including the face, was paralyzed; this continued four days, when the pad was removed, and the symptoms immediately passed away.

Fig. 4 exhibits the appearance of the grafting on December 25th, and shows the rapid progress which it had made up to that time. When I visited the woman with Dr. Hayes at Tralee on August 14, 1879, I found the whole surface of the side of the head was smoothly covered with skin, and the woman had no paralysis and was able to use the arm of the affected side by carrying a heavy basket for a good part of the day; could also knit and sew. The parts were not very sensitive to pressure. She was intelligent and able to answer all questions put to her. The gentlemen who visited Dr. Hayes's residence and had an opportunity of seeing this woman with me, were Mr. Ernest Hart, of London, Dr. Edward Carpenter, of Croydon, near London, Dr. Novel Gueneau de Mussy, Hotel Dieu, Paris, Mr. Nickelson, surgeon, of Hull, Mr. Baker, surgeon, of Derby, and Dr. Mason, ophthalmologist, of Bath, England.

ON THE TREATMENT OF SYPHILIS AT THE COMMENCE

MENT AND END OF THE 19TH CENTURY.

BY CHARLES R. DRYSDALE, M.D., M.R.C.P., F.R.C.S.E.,

ENGLAND.

SYPHILIS has been called by one of the greatest writers upon it in the nineteenth century, Dr. T. Ricord, of Paris, "the greatest plague that menaces civilization." How far this may be true, the writer presumes not to pronounce; but, when we take into account the vast numbers of our modern populations that in the very heyday of youth are assailed by that redoubtable virus, we are forced to confess that no disease plays a more important part in modern times. In London, in Paris, and throughout all European cities, syphilis is the cause of hosts of diseases, of greater or less severity; and this in spite of the most strenuous attempts on the part of the medical authorities. in modern cities to prevent the spread of and cure it as soon as it exists.

Familiar as I am with Paris and London, I have learned lately to expect but little from government schemes, and it is to the treatment of the disease that I have, therefore, recently directed my attention. Marriage, I maintain, will have to become universal, and to be made compatible with those economical laws which govern man's existence on this planet, before much can be done to stamp out syphilis. Let me ask, then, IIow ought this disease to be treated?

Had I asked this question at the beginning of this century, the reply would have been simple in the extreme. Mercury was at that time the only remedy known, which seemed to have any great influence over the disease.

Shortly after the introduction of syphilis into Europe—which in my opinion took place in 1493, when there landed in Europe. the ships of Columbus at Lisbon-mercury began to be tried in syphilis, and soon was used to an enormous extent in all forms

of disease affecting the generative organs. Poor Ulrich von Hutten, one of the martyrs of the palmy days of mercury, relates how he had been salivated eleven times for syphilis. "He was hardly anointed before he began to languish amazingly; and so great was the strength of the ointment, that it forced into the stomach whatever portion of the disease lay in the upper part of the body in so violent a manner as to make the teeth drop out. . . After all, there was hardly one in a hundred cured by it."

66

Mercury," says John Hunter, the celebrated Scottish surgeon, in 1786, "in the lues venerea, as in the chancre, is the real specific; and hardly anything else is to be depended upon." Hunter gave it in gonorrhoea. The consequence of these views is shown in a sentence from Mr. Pearson, surgeon to the London Lock Hospital, who, writing in 1800, says: "If credence may be given to men of eminence in the profession, this rigorous course of discipline is not necessary; for, according to Thierry de Héry, M. de Blegny, and others, the disease may terminate by a natural crisis, and is susceptible of a natural cure. . . Νο proof can be brought that the powers of the constitution, aided by this sort of discipline, did ever effect the cure of the disease without the intervention of medical assistance."

Such was the state of medical belief as to the influence of mercury in curing syphilis, at the beginning of our century, when Dr. Fergusson, who was chief of the medical forces in Spain, wrote home, in the following terms: "Until our experi ence in the Peninsular wars, there had been but one opinion among us, as to the utter incurability of syphilis but by mercury; and if, by chance, the disease got well without it, we had as little hesitation in declaring that it could not possibly have been syphilis, but some other disease putting on its form. . I confess that nothing in the practice of medicine ever staggered me more than the discovery (made by him in Spain, when syphilis was not treated by mercury) that the creed of ages should be found utterly baseless; that the wisest among us should have, in all the intermediate time, been destroying, instead of saving, their patients, by murderous and unnecessary doses of mercury, was enough to shake the firmest faith in physic."

Dr. Fergusson's views were carried out by Mr. Rose, 1817; Mr. Guthrie, 1817; Dr. John Thompson, 1818; Dr. Hennen, 1818; Dr. Desruelles, Val-de-Grace, 1928; Dr. Fricke, of Hamburg,

1828; and afterwards by a commission established by the Swedish government, with the result that it was clearly seen that a large number of cases of syphilis tend to spontaneous cure.

About the year 1838 M. Ricord began to write upon venereal diseases; but two years before that one of the greatest discoveries ever made in practical medicine was made at Dublin by Mr. Wallace, who experimented on the treatment of syphilis with iodine, and who definitively introduced the treatment by iodide of potassium in 1836. He there gives the results of treatment of 139 patients, of whom six had iritis; six, affections of the testicles; ten, diseases of the bones; ninety-seven had syphilitic skin affections; and twenty had mucous tubercles. Adults took thirty grains of the iodide in the twenty-four hours. Wallace's experiments commenced in 1842.

Ricord admits that hard sores heal without mercury, and treats the later symptoms (tertiary) with iodide of potassium ; but gave for many years a six months' course of mercury of about one or two grains of the iodide (protoiodide) of mercury in the twenty-four hours, as soon as the diagnosis of syphilis was made. In Paris the school of Ricord has maintained his practice. In Edinburgh the tenets of Dr. John Thomson and his illustrious pupil, Professor Syme, almost banished mercury from the therapeutics of syphilis for a long time. In London, compromise has been the practice of the profession. In Christiania, Professor Boeck was a bitter opponent of mercury. In Germany, Berlin was mercurial, and Vienna less so.

Thus had professional opinion halted between different contradictory views, when Diday, in 1863, wrote his work on the "natural history of syphilis." This was followed by several works on the same subject in London and elsewhere. In 1867 a very important discussion took place in the Société de Chirurgie of Paris, in which MM. Dolbeau, Perrin, Deprés, etc., took the non-mercurial side, recommending, in place of mercury, iodide of potassium and the external treatment of mucous tubercles; whilst Dr. Diday, of Lyons, was eclectic, and the mercurial side was maintained by MM. Lefort, Verneuil, Velpeau, Depaul, and Panas.

At this time, in 1880, the mercurial treatment of true syphilis is the ruling treatment in London and Paris. In the latter city

The Lancet, 1836.

2 Lettres sur la syphilis.

M. Fournier recommended a long course of intermittent doses of mercury at the onset of the disease, during two years, to ward off tertiary symptoms, and to mitigate the severity of the eruptive period; and Mr. Jonathan Hutchinson, in London, is a strong and decided mercurialist; believing firmly that mercury can occasionally ward off all secondary rash when given for hard sore, and recommending it for an uncertain period in the eruptive period.

Lancereaux, on the other hand, does not believe that mercury prevents the occurrence of tertiary syphilis, and mentions that the favorite remedy of Ricord and the Parisian school is extremely prone to cause salivation. For my own part, I claim a right to take a part in the discussion, in that I have endeavored for many years past to study syphilis both without and with the interference of mercury. For some years I carried out the non-mercurial treatment, treating patients with hard sores or secondary eruption with iodine, in the form of small doses of the tincture or of iodide of potassium. What I found was, that iritis occasionally supervened-perhaps in two per cent. of the cases; but that that lesion usually did well when treated by blisters, belladonna, and fomentations: that hard sores always healed in a short time without any internal medication being required: that secondary eruptions gradually faded, and in many cases seemed to be benefited-contrary to general opinion -by iodide of potassium; whilst, on the other hand, I found tertiary symptoms, such as sarcocele, cerebro-spinal syphilis, etc., to occur in a certain indeterminate number of cases treated simply by iodine.

Moved by this latter fact, and the powerful allegations of my respected friends, M. Fournier and Mr. Jonathan Hutchinson, I have for the past three years treated all cases of primary and secondary syphilis by small doses of mercury, setting out from the theory (of Hutchinson), that in syphilis there is present some parasite in the blood and tissues, of low vitality, which can be acted on by small doses of mercury or iodine, just as these substances have the power to destroy the fungus of ringworm, when locally applied.

My patients have been usually young women under the age of twenty-five, the occupants of the Rescue Society's Hospital at London. I have used no form of mercury with these girls but the green iodide. At first I gave one-third of à grain twice