He used the injections mornings, applying it to the right and left side of the back. The pain was insignificant, and he found · no inflammatory action at the site of the punctures. In one hundred and ninety-six patients he had but four cases of salivation, and these were very slight. In most cases, after five to To the perfect cure, he six days began the process of cure. averaged sixty-eight injections (that is, so many syringefuls, containing each 2 mgrm. (0.002), gr. 3, of corrosive sublimate). The shortest time to make a cure was in those patients who had already begun taking mercurials. He found that the younger a patient was the more injections were necessary, and more seldom the relapse. In tertiary symptoms, Liegeois advised the employment of the hypodermic method in preference to all others, his views being in correspondence with those of Lewin. He says further: "After due deliberation, I found that there was by this method a gaining of strength and weight to the body which I had never seen before by any other method.” Professor Bernatzik (Vienna), in his admirable essay on the Hypodermatische Methode (in the Real Encyclopædie der Gesammten Heilkunde, 1881), gives the following formula and directions for the use of corrosive sublimate: Solution in water: 1 part of the sublimate in one hundred parts of distilled water, using to 1 syringeful (containing to 1 etgrm., gr. gr. of the sublimate) daily, or only every second to the fourth day. This solution, though greatly diluted, causes sometimes more or less pain, inflammatory swelling, and in some cases abscesses, though very rare. He uses morphia to soothe the pain (of hydrochlorate of morphia to 1 of sublimate). For the cure he uses on the average from 15 to 20 etgrms. (0.15-0.20), gr. ij to iij, of corrosive sublimate, which is given and eliminated in three to five weeks. For children he uses: Under one year, 2 mgrms. 0.002 gr. per day. Up to the age of five, 2.5 mgrms. 0.0025 gr. per day. In larger and well-nourished children he 6 advises, 3-5 mgrm., 0.003–0.005 gr. 21, per day. (Monti.) 22 With the object of making corrosive sublimate to be absorbed quickly, he combines with it common salt. Hydrargyrum bichloratum cum natrio chlorato in proportion of one to ten natrio chlor. (J. Müller and Stern) was proposed. Bouchardat mentions (1875) the following solution (of Staub): Corrosive sublimate, 1 grm. 25 etgrm., 1.25, Sodium chloride, White of egg, Distilled water, 1 grm. 25 etgrm., 1.25, gr. xviij} gr. xviij gr. xviij No. 1. 250 grammes, This is called a solution of the "chloro-albuminate of mercury" by its inventor. Hydrargyrum (bichloratum) albuminatum solutum. The following is Bamberger's formula: : Diluted and filtered white of egg is beat together with a solution of corrosive sublimate, and the precipitate is dissolved in salt water, in such proportion that the filtered liquid contains in each cubic centimeter one centigramme, 0.01 gr., of corrosive sublimate. The directions are half to one syringeful per day, to be injected, as the best place, either in the left arm or on the side or back. "It was Mialhe that first called the attention of physicians to the fact that subcutaneous injections of corrosive sublimate cannot be absorbed, except when the metallic salt acts upon the albuminous contents of the connective-tissue spaces, and produces, at their expense, an 'albuminate of mercury,' which is easily absorbed. This coagulation in the connective tissue is the principal cause of pain, of formation of inflammatory nodules, or even of the sloughs we sometimes find. It is therefore reasonable to form the albuminate of mercury' outside of the body and avoid these annoyances." (Terillon, Bulletin de Therapeutique, 4th, 5th, and 6th parts, 1880. Quoted by the Buffalo Medical and Surgical Journal, March, 1882.) The thesis of M. Cotte (Paris, 1873) may be referred to for interesting details on this point. This advance was appreciated, and many accidents were supposed to have followed these injections. Nevertheless the art advanced, and surgeons sought after new compounds; and as I have thus far dwelt more extensively upon the chloride salts of mercury, as I deemed it of the most importance, I shall therefore now append some formulæ of the other salts of mercury. Cullingsworth used the bicyanide in glycerine and water; Sigmund also advised a similar formula, viz :— Bicyanide of mercury, Distilled water, 1 part 100 parts Aimé-Martin uses the double iodide of mercury and potassium, and presented his method to the Society of Medicine of Paris, on the 7th of August, 1868. He prefers a formula like the following: Double iodide of mercury and potas., 40 ctgrm., 0.40, gr. vj Distilled water, M.-Inject 10 drops every other day. 5 etgrm., 0.05, gr. 10 grm., 10.0, 3ijss The morphia to be added at the moment of injection, to prevent precipitation. Martin reports his cures as rapid, and free from local lesions. Previous to this Lewin had tried and abandoned it, to take it up again in the following proportions : M.-5 to 10 drops as an injection, once or twice a day. 1 grm. (gr. xv) contains 1 etgrm. (gr. 4) of the mercuric salt. Belhomme employs this formula :— Double iod. of mer. and morphia, 50 ctgrm., 0.50, gr. vijss M.-5 to 10 drops once a day. At last Bamberger used chemically pure peptone in combination with mercury. Martineau (of whom I spoke in my former paper,—see The Medical Bulletin, February, 1882), in his excellent paper, which I am using so freely (Union Medicale, No. 99, 1881), does not say how to prepare his "peptone de viande" (it is erroneously printed "pepsin de viande," which is non sense); but Catillon (Repertoire de Pharmacie, quoted by The Druggists' Circular, January, 1881) uses this formula: Lean beef, minced, Water, Pepsin, q. s. 2 pounds. Digest twelve hours at 45° C. with slight excess of pepsin, keep temperature between 43° C. and 48° C.; agitate from time to time, and after two to six hours the mixture is nearly transparent. After twelve hours, strain and filter. Saturate with bicarbonate of soda, and evaporate on a water-bath till a pellicle forms on its surface. It then has, when cold, a sp. gr. of 1.15, and contains one-half of its weight of solid peptones. Bamberger's formula was this: Having made a solution of the sublimate in water of five per cent., and one of chloride of sodium of 20 per cent., he dissolved 1 grm. (gr. xv) of " meat peptone" in 50 c.c. 3xiij of distilled water, and filtered it. He then adds to the last 20 c.c. 3v of the mercury solution; and after well mixing, he adds just enough of the sodium-chloride solution to dissolve the precipitate of peptonate of mercury, the amount required being about 15 to 16 c.c. (about 3iij). Then add to the solution of "mercuric peptone" enough distilled water to make up 100 c.c. (3iij-v), thus making it one per cent. mercury—that is, one gramme (gr. xv) of the solution represents 1 ctgr. (about of a grain of the sublimate). The solution is fit for use after settling some days, with decantation and filtration. The dose is 1 c.c. (gr. xv) every three or four days; if oftener repeated, abscesses and salivation are to be feared. Zeissl and Neuman, of Vienna, and Von Rinecker, of Wurzburg, have used Bamberger's formula. Terrillon used it also during his earlier experiments. Later on, he used the following formula: Both formulæ have produced some local lesions, painful nodosities, more or less persistent indurations, but no serious troubles like abscesses or sloughs. Other preparations, the lactate, phosphate, acetate, and biniodide of mercury, have been used, but they were not more successful than those already noted. Dr. Martineau, of the Hospital de Lourcine, has, since the 12th of April last, used the following formula: Bichloride of mercury, : 10 grms., 10.0 5ijss Chloride of ammonia, c.p. of each 15 grms. 15.0 āāɔ̃iij,-gr.xl. 1 grm. (gr. xv) contains 25 ctgrm. (gr. iij) of the sublimate. This formula has given the best results because the Catillon peptone is exceptionally fine and pure; and, since pure muriate of ammonia is the best solvent of albuminate of mercury, which is so easily precipitated, it has been found best to let the peptone be in excess slightly. The following solutions havé proved excellent. Solution (A): Ammoniated mercuric peptone, 40 etgrm., 0.40, gr. vj Distilled water, 30 grms., 30.0, gr. vijss M. This contains 4 mgrm. (gr. 1) of sublimate in 1 grm. 20 etgrms. (gr. xviij), and will keep well for several days. Solution (B) is more stable: Mercuric peptone (as above), 40 ctgrms., 0.40, gr. vj Distilled water, 25 grms., 25.0, 3y-Div Neutral glycerine, 6 grm., M.-Dose and strength same as (A). Solution (C) appears entirely stable : Mercuric peptone, 40 etgrms. 0.40 gr. vj 36 grms. 36.0 3ix M.-Same dose and strength as (A) and (B). Since the 12th of April, Dr. Martineau has treated fifty-one patients. The total number of injections up to June 21, 1881 (the date of his paper), is 751. Series 1 consists of those who had 1.mgrm. 0.001 (gr. 65) of mercury injected every three days. Series 2. The dose was raised to 2 mgrm. (gr. 3) 0.002 every three days. Series 3. 2 mgrms. 0.002 (gr.) every two days. Series 4. The same as in 3, every day. Series 5. 3 mgrms. 0.003 (gr.) a day. Series 6. 4 mgrms. 0.004 (gr. 1) every day, and finally— Series 7. 5 mgrms. 0.005 (gr. 1) every day; the last only |