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that from the day he first noticed it he had been under treatment, and for five months he had taken Hyd: c Creta. gr. i, from four to five times a At the end of that time he became day. The induration greatly diminished. very weak and debilitated: appetite was very bad, and he suffered now and then from diarrhea. He was advised by his medical man to stop the mercury. This he did, and his health rapidly improved; but at the end of three weeks the induration had returned to its original size. He was then put on a course of Liq: Hydrarg: and Iodide of Potassium, and had been taking this, together with grey powder, in varying doses up to the time when I saw him.
When he came under my notice he had a large induration on the penis, also induration of the inguinal and cervical glands, and an ulcerated throat. He was anemic and weak, appetite very poor: on the whole he was very much pulled down. He said he had been advised by a "friend
to go to Aix-la- Chapelle, but he decided to remain under me for the present. He did so for two months; but although the induration decreased very much, his health did not improve, and the disease kept breaking out in various ways. He then made up his mind to go to Aix. There he went; and in three weeks' time he wrote to me saying that he felt much better-all signs of the disease, with the exception of the induration, had disappeared, and even the latter had very nearly done so. I saw him five weeks after his departure for Aix. I was astonished at the he had put on gone; improvement he had made. Every sign of the disease had weight, and looked a different man.
*
The case made a great impression on me, as I know the patient had spared no expense in getting the best advice, nor trouble in carrying it out. He was a regular liver, and very abstemious.
About this time I had two similar cases which eventually found their way
to Aix, and returned thoroughly restored to health.
I was so struck with the above cases that I determined to pay a visit to Aix, and see for myself of what the treatment really consisted. In October, 1889, I went there with introductions to Dr. Brandis, the celebrated surgeon of that place. He was very kind to me, and afforded me every facility of seeing of what the treatment consisted.
Briefly, it is as follows :-
1. The patient is advised to rise early and to take a walk to the sulphur springs, and then he drinks a tumbler or two of the natural waters.
2. After the above, breakfast of a very light nature.
3. From one to two hours later he proceeds to the baths, where he remains immersed in a bath of the natural water for not less than twenty minutes.
4. Half an hour later a professional rubber rubs into the patient's skin 75 grains of mercurial ointment, a little stronger than the Ung: Hydrarg: (B.P.). The rubbing lasts fifteen minutes, and the parts of the body into which it is rubbed are selected as follows-1st day, into the calves of the legs; 2nd, the thighs; 3rd, back; 4th, chest; 5th, sides; 6th, arms, returning then to the calves. By alternating the parts rubbed, the chances of their becoming sore from the friction is very much lessened.
This treatment lasts generally about six weeks, or, as they say at Aix, Forty rubbings is the cure." During this time the patient is directed to pay great attention to the cleanliness of the teeth: to be very careful to brush them well after each meal, and in the intervals to frequently wash the mouth out with a strong mouth wash, consisting of Acetate of Load and Sulphate of Alum.
His diet is not restricted in any way. He is advised to live well: to drink freely of new milk (which can he got in abundance at Aix). Spirits are forbidden; but beer, and the Rhine wines, and claret are allowed. A fair amount of exercise is advised, and remaining in the open air as much as possible insisted on.
During a visit of nearly three weeks at Aix, saw patients of all nation- alities, the great majority being English. Class was well represented-from the Peer to the prize fighter and professional strong man. Most of the English cases I met were of at least a year's standing. They had been during that time
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under treatment at home; but the disease recurring over and over again, and being sick of taking medicine internally, they at last found their way to Aix. This was the history in two out of every three patients I met. They were all loud in their praises of Aix, and the treatment, and the benefit they had derived from it, and regretted not having gone there before.
Here I may remark that it is astounding to me the ignorance that exists (whether real or assumed) among the profession in England concerning the treatment that is carried out at Aix-la-Chapelle. I will quote the following passage from Hilton Fagge's Principles and Practice of Medicine, one of the latest standard works of inedicine: "There are greater advantages in residence at the seaside than at Aix-la-Chapelle, where, if report speaks true, the real method of cure is neither, the baths, or the waters, but mercury." One cannot help feeling surprised, not to say disappointed, at such a remark coming from the author, as he clearly shows that he is in doubt as to what the treatment at Aix really consists; and this is all the more astonishing considering the short distance it is between England and Aix, and that for years scores of English- men, who have been under treatment at home, have been in the habit of going there and returning much benefited. By his remark he also suggests that the German surgeons make a secret of the treatment at Aix. This, to anyone who has taken the least trouble to find out, is quite untrue. Everything there is done in the most open manner. As for their claiming for the waters and baths the success of the cure, I will quote what passed between Dr. Brandis and myself: He said, "Why do you not carry out this treatment in England?" I remarked, "How can we without the Aix water?" He answered, "You do not need the waters; any water will do, provided it is soft: the baths are used solely for the purpose of preparing the skin for the inunction of mercury."
My reason for alluding so extensively in this paper to the treatment of syphilis, as carried out at Aix, is, that from it I learned that by far the best channel for the introduction of mercury into the system is through the skin, and that the internal administration of the metal is radically wrong, and in my opinion it should never be employed for reasons I have given above.
On my return to England I gave the treatment every trial, and treated all my syphilitic cases at Shorncliffe Station Hospital by it. In my essay for promotion, which I wrote in May 1891, I gave the notes of these cases showing the marked success I had with this treatment. I do not intend to allude to
them in this paper, further than to remark that, in spite of the marked success I had, I saw one great difficulty to its ever becoming the general treatment, especially in the military service; this difficulty was, because I found it quite impossible to have it thoroughly carried out. The patients became careless, as did the orderlies put to superintend the treatment. I found that it was not done properly unless I personally saw that it was. that in a hospital, where there were a great number of patients, it would never I could not help seeing hold ground. One other drawback to it was, that it was dirty.
It was then that I thought of a treatment which had been tried over and over again, but had always been given up as a failure for many reasons, the principal among them being, it was stated, its liability to produce tetanus and abscesses, besides being very painful: I allude to the hypodermic injection of mercury. In spite of these drawbacks, it struck me that if it could possibly be carried out, it would be the greatest boon to the military surgeon, and at the same time a direct saving to the State, as whilst undergoing it there would be no need for the soldier to be absent from his duty.
Accordingly, I determined to try it; and on June 2nd, 1891, I gave my first injection. I used a solution of Perchloride of Mercury gr. to 20 min., injecting the 20 min. deep into the gluteal tissue. There was a good deal of pain at the time, but no other bad signs followed. I repeated the injection once a week, and did this for some time. The case I treated thus did very well; in fact, so well that I began to use the injection in several of my syphilitic cases, and they also made rapid recoveries. In all I gave 60 injections with the above solution, only one of which was followed by an abscess.
As I said above, there was a good deal of pain following the little operation, and this, in some instances, lasted a day or so. This fact was very much against the method, and patients (especially officers) objected very strongly to the operation. I was obliged to discontinue it in most of my cases. I also tried the Sal Alembroth solution, but pain was just as great with it.
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