A CLINICAL INVESTIGATION 
TO DETERMINE THE VALUE OF 
CORROSIVE SUBLIMATE AND THE GRAY OIL ADMIN- 
ISTERED HYPODERMICALLY 
IN THE 
TREATMENT OF SYPHILIS. 
BY 
ORVILLE HORWITZ, B.S, M.D., 
Clinical Professor of Genito-Urinary Diseases in the Jefferson Medical 
College; Surgeon to the Philadelphia Hospital, etc. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, MAY is, 18Q4. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1894. A CLINICAL INVESTIGATION TO DETERMINE 
THE VALUE OF CORROSIVE SUBLIMATE AND 
THE GRAY OIL ADMINISTERED HYPODERMI- 
CALLY IN THE TREATMENT OF SYPHILIS. 
THE experience of many investigators is ad- 
verse to the employment of the insoluble 
salts of mercury hypodermically. 
The general belief is that the use of these 
salts results in great pain and produces callosi- 
ties, abscesses, and stomatitis. Our experience 
corresponding with those of other observers, we 
some time since determined to enter upon a 
clinical investigation to ascertain, if possible, 
the value of both corrosive sublimate and the 
gray oil in the hypodermic treatment of 
syphilis. 
These remedies, it is believed, we have fairly 
and fully tried. The result is here recounted, 
that all may judge of the value of our observa- 
tions. 
The first experiments were made with a view 
to ascertain whether the disease could be 
aborted after the method suggested by Bron- 
son, who has recently advised hypodermic in- 2 
jections of mercurials into the chancre and the 
indurated lymphatic glands in its neighbor- 
hood. His views are based upon the theory 
that the initial lesion is the storehouse of the 
syphilitic poison, or the point during the pri- 
mary stage from whence the disease is dissem- 
inated ; and that the mercurial being brought 
into direct contact with the micro-organism 
which causes syphilis, necessarily exerts its 
germicidal influence, destroys it, and thus 
aborts the disease. 
Ten cases were selected and placed under 
treatment. A quarter of a grain of corrosive 
sublimate was administered daily to each hypo- 
dermically until thirty injections had been 
made. It was possible to insert but three or 
four injections at the site of the chancre; the 
remainder were introduced into the indurated 
glands about the groin. These injections were 
attended with slight pain and more or less 
oedema of the penis. 
A suppurating bubo made its appearance in 
but one instance. Whether or not this was 
caused by the treatment could not be deter- 
mined, as a certain proportion of syphilitic 
cases will always be accompanied by a compli- 
cation of the kind. 
In nine of the cases the symptoms were de- 
layed, and did not appear for a period varying 
from between two and nine months after all 
treatment had been discontinued. The mani- 
festations were very mild, taking on the form 
principally of mucous patches, slight alopecia, 
and macular eruptions. In the tenth case, al- 
though over one year has elapsed since the dis- 
ease was contracted, no untoward symptoms 
have appeared. 3 
With this patient the doubt as to a correct 
diagnosis must be taken into account, for the 
origin of the disorder might not have been 
syphilitic. 
As far as can be determined, this method of 
treatment simply delays the appearance and 
mitigates the symptoms of the disease, render- 
ing it difficult to give a correct prognosis, and 
leaving it uncertain in the mind of the practi- 
tioner how long treatment should be continued. 
Sixty cases of secondary syphilis were se- 
lected for the purpose of investigation and to 
determine as far as practicable the value of 
this method of routine treatment. The quan- 
tity of corrosive sublimate employed was a quar- 
ter of a grain to each injection. Each pa- 
tient received thirty injections, making, in all, 
eighteen hundred hypodermic insertions. 
Fifteen patients were inmates of the Phila- 
delphia Hospital, thirty of the Jefferson Medi- 
cal College Hospital, and fifteen were selected 
from private practice. 
The cases that were treated at the Philadel- 
phia Hospital quitted the establishment within 
a month and could not be followed; of those 
treated at the Jefferson Hospital, nine have not 
been heard from since being discharged ; of the 
remaining twenty-one still under observation, 
eleven have relapsed, and have been placed on 
other forms of treatment. Of the fifteen pri- 
vate cases, four have not been heard from since 
they have been discharged ; and of the eleven 
remaining cases, three have relapsed, and eight 
up to the present time remain in good health. 
The longest period that has elapsed since the 
treatment of the last case is six months. Most 
of these relapses occurred within from four to 4 
eight weeks after the injections were discon- 
tinued. None of the patients made any special 
complaint of pain produced by the injection; 
in no instance was an abscess formed, nor was 
there induration about the seat of the injection. 
When relapses took place, several of the pa- 
tients were desirous of returning to the use of 
the hypodermics. In all the rapid disappear- 
ance of the symptoms was remarkable. In 
most cases, as a rule, constipation prevailed, 
and the employment of salines became neces- 
sary. In no instance was salivation produced. 
So that in sixty patients on whom the hypo- 
dermic method had been employed, on each 
of whom thirty injections were administered, 
twenty-eight disappeared and are unaccounted 
for; the remaining thirty-two have been care- 
fully watched. 
Of this number, fifteen relapsed within eight 
weeks after treatment had been discontinued, 
leaving seventeen free from disease. The long- 
est period that has passed since any of these 
has received treatment is ten months. 
The advocates of this method advise that, 
when recurrence takes place, injections be re- 
sumed, reducing the dose, however, to one- 
sixth of a grain of corrosive sublimate, return- 
ing to the mercurial whenever the disease re- 
appears, and reducing the amount of the drug 
on each occasion. 
This rule was not followed in the relapsing 
cases here referred to after thirty injections 
had been used without good results. It ap- 
peared to us merely a symptomatic method of 
treating the disease, which is generally fraught 
with so much danger, tertiary lesions usually 
following. 5 
The supporters of the routine method of 
treatment by hypodermic injections of corro- 
sive sublimate agree that about forty per cent, 
of the cases relapse. It will be observed that 
with us well-nigh fifty per cent, recurred, and 
that the disease returned in a remarkably short 
time after treatment had been discontinued, the 
longest period of exemption being eight weeks. 
In order to determine the value of the hypo- 
dermic injections, when used in conjunction 
with other methods, nineteen cases were sub- 
mitted to treatment. In five of these the 
lesions were situated upon the face, and were a 
source of great annoyance; hypodermics of 
corrosive sublimate were administered, when 
the eruptions disappeared with remarkable 
rapicjjty. Mercury was then administered by 
the mouth. 
In fourteen cases of severe syphilitic poison 
a systematic course of treatment was pursued. 
For a period of four months the mercurial was 
administered by the mouth, and instead of 
making use of inunctions of mercury for two 
weeks, which is the usual method, injections of 
a sixth of a grain of bichloride were given 
daily for that length of time, when these were 
discontinued and the administration of the 
drug by the mouth resumed. 
In the case of a married man who con- 
tracted syphilis in the absence of his wife dur- 
ing the summer, and who expected her return 
within three weeks, and who was most anxious 
that no symptom of the disease should be 
present on her return home, eighteen hypoder- 
mics were administered, with the result that at 
the end of twenty-one days he was perfectly 
free from all manifestations. 6 
In two cases of iritis fifteen injections of cor- 
rosive sublimate were administered in each 
case, the patients taking in conjunction ten 
grains of the iodide of potassium three times 
daily, when the symptoms rapidly disappeared. 
In a rare case of gumma of the conjunctiva, 
occurring in the clinical service of Professor 
Thompson, eight hypodermics caused its dis- 
appearance, when treatment was continued by 
the mouth. 
In four cases of relapsing syphilis hypoder- 
mics of gray oil were given once a week for six 
weeks, and although nearly a year has elapsed 
since treatment has been discontinued, these 
patients, who were constantly suffering from 
manifestations of the disease, have remained 
free from any symptoms. With these cases all 
other methods heretofore employed had failed. 
In one case of gumma of the palate the pain 
produced by the corrosive sublimate was so 
severe that the injections had to be discon- 
tinued after two administrations, when other 
means were resorted to. 
In three women who were inmates of the 
venereal ward of the Philadelphia Hospital, 
and who had been on a continuous course of 
treatment by the mouth before the hypodermic 
method was employed, slight ulceration of the 
gums was produced, and the injections were 
necessarily discontinued. 
In one case of gumma of the brain fifteen 
hypodermics of the gray oil, in conjunction 
with small doses of iodide of potassium, effected 
a rapid cure. 
In one case of syphilitic insanity six hypo- 
dermics of gray oil were given with marked 
improvement. 7 
In two cases of syphilitic locomotor ataxy the 
staggering gait, the great pain, and the vertigo 
have almost entirely disappeared, and there has 
been a progressive increase of weight and 
strength; both patients, who were unable to 
work when first placed under treatment, have 
returned to their respective occupations. The 
gray oil was likewise employed in twelve cases 
of obstinate skin-eruptions which refused to 
yield to other methods of treatment. 
In eighteen cases of secondary syphilis, which 
had shown constant tendency to relapse during 
a course of two years' treatment, and in one 
case of malignant syphilis, marked improve- 
ment was manifested by the treatment here 
recommended. 
The following table exhibits the number and 
conditions of the cases and the number of 
hypodermics of corrosive sublimate adminis- 
tered in each instance: 
No. of Cases. 
Conditions. 
No. of 
Hypodermics. 
IO 
6o 
Attempt to abort the disease 
Routine treatment 
3°O 
1800 
6 
Obstinate skin-eruptions 
180 
5 
Eruptions on the face 
I IO 
14 
Conjunction with systematic treatment 
196 
1 
Married man 
18 
2 
Iritis 
30 
1 
Gumma of conjunctiva 
8 
99 
2642 
A second table is submitted, exhibiting the 
conditions of the patients and the number of 8 
hypodermics of gray oil administered in a given 
number of cases: 
No. of Cases. 
Conditions. 
No. of 
Hypodermics. 
2 
Gumma of the brain 
12 
I 
Insanity 
6 
2 
Locomotor ataxy 
12 
4 
Relapsing syphilis 
24 
12 
Obstinate skin-eruptions 
72 
18 
Termination two years' course treatment.... 
108 
I 
Malignant syphilis 
6 
40 
240 
From a careful study of the clinical cases just 
cited the following deductions may be drawn : 
1. Hypodermic medication will not abort 
the disease. 
2. That it should not be employed as a rou- 
tine method of treatment. 
3. That the production of abscesses or of 
•ptyalism by this method must be very rare. 
4. Injections of corrosive sublimate give rise 
to trifling pain, but not to callosities. 
5. The gray oil gives rise to slight pain and 
always produces induration. 
6. The gray oil employed in this manner is 
more dangerous than corrosive sublimate, and 
when administered the patient should be care- 
fully watched. 
7. In suitable cases, when properly employed, 
these remedies are among the strongest weapons 
possessed by the profession wherewith to fight 
the disease. 9 
8. When employing corrosive sublimate, a 
quarter of a grain should be administered with 
each injection, provided the patient has not 
previously been submitted to treatment; if 
mercurials have already been employed by the 
mouth, the quantity employed should be one- 
sixth of a grain. 
9. Hypodermic injections of corrosive sub- 
limate are of undoubted value when the lesions 
appear upon the face and a rapid impression is 
desired ; likewise when some important struct- 
ure, as the eye or brain, is attacked. 
Mercurials may be employed hypodermically 
as a substitute for inunctions in a systematic 
course of treatment. 
They may be used with advantage when time 
is an object. 
In cases of relapsing syphilis where other 
methods have failed, injections have completely 
controlled the outbreak. 
In syphilitic diseases of the nervous system 
their use generally produces most satisfactory 
results. 
They are frequently beneficial in those forms 
of eruption that have proved rebellious to other 
treatment. 
10. It is well to employ the gray oil in cases 
of severe secondary syphilis where there is 
evidence of a tendency to relapse during the 
course of a two years' treatment, winding up 
with a weekly administration of a hypodermic 
for the space of six weeks. The patient should 
then be placed upon small doses of iodide of 
potassium for the period of three months. This 
treatment is valuable in the obstinate relapsing 
tertiary variety of the disease, and has proved 
more potent in our hands than any other 10 
method. In nervous syphilis it is far superior 
to inunctions. 
Finally.-This mode of treatment is un- 
hesitatingly recommended to the profession, 
under the conditions already laid down, as 
the most reliable and active that can be em- 
ployed. JANUARY Ifl, 1893. 
WHOLE SERIES, VOL. XVII. No. I. THIRD SERIES, VOL. IX. 
THE 
Therapeutic Gazette 
A MONTHLY JOURNAL 
- OF- 
General, Special, and Physiological Therapeutics. 
GENERAL THERAPEUTICS, 
H. A. HARE, M.D., 
ophthalmic ano Aural therapeutics, 
O. E. DE SCHWEINIT2, M.D., 
Clinical Protestor of Ophthalmology in th* 
Jefferson Medical Colt'ge. 
Surgical *ne genito-urinary therapeutics. 
EDWARD MARTIN. M.D.. 
Clinical Profcaaor of Grain Urtmary Ducaaca, Uni.erauy of 
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