the chest, coughing up of blood, hectic fever, dropsy, scurvy, and the like. When, however, these diseases are the consequence of syphilis, the frietion-cure is indicated. The skin of many persons has also a too great or too little receptivity for mercury, which at first cannot be determined. In the former case generally the cure is not completed; in the second no cure

ensues.

[(1) I cannot at all agree with CHELIUS's opinion on this point; for, beyond all doubt, the employment of mercury by friction is the mildest mode in which it can be used, and the only way in which it should be used, if imperatively called for, in the very cases where CHELIUS forbids it. One very important point must not, however, be lost sight of, to wit, the support of the constitution by generous diet, with porter or wine.J. F. S]

845. The cure itself primarily consists in the proper preparation of the patient by bathing, purging, and a strict diet, by which the susceptibility for the operation of the mercury is increased and the absorbing process promoted, so that even a smaller quantity of mercury may produce the alteration of the constitution. The patient should first take a purge, then every other day a bath not warmer than 29° R. [= about 97° FAHR.] Without any contrary indication twelve baths should be taken, but where the destruction of an important part is to be feared, then less may be used. In robust full-blooded persons the effect of the cure is always rendered more powerful by one or two blood-lettings. Phlegmatic puffy persons often derive no benefit from bathing, and therefore must not bathe beyond three days. During the use of the bath, and subsequently during the rubbing in, the patient should take thrice a day a lightly boiled porridge of a pint of meat broth with some grits, barley, rice; or instead of the porridge a cup of coffee on the first day, also some boiled ripe fruit or pears; and for drink a decoction of rad. bardanæ, liquiritiæ, and althee, not exceeding three pints in the twenty-four hours. But frequently it is necessary with old weakly persons to give more strengthening diet, wine, meat broth, with eggs and the like. In women the preparatory treatment must be complete before the commencement of the menses; and when they are over, then the rubbing in may be begun. If the menses recur at every fourteen days, the treatment must be so arranged, that they should have ceased before the critical days, and not interfere either with the medical treatment or with the evening frictions. If it should come on unexpectedly during the cure, the friction must be put aside. After the bathing is finished a second purge is to be ordered, and then the rubbing in proceeded with.

[Of all the preparations here recommended English Surgeons take no heed, excepting the clearance of the bowels at the onset, and a light unstimulating diet during the treatment. Nor is there any necessity to suspend the rubbing, in women during their monthly courses.-J. F. S.]

846. Twelve rubbings are nearly always sufficient to cure the inveterate venereal disease; frequently from five to six, most commonly nine; mostly no syphilitic disease requires more. Nothing definite can, however, here be fixed; the number of rubbings must depend on circumstances. For rubbing in, at first one drachm, and afterwards one and a half or two drachms of well-prepared gray mercurial ointment is to be used. The hand with which the rubbing is to be done should be previously warmed before the fire, and the rubbing should be continued five minutes.

According to WEDEMEYER (a), in old and stubborn cases from eighteen to twenty (a) Bemerkungen über die Syphilis und ihre Quecksilbers in derselben; in RUST's Magazin, verschiedenen Formen und den Gebrauch des vol. ix. pt. ii. p. 297.

rubbings of a drachm and a half each are necessary; in very old and very stubborn cases, especially if the salivation be backward and sparing, from twenty-four to thirty rubbings of a drachm and a half each, but seldom more are required. On the contrary, RUST (a) thinks he has never found this necessary; but when it was practicable, he increased the quantity of the ointment to be rubbed in commonly to two, two and a half, and even to three drachms, which agrees with my own experience.

[Our common hospital practice is to rub in a drachm of mercurial ointment every other night till the gums begin to swell, become spongy and sore, and the flow of spittle be increased; which effected, the rubbing is continued either as frequently or less frequently according as the soreness of the gums and the salivation continue the same or increase. The state of the gums and the flow of spittle are not, however, always indicative of the effect of the mercurial rubbing on the constitution; often is there neither soreness of gums nor salivation, but other excretions are increased, as the perspiration, or urine, or both, or there may be neither even of these, but the constitutional affection is shown by the wasting of the body and of the strength. The best guide, however, is the condition of the sore, which improves as the rubbing lays hold on the constitution. -J. F. S.]

847. The following is the order in which the rubbings-in are to be conducted:

On the first day, in the morning, the patient rubs in the prescribed quantity divided on the two legs, on the third day on the thighs, on the sixth day on the two arms, from the wrists to the shoulders, on the eighth or ninth day on the back, from the hips to the neck. From the seventh to the fifteenth day, according to circumstances, two, three, or four rubbings on these parts may be made in the way mentioned. Between the fourteenth and sixteenth day a more or less remarkable change occurs in the patient. He becomes restless, anxious, his breathing is oppressed, the pulse quickened, tongue loaded, and the belly puffed up. At the same time come on colicky pains, palpitation of the heart, crying out in his sleep, troublesome dreams, rumblings in the belly, and so on; from which discomforts the patient is relieved by a perspiration often continuing from twenty-four to forty-eight hours, and by increased secretion from the bowels and kidneys. On the sixteenth day another rubbing is to be made at evening, then on the next morning a purge, and so continuing to the twenty-fifth day, when, if there be not convulsions, severe oppression, great weakness, and so on, an early termination of the cure may be expected. On the twenty-sixth day the patient is to be put into a warm bath, and after half an hour washed quite clean with soap-spirit and a sponge, and dried. He is then to have fresh linen and to be carried into another room. The patient must during the whole cure be kept in a regularly warm room, and should neither get up, change his linen, nor cleanse the parts smeared with the ointment.

848. The following are the principal symptoms to be observed during this cure. The salivation usually appears between the fourth and fifth rubbing in, and is only to be checked when severe. The inconveniences attendant upon it may be best diminished by syringing the mouth with mild or slightly astringent decoctions. If the tongue swell so that it squeeze itself between the teeth, a piece of cork must be introduced between the grinding-teeth. But if from its swelling there be danger of stifling, the cure must be suspended and the tongue scarified. Ulcers on the tongue and gums are to be touched with a mixture of a drachm of camphor to an ounce of oil of almonds. The patient must frequently move his tongue to prevent its growing together.

If the salivation appear before the third rubbing-in, a smaller quantity (a) Above cited.

of the ointment must be used, and at more distant iutervals. But the salivation frequently diminishes when the rubbing in is continued, and nearly always if it be restricted to the evening. The salivation oftentimes continues after the cure is completed and ceases of itself. If during the whole cure there be no effect upon the salivary glands, it must not be forced; the hope of a happy result is then, however, always slight. In this case there often occur frequent intestinal and urinary evacuations, increased perspiration, and critical symptoms. Spasms, faintings, high fever, weakening perspirations, if occurring previous to the third rubbing in, and cannot be removed by chamomile and peppermint tea, by old wine, coffee, HOFFMANN's spirit, and require the suspension of the cure.

From my own experience I cannot recommend the modification of the friction-cure adopted by some, and formerly known by the name of the MONTPELLIER treatment, or steam-cure, in which the diet is neither so strict, nor the rubbing-in made so regularly, or in such quantity as directed by LOUVRIER and RUST to produce salivation; but it is rather endeavoured to avoid it by suspending the rubbing-in, by purging, and so on; and then the friction is recommenced, and subsequently wood drinks are employed.

849. If the salivation or critical sweating be checked by cold and so on, in consequence of which severe spasmodic symptoms and even sudden death may ensue, the patient must be cleansed in a warm bath, put into a clean warm bed, the whole body rubbed with warm cloths, and with these also may be employed, mustard poultices, diaphoretics, and even emetics.

850. During the time of the evening frictions spasmodic symptoms, oppression, fainting, convulsions, nausea, and small contracted pulse, which often arise, are either forerunners of a second crisis, especially if the fifteenth day be not completed; or they are consequent on the use of purgatives. In the former case, stimulating remedies must be given; in the latter, the operation of the purgative must be stopped, and the next time a less powerful one given. But if under this treatment the symptoms do not subside, the treatment must be suspended.

851. When the cure is perfected, the patient, by the use of nourishing food, care being taken to avoid overloading the stomach, soon acquires a healthy blooming appearance: but if this do not follow, there is great probability of an imperfect cure. Should it be necessary still to repeat the cure once more, the patient must be first recovered from the previous treatment.

852. WEINHOLD (a) employs a grand Mercurial Cure with calomel, which, as well as the friction cure, may be of greater service, and not only in old syphilitic, but also in rheumatic, scrofulous, and gouty diseases, as well also as in those cases in which often we are unaware on what the diseased action depends. Its object is, that a sufficiently large quantity of calomel should, at long intervals, so operate on the organism, that no salivation should be produced, because it would prevent the continuance of the calomel, and suspend the operation of the mercury on the unnatural reproduction.

853. In this cure the patient takes every evening, two hours before bed-time, on an empty stomach, a powder of ten grains of calomel and fifteen of sugar, and drinks two cups of warm beef tea; half an hour after,

(a) Von den Krankheiten der Gesichtsknochen und ihrer Schleimhaute der Ausrottung eines grossen Polypen in der linken Oberkieferhöhle,

dem Verhüten des Einsinkens der gichtischen und venerischen Nase und der Einsetzung künstlicher Choanen. Halle, 1818. 4to. p. 36.

he takes a second like dose, and if he be a strong person, at the third half-hour he takes half a dose, so that together twenty-five grains of calomel and six cups of beef tea are taken. He then goes to bed, and drinks in the morning a couple of cups of moderately strong coffee, which usually produces three or four thin motions. If this do not happen at the tenth or twelfth hour after having taken the medicine, a powder of fifteen or twenty grains of jalap, and as much tartrate of potash, must be given in order to produce at least one evacuation. After two days' rest, the patient must, according to circumstances, take the same dose of calomel in two or three portions; on the seventh day, the third; on the tenth, the fourth; on the thirteenth, the fifth; on the sixteenth, the sixth; and the conclusion is made on the nineteenth or twenty-first day, with the seventh or eighth dose. As at the third and fourth dose the stomach becomes accustomed to the irritation of the mercury, from five to six grains of jalap must he added to each dose. At the same time, a weak decoction of bark must be taken to support the reproductive powers, whilst the mercury destroys the dyscrasic. During this cure the patient must keep in-doors at least two or three hours in the forenoon, to promote perspiration; in not very bad weather he may, without harm, go about his business. The principal object of this treatment is, to produce stools, because they more certainly prevent salivation; but if that come on, which frequently happens in persons who have already used much mercury, the cure must be suspended.

854. ZITTMANN's decoction (a) is to be used in the following manner: on the first morning the patient takes sixteen portions of pil. merc. laxant; on the four following days he drinks in the morning a bottle of warm strong, and at noon a bottle of not warmed weak decoction; on the sixth day, again he takes the purging pills, as at first; and on the four following days, the decoction in like manner. Herewith the patient should eat only two ounces of roast meat, and as much white bread daily; and soup three times on those days when the purge is taken. The patient keeps in bed during the whole time, for the purpose of properly producing the perspiration. After the use of the decoction, he should keep his room for some time, drink infusion of spec. lignorum, or of sarsaparilla, and observe a weak diet. If the patient be not restored, the whole cure must be repeated a second time. In very robust persons, the purging pills must be once given on the eleventh day. The ulcers during the cure are merely to be cleansed with lukewarm water, and covered with charpie, either dry or spread with mild ointment. On an average, the use of the decoction is followed by five or six, and more, thin watery motions, and more or less, great perspiration. I have never noticed any accident which rendered breaking off this cure necessary. In largely spreading eruptions and very weak persons, it may be advantageous that only one bottle of the decoction should be drunk daily for the purpose of lengthening the (a) R Rad. sarsæ 3xij. et coque cum

Aq. font. bxxiv. pro hor., et adde
Alum. sacchar. 3jss.

Merc. dulc. 3iv.

Cinnab. antim. 3j. in nodul. ligat. sub

fine coct. admisce

Fol. senn. 3iij.

Rad. liquirit. 3jss.

Sem. anis. vulg.
--fæenicul. ǎā Ziv.

Colat. lib. xvi. D. ad lagen, viii. S. Decoct.
furte.

R Resid. decoct. fort.

Rad. sarsap. 3vi. coq. cum

Aq. fontan. bxxiv. sub fine coct. adde
Pulv. cort. citr.

cinnamomi.

cardamom. ãå 3iii.

Rad. liquirit. 3ij.

Colat. lib. xvi. D. ad lag. vii. S. Decostum

tenue.

cure by the prescribed diet. Frequently the pills are thrown up and then they must be again taken in divided doses. Nausea, disposition to vomit, and even actual vomiting, during the use of the decoction subside, if a smaller quantity of the decoction be drunk at one time. I have observed, in one instance, severe pain in the belly every time after taking the weak decoction, and frequently a gentle, not very lengthened salivation, has been noticed (a).

The Arabian treatment and dry diet resembles that with ZITTMANN's decoction (b). Here also must be mentioned the plan of treatment proposed by DZONDI (c), in which the patient commences with one-fifth of a grain of sublimate in four pills, taken immediately after dinner; from day to day the medicine is increased by two additional pills, so that on the last day of the cure, which occupies twenty-seven days, thirty pills, or 1 grain of the sublimate, is taken at a dose. All this time the patient lives moderately, keeps himself warm, and drinks sarsaparilla tea. If the cure be disturbed by salivation, after that has been relieved, the number of pills still remaining must be continued. If mercury have been previously immoderately or irregularly used, sulphur should be first employed internally or in baths.

According to KLUGE (d), DZONDI's treatment is not to be depended on; in certain cases, however, especially in ulcers of the bones and nose, it is very efficacious.

855. In reference to the efficacy of the friction-cure, of ZITTMANN'S decoction and of WEINHOLD's treatment, I must undoubtedly give the preference to the former over the latter, which, according to my experience, more frequently checks than actually cure the disease; often indeed it cannot be borne, and may often continue injurious and scarcely to be gotten rid of disturbance in the functions of the alimentary canal, which depend on an usual and peculiar treatment. The friction cure and ZITTMANN's decoction, in general, act more surely; but the latter is connected with by far less inconvenience to the patient, on which account, according to my present experience, I prefer ZITTMANN's decoction to the friction cure, and only employ the latter when the former has been inefficient. The effect of this decoction I have proved, not merely in all forms of syphilis, but also in other inveterate disease.

Compare my above-mentioned statement, in which I have endeavoured to contradict the opinions put forward by NEUMANN (e) against the friction-cure, and in favour of WEINHOLD'S mode of treatment.

What is the result of WEINHOLD's treatment, when, from the coming on of salivation, it be not determined to interrupt the cure, (which WEINHOLD and NEUMANN expressly enjoin,) I cannot from my own experience determine.

(a) CHELIUS, Ueber die Anwendung des Decoct. ZITTM. im Vergleiche mit anderen gegen inverterirte Lustseuche und andere Krankheiten empfohlenen Behandlungsweisen; in Heidelb. klinisch. Annal. vol. i. pt. i. p. 116.

HACKER; in Heidelberger klinischen Annalen; in RUST's Magazin, vol. xxxix. pt. i. p. 1.-vol. lxvii. pt. ii. p. 203.

HABEL, Ueber die Heilkraft des ZITTMANN Decoctes in secundarer Syphilis; in Med. Jahrbüchern des östen Staates. Neue Folge, vol. ix. 1835.

MARTIUS, Einige Bemerkungen über das Decoctum ZITTMANNI; in Heidelberg med. Annalen, vol. ix. pt. iii. p. 418.

(b) S GANDY, Aperçu sur l'efficacité du Traitement dit arabique dans les Maladies Syphilitiques ou anciennes ou dégénérées. Montpellier, 1827. KLAATSCH; in RUST's Magazin, vol. xvii. p.

kur, mit besonderer Beziehung auf DzonDr's nece zuverlässige Heilart von Lustseuche, und die LOUVRIER-RUST'sche Inunctionskur. Hamburg,

1826.

BARTELS einige Bemurkungen über Dzosat's neue Heilart der Lustseuche; in VON GRAFFE und VON WALTHER'S Journal, vol. ix. p. 513.

(d) Bericht über die, auf höheren Befehl mit der DzoNDI'schen Heilmethod gegen die Lustseuche in dem Berl. Charité Krankenhause arge steilten Kurversuche und deren Resultate, nebst Gutachten über die Methode selbst; in RUST'S Magazin, vol. xxvi. p. 211.

(e) Vergleichung der LOUVRIER'schen und WEINHOLD'schen Methode, das Quecksilber antwenden; in VON GRAEFE und voN WALTHER'S Journal, vol. ii. p. 405.

WITICKE, Dissert, de WEINHOLDII Hydrargyrum adhibendi methodo. Berol. 1821.

NEUMANN, über die Lustseuche; in VON GRAFFI und VON WALTHER'S Journal, vol. xvii. p. 1.

HEINZE, Ueber die Bekämpfung der Lustseuche durch eine modificirte Inunctionskur, U. s. W. Wien, 1836.