
giving more illustrations of the morbid 
changes produced by this dreadful mal- 
ady. 
At the Edinburgh Medico-Chirurgi- 
cal Society in May 2, 1894, Dr. A. 
Bruce read a paper on two cases of no- 
dose periarteritis. The first case was 
that of a man aged 37, who had been ill 
for two years and in whom the tertiary 
symptoms appeared after eighteen 
months. In the end there was diplopia, 
paralysis, dilatation and fixation of the 
left pupil, convulsions and death in six 
hours. There was fluid in the subar- 
achnoid space, no thickening of the pia 
mater ; there were clumps on the basilar 
posterior communicating; and vertebral 
arteries in the form of fusiform swell- 
ings ; the pons was softened here and 
there ; there was marked periarteritis 
and foci of softening ; there was little 
affection of the inner cord of the arteries 
and there was no meningitis. 
The second case was that of a woman 
who, on admission, was all but para- 
lyzed in both upper and lower limbs ; 
the tongue could only be protruded as 
far as the lips ; there were a few spots 
on the legs ; the temperature rose to 
104.2° and the pulse was 142 and she 
died of paralysis the next week. She- 
had been infected in the discharge of 
her duties in Soho Hospital. She was 
in St. Thomas's Hospital from Decem- 
ber to October, with skin affections and 
paresis of the face. There was optic 
neuritis. Later, paralysis of the limbs 
set in and this lasted six weeks. Then 
she improved and ultimately was dis- 
charged. She came to Edinburgh and 
was very well till two days before ad- 
mission to the Royal Infirmary. On 
post-mortem examination there was 
leptomeningitis, the basilar and cere- 
bral arteries were in the same state as in 
the first case, there were several areas 
of congestion and softening in the pons, 
there were changes in the outer, but no 
changes in the inner, coat of the vessels, 
there was great thickening of the veins 
(a periphlebitis), the brain substance un- 
der the membranes was softened and 
nearly all the vessels contained a throm- 
bus and some of these had begun to or- 
ganize. Only some six or eight cases 
of this condition have been described. 
Probably the first description of syphi- 
litic periarteritis was given by Dr. Batty 
Tuke in the American Journal of the 
Medical Sciences for 1874. True gum- 
matous formation on the outer coat was 
the third stage of this periarteritis. In 
the more acute forms there was simply 
the cellular infiltrations. In the less 
acute forms there was a tendency to the 
formation of gummata. The conclu- 
sion one must come to, from a study of 
these two cases, Dr. Bruce held, was 
that there was a perfectly distinct syph- 
ilitic affection which attacked the outer 
coat of the arteries. 
Syphilitic Hematoma.-Dr. Hahn has 
published the particulars of a case of 
this rare affection of the dura mater. 
The patient was a man aged thirty-six, 
who had syphilis about ten years before 
the onset of his nervous symptoms. 
These began with attacks of giddiness 
and severe headache, while his charac- 3 
ter underwent a great change. He fi- 
nally had an attack of giddiness with 
loss of consciousness, and on the follow- 
ing day it was noticed that there was 
slight left ptosis, deviation of the tongue 
to the left on protrusion, deficient move- 
ments of the palate, indistinct articula- 
tion, and exaggerated reflexes. A few 
days later the following symptoms were 
also observed, viz.: Weakness of the 
right hand, diminution in the reflexes 
(especially of the knee-jerk on the right 
side), slight sensory disturbance, and 
impairment of hearing. He died about 
two weeks later comatose, having had 
previously some irregularity of breath- 
ing. At the necropsy it was found that 
over the whole of the left hemisphere, 
between the dura mater and pia mater, 
there was a thick layer of blood-clot ; 
while on the right the dura mater was 
smooth, the pia mater was thickened, 
and the convolutions flattened. At the 
base the pia mater was thickened, as 
well as in the Sylvian fissure, while the 
basilar and the carotid arteries were 
atheromatous. The left third nerve was 
flattened and apparently destroyed. 
(Deutsche Medicinische Wo c hens c hr ift.') 
At a recent meeting of the Vienna 
Medical Club, Dr. Kahane described a 
case of malignant syphilis in which ner- 
vous disorders were observed in the 
secondary stage. The patient, who 
was a drunkard and had acquired syph- 
ilis some seven months previously, was 
suffering from paresis of the left arm 
and leg and of the face ; due either 
to gummatous meningitis or to changes 
in the vessels. As gummatous menin- 
gitis would give rise to general symp- 
toms and disease of the cortex of the 
brain would cause Jacksonian epilepsy, 
he supposed the patient's condition to 
be dependent on syphilitic endarteritis 
of the artery in the Sylvian fissure. 
A study of 100 consecutive cases of gen- 
eral paralysis published by Dr. R. M. 
Phelps in the July issue of the American 
Journal of Insanity leads the author to 
lay the cause, in all probability, in every 
instance to syphilis. It is not possible 
in every case, nor, indeed, in the ma- 
jority of cases, to obtain a distinct his- 
tory of infection. " In a multitude of 
cases it can be suspected ; in almost 
none can it, with great probability, be ex- 
cluded." Every physician knows how 
difficult it is, even with a rational pa- 
tient, to always obtain an admission of 
specific infection, even when it can 
be easily read in the symptoms and 
almost on the very face of the ques- 
tioned one ; then how much more diffi- 
cult to get at the true history of an 
irrational being, getting a clear light' 
upon events of this nature of many years 
past! Eighty per cent, of the cases of 
locomotor ataxia, according to the Chi- 
cago Clinical Review, are said to have a 
syphilitic causation ; the same ratio, or 
even a greater one, undoubtedly main- 
tains in the case of general paralysis. - 
Locomotor Ataxia. -Aitken, many 
years ago, gave a description of the 
pathological changes occurring in the 
spinal cord, in that group of symptoms 
known as locomotor ataxia. Syphilis 
as a cause was not suggested, and the 
treatment recommended would be in- 
jurious, instead of beneficial. He de- 
scribes this condition as, ''A peculiar 
form of apparent paralysis, character-' 
ized by unsteady and disorderly muscu- 
lar movements, but with muscular 
power entire, and more or less pro- 
gressive loss of the faculty of coordinat- 
ingpower (voluntaryinstinctive). There 
is sometimes temporary diplopia, with 
unequal contraction of the pupils. The 
course of the disease is slowly progres- 
sive, and the anatomical lesion is gen- 
erally a degeneration of the posterior 
columns and horns of the spinal cord 
and posterior roots of the spinal nerves; 
sometimes with peripheral structure 
change in the cranial nerves, chiefly 
the second, third and sixth pairs, in 
cases where the sight is affected, and, 
exceptionally, in those of the extrem- 
ities." 
Scalfati reviews recent knowledge 
with regard to spinal syphilis. It is 
generally admitted now, he says, that 
syphilis may produce myelitis directly 
as well as indirectly ; it may come on 
six months or less after infection, or 
after ten or even twenty years. Of the 
three chief clinical types (meningitis; 
meningo-myelitis and myelitis), the> 4 
rarest is meningitis ; it is most favorable 
as far as prognosis and treatment are 
concerned, and is frequently character- 
ized by nocturnal rachialgia compar- 
able to the nocturnal headache of syph- 
ilis. The meningo-myelitic variety pre- 
sent two distinct phases. 
1. Prodromal or meningitic, often 
complicated with cerebral symptoms 
(headache, visual affection, paralysis of 
cranial nerves). 
2. Spinal paralysis. This type of 
meningitis, commencing in the brain 
and traveling downward, is typical of 
syphilis. In a considerable number of 
cases, however, the meningitic symp- 
toms are wanting or are very slight. 
Acute forms with complete sphincter 
paralysis, profound sensory disturbance, 
and marked trophic affections (for ex- 
ample, bed-sores), may occur and cause 
death in a month, being little influenced 
by treatment. Tachymeningitis, espe- 
cially affecting the cervical regions, may 
give rise to pseudo-tabetic phenomena. 
The myelitis of syphilitics presents in 
several cases anatomical characters 
such as to enable one to affirm that 
there exists a legitimate syphilitic my- 
elitis, which may sometimes be acute. 
Fournier's ''neurasthenia syphilitica" 
is probably in some cases only the pro- 
dromal stage of syphilitic myelitis. In 
general one may say that spinal syphi- 
lis is a serious disease ; even when life 
is not threatened, the disease is rarely 
cured. 
In 1881 the late Dr. Fordyce Barker, 
then President of the New York Acad- 
emy of Medicine, referred to a case of 
ataxia due to syphilis, in which there 
was complete paraplegia, with paralysis 
of the bladder and rectum. To that pa- 
tient he gave a drachm of the iodide of 
potassium three times daily, beginning 
with twenty grain doses, and an entire 
cure had been effected. Professor Erb 
of Heidelberg makes the following state- 
ment : " He who has not had syphilis 
is scarcely ever apt to have tabes." On 
the other hand, Leyden and Westphal 
and others contend that the connection 
between syphilis and tabes are by no 
means constant. Fournier's statistics 
exceed that of Erb, ''ninety-one to 
ninety-eight in every one hundred cases 
of tabes, gave a history of syphilis." 
" Rumpf gives eighty to eighty-five in 
one hundred." Althaus, " ninety in one 
hundred." Dr. B. Sachs (Morrow's 
Work on Dermatology and Syphilology) 
says: ''In view of such statistics 
as these, one can not possibly escape 
the conclusion that fully nine-tenths of 
tabes are due to syphilis, and my own 
experience leads me to think that this 
percentage might well be placed higher. 
In private practice I do not see one case 
in fifteen of tabes which does not give 
the full history of syphilis." 
Dr. Thomas Stretch Dowse of Lon- 
don says : " There can be no doubt, 
unless we have contrary proof of the 
most absolute and positive kind, that 
irregularity of movements and disturb- 
ances of volition, either in the engen- 
derment of ideas or in the performance 
of coordinate muscular acts, are, in a 
very large majority of cases, due essen- 
tially to some syphilitic affection of the 
nervous centers. With this fact the 
clinical observer is becoming every day 
of his life more familiar and it is a mis- 
fortune of the most serious nature to the 
patient when these symptoms and signs 
of incoordination are treated as mere 
trifles and thought to be due merely to 
fatigue, or to stomach or liver derange- 
ment. I have no hesitation in making 
the statement that every case of locomo- 
tor ataxia is curable, provided it be 
treated sufficiently early and in the 
most energetic manner. Every case of 
locomotor ataxy (with very few excep- 
tions) can be traced to a syphilitic ori- 
gin if due care be taken to inquire care- 
fully into the patient's history. 
Of these various signs there is only one 
upon which I place the most absolute 
reliance from a diagnostic point of view 
and that is the fulgnmating pains ; and 
patients will often describe them to me, 
as though a fine lancet, which had been 
made hot, had been driven into the skin 
for about an eighth of an inch. These 
pains are not limited to the lower limbs; 
they may attack the head, the nose, the 
ears, the shoulders, the buttocks, and 
the scrotum, and even the penis, but as 
the disease advances and the ataxia be- 5 
comes pronounced and decided, the legs 
alone are the seat of pain. I had a pa- 
tient under my care a few months since, 
who spoke of these pains as resembling 
the sting of a horsefly. These pains 
succeed each other with the greatest 
rapidity ; they occur for the most part 
singly and the patient has scarcely time 
to rub one part of the body before his 
attention is called to another part. Now 
these pains may be preceded and suc- 
ceeded by intense itching over a limited 
and circumscribed area, and this state 
of itching will be as rapidly migratory 
as were the pains just described ; and if 
we test the sensibility of the skin of the 
feet and lower limbs we shall find 
patches which are decidedly anesthetic; 
but this is more particularly maiked 
over the plantar and dorsal surfaces of 
the feet and inner part of the legs." 
Erb gives the following statistics, 
showing the time that had elapsed be- 
tween the syphilitic infection and the 
beginningof tabes. 
12.3 per cent, appeared within 1 to 5 years 
after infection. 
37 per cent, appeared within 9 to 10 years 
after infection. 
24.7 per cent, appeared within 11 to 15 years 
after infection. 
14.2 per cent, appeared within 16 to 20 years 
after infection. 
4.8 per cent, appeared within 21 to 25 years 
after infection. 
1.9 per cent, appeared within 26 to 30 years 
after infection. 
.7 percent, appeared within 31 to 33 years 
after infection. 
The majority of cases occurred after 
the first six years. I agree with Erb 
that locomotor ataxia is only to be 
feared by those who have had syphilis. 
Treatment of syphilis by hypodermic in- 
jections of mercury.-A year or two after 
our civil war, while on a visit to New 
York City, Dr. F. J. Bumstead invited 
me to go with him to Charity Hospital. 
We took the boat at the landing near 
Bellevue Hospital and went to the 
Island. On the way he told me that 
he was going to try a new method of 
treating syphilis and that was by hy- 
podermic injections of mercury. The 
injections were introduced into the arms 
of six patients subcutaneously. I do 
not know what form of mercury was 
employed, but I remember that it caused 
the most atrocious pain and I prophesied 
that it would never become a popular 
method of treatment. Since then I 
have conversed with many enthusiasts 
on the subject, but as a rule, it was by 
those of a very limited experience in 
any form of disease. With an air of 
great wisdom, I have heard it asserted 
that syphilis would be throttled by this 
method of treatment. "You have him 
by the neck and can shake the little 
devils out of him." This is equal to 
our numerous patients who believe in 
hoodoism and just about as reasonable. 
They say ten or fifteen injections will 
cause the disappearance of all symptoms 
dependent on syphilis. The mercurial 
vapor bath, or the inunction method, 
will do the same and are free from dan- 
ger. What are the objections ? I have 
spoken of the intense pain they some- 
times produce and which may last for 
days, incapacitating the patient from 
doing any kind of work. Abscesses 
also frequently result. The dangers 
which may take place were admirably 
given in an editorial article in the Uni- 
versity Medical Magazine several years 
ago. By injection into a large vein em- 
boli have lodged in the lungs and have 
caused symptoms of great, though tem- 
porary, danger. Again, when the con- 
stitutional symptoms of the drug are 
manifested, it is impossible to prevent 
further absorption, since a considerable 
proportion of mercury remains at the 
seat of injection for days or even weeks 
and is slowly but continuously absorbed. 
Kaposi, Hollopeau and Runeberg have 
all reported cases of fatal mercury poi- 
soning attributed by them to this con- 
tinued absorption. Where soluble salts 
of mercury are used the pain is less, the 
absorption is more rapid ; hence there is 
less danger of cumulative effects, but 
the doses must be more frequently re- 
peated and recidivity is more frequent 
and earlier than where the insoluble 
preparations are used. The. treatment 
of syphilis by hypodermic injections is 
destined to be the exceptional and not 
the routine method. Where rapid dis- 
appearance of the symptoms is abso- 
lutely essential, where medication by 6 
the stomach or by inunctions is impos- 
sible, these mercurial hypodermics may 
be employed with advantage. 
The injections should be made in the 
gluteal region, alternating on the two 
sides of the body, and the point of 
the needle should be thrust deep into 
the muscles. As a means of avoiding 
an intravenous injection, it is suggested 
that the perfectly clean needle, sepa- 
rated from the syringe, should be thrust 
into the tissues. If no blood escapes 
through the canal of the needle, it can 
be assumed that its point is not within 
the lumen of a blood-vessel. The syr- 
inge can then be attached and the med- 
ication forced into the tissues. If it is 
desired to secure the most permanent 
effects with the fewest injections, an in- 
soluble preparation will be used. Of 
these, calomel and yellow oxide are 
most efficient. Either may be used in 
the strength of i to 30, suspended in 
water, mucilage, olive oil or vaseline. 
To diminish tire pain, a solution of co- 
caine may be added. The injections 
may be repeated at intervals of about a 
week. Four to six are sufficient and 
each one should not contain upwards of 
a sixth of a grain of the mercuric prep- 
aration. Of the soluble preparations, 
Hebra chiefly commends the sublimate 
sodium chloride solution. This is made 
by adding to a 1 per cent, sublimate so- 
lution 6 per cent, of sodium chloride. 
Each injection should contain a sixth 
of a grain of mercuric salt. This prep- 
aration is cheap, readily prepared, al- 
most painless, and clear. Twenty in- 
jections given in three weeks, alternat- 
ing so that one gluteal region receives 
the medication every other day, are usu- 
ally sufficient to accomplish the cure ; 
occasionally more injections are re- 
quired. Mercuric poisoning, where the 
drug is used in this way, is exceedingly 
rare. Absorption must be rather slow, 
since there is an albuminate of mercury 
firmed before the salt can be taken into 
the system, and since Bockhart has 
found mercury in the urine thirteen 
weeks after the injections. Other solu- 
ble preparations are the albuminate and 
peptonate of mercury. 
Eeloir and Tavernier state that this 
hypodermic treatment has its minimum 
action upon syphilides of the mucous 
surfaces; that it should not be employed 
in cerebral or spinal syphilis, in visceral 
manifestations of the disease, in preg- 
nant women, or in young children. 
This method of intra-muscular injec- 
tions of mercury is claimed to be more 
efficacious than by folding up a portion 
of the skin, and introducing the needle 
to the required depth, according to the 
ordinary method of hypodermic injec- 
tion. The consensus of opinion of the 
most eminent syphilographers is adverse 
to the routine employment of this 
method of treatment. Dr. J. Wm. White 
has contributed a most valuable review 
in Morrow's work on Dermatology and 
Syphilology, on this method of treatment. 
All that can be said in favor or opposi- 
tion is concisely stated. I will take the 
liberty of quoting the opinions of a few 
of the most renowned writers on syph- 
ilis, which he has obtained, and pre- 
sented to the profession at large. Four- 
nier, about five years ago, was asked 
his opinion by Dr. Morrow of New York. 
He answered : " My opinion is, it is not 
a good treatment. The injections are 
painful, they interfere with the patient's 
avocation, they necessitate frequently 
repeated visits. Above all, the method 
is not practicable. In private practice, 
patients will not tolerate it. In hos- 
pital practice it is possible, but note the 
result ; patients leave the Du Midi and 
Lourcins, where this treatment is em- 
ployed, and flock to the St. Louis, where 
they know they will not receive it." 
"In England, Hutchinson, who is 
facile princeps the leader of British syph- 
ilographers (and who in my opinion 
is with the possible exception of Four- 
nier the leading syphilographer of the 
world, says hypodermic injection has 
come but little into employment in En- 
glish practice, nor does it appear to in- 
crease in favor with those Continental 
surgeons who at one time thought high- 
est of it." In this country Taylor, so 
far as I know, voices the prevailing sen- 
timent among specialists in this branch 
when he says : " The extent of the lit- 
erature of hypodermic injections in 
syphilis contributed within the past ten 7 
or twelve years is simply appalling, and 
there is really very little which is of 
practical value. It will be seen that al- 
most every preparation of mercury has 
been experimented with in the hypo- 
dermic injection treatment, and that the 
chemist's art has been sorely taxed to pro- 
duce new preparations. Each new prep- 
aration has been exploited as the ideal 
of perfection, and in most cases a hearty 
welcome has been accorded it, so that a 
witty German reviewer has made the 
following paraphrase of an old maxim 
applicable to the subject: "De 'navis' nil 
nisi bonum." "As to the injection of 
insoluble preparations he says he has 
no leaning toward its employment, and 
that he is firmly convinced that it will 
never be used as a systematic treatment 
extending over a period of years." He 
adds: ' ' It is a treatment which is gener- 
ally irksome and repulsive to patients, 
always attended with more or less dis- 
comfort and pain, and often producing 
destructive subcutaneous lesions over 
the body, which cause mental and physi- 
cal suffering, and which of necessity 
must impair the patient's health and 
strength. In some cases, we have seen, 
it has been known to imperil and to de- 
stroy life." ''In a more recent com- 
munication to the writer (Dr. J. Wm. 
White) Dr. Taylor reiterates his prefer- 
ence for the bichloride as the best prep- 
aration for hypodermic use, and states 
his belief, in which I cordially agree, 
that it is a method of ''utility, exi- 
gency, and emergency." In the pres- 
ence of intercurrent disease, as of in- 
fluenza, he has found it most valuable 
and has occasionally used it for long 
periods. He adds : ''No importance 
should be attached to claims of speedy 
cure. They show that their sponsor 
knows little about the natural history 
of syphilis. The disease is chronic and 
far-reaching, and requires a correspond- 
ing treatment. Many men who have 
ransacked drug stores and importuned 
chemists for some ideal preparation of 
mercury, having got one to their notion, 
have used it for a short time and seeing 
the prompt disappearance of existingle- 
sions (which condition could be induced 
by the bichloride bicyanide, and salicy- 
late of mercury, have rushed into print 
and claimed marvelous and rapid cures. 
A thoughtful and experienced student 
of syphilis will only claim cures when 
the patient has undergone careful, 
watchful treatment for two years and 
more, and when, from the course of the 
case, he is satisfied that the disease has 
been brought to an end." 
Dr. F. R. Sturgis of New York says: 
''It is many years since I have used the 
hypodermic injection of mercury in the 
treatment of syphilis, and my reason for 
abandoning it was the great pain it 
caused, and the tendency which it had 
to produce abscessess in the cellular 
tissue. Indeed, the pain was so great 
that the charity patients at the hospital 
ran away rather than submit to the 
treatment. That it was in many cases 
efficacious I have no doubt, but I do not 
think that the advantages outweighed 
the pain, nor was its action any more 
certain and lasting than when mercury 
was given by other methods. I am very 
doubtful, indeed, if it cures syphilis in 
a much shorter period than when given 
by the mouth, or inunction, or fumiga- 
tion, although in some cases it caused 
the symptoms to disappear a little more 
rapidly perhaps than they would have 
done under other circumstances. The 
preparations used were the bichloride, 
which was excessively irritating; then af- 
terward calomel, which was less so; and, 
lastly, the albuminate; which seemed 
to be the best borne of any; but as I say, 
I have not used it for many years, and 
think its use, certainly in private prac- 
tice, is restricted." 
Dr. E. L. Keys of New York says: ''I 
do not think the hypodermic use of mer- 
cury suitable for routine use in syphilis. 
I believe it impossible to 'cure' syph- 
ilis by a 'short course ' in this or any 
other method." Dr. Walter L. Pyle of 
this city, in the Medical News, February, 
1895, published an interesting mono- 
graph on the ''Intravenous injection of 
mercuric chloride in the treatment of 
syphilis." It was originally suggested 
by Professor Guido RacceWi {Gazettemed- 
tea di Roma, 1893.) ''Hisinvestigations 
met with the most brilliant results and 
since then thorough investigation into the 8 
meritsand value of the method has been 
made by Baccelli, Jamma, Colombini, 
Nieddu, Campana and many others, 
throughout Italy." Sufficient time has 
not elapsed to give an opinion either 
in favor or in opposition to this new 
method, but testimony seems to be 
against it.