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Luckily for me, at this time I came across an officer who was suffering from syphilis. He told me that he was being treated by Dr. Whitmore, of London, by the Hypodermic method, and that the injection he received caused him no pain. I wrote to Dr. Whitmore, and asked him what the solution he used was. He very kindly told me that it was a solution, or cream, which had been lately introduced by Dr. Althus, of London.
The following is its composition
B Hydrarg: zi.
Lanolin Pur: ziv.
Ol: Carbol: (2) 3v.
This must be thoroughly mixed before using, He said that he had been using it hypodermically for some time, and that, whilst it caused absolutely no pain, he had had excellent results from it.
I wrote and got the cream from Messrs. Savory & Moore, London. The first case I treated with this preparation was:-W. F.-an officer aged 25, who stated that about two years previously he contracted a hard sore on his penis; had had induration of the inguinal and cervical glands, followed later on by ulceration of the mouth and tongue, and he was covered by a roseolar rash. Under the internal exhibition of mercury he got rid of these signs to a great extent, but he had never regained his former health; and in spite of the fact that he had been taking mercury on and off for the last two years, the disease was constantly breaking out in the shape of ulceration of the mouth and tongue, and in the case of the latter it was most persistent. He had lost weight considerably.
When I saw the patient, besides suffering from ulceration and thickening of the tongue, his right testicle was enlarged, and hard, which was no doubt syphilitic orchitis. It had been in this state for some months, and in spite of treatment it had got no smaller.
On September 12th, 1891, I first saw the patient, and on that day gave him an injection of the above preparation. I injected 10 mins. of it deep into the gluteal muscles, pushing the needle of the syringe as far as it would go. These injections I repeated once a week until the end of October, 1891. After the first two or three injections there was a marked change for the better in the ulceration of the tongue, and it had quite healed after two more, and the thickening had quite disappeared. By the end of October the testicle was much reduced in size, and the patient had put on flesh and looked ever so much better. He expressed himself as feeling much stronger and better than he had done for some months. About this time he was obliged to leave England on account of some private business, and I did not again see him until February 12th, 1892.
In the meantime I had heard from him that the testicle had not got any smaller, and that the ulceration had returned on the tongue. He was being attended to by a well known surgeon, who was giving him Mercury and Iodide of Potassium internally, and the testicle was being strapped with some mercurial preparation.
On his return to me in February the patient looked anæmic, and had lost flesh considerably. He complained of loss of appetite. Ulceration had again broken out on the tongue, and the testicle was in about the same condition as when he left me in October. I at once stopped the medicine he was taking, and resumed the "Hypodermic treatment." In four weeks' time (he then having had four injections) all ulceration had disappeared, testicle had almost regained its normal size, and he had quite regained his health. I continued this treatment for some months, with the greatest benefit to the patient. Soon the testicle was quite healthy, and when I last saw him (October 3rd, 1892) he had had no return of the disease, and was in robust health. This patient used to come to me one day a week for an injection. The little operation never caused him the least inconvenience, and he was able all the time to be at his duty, as also to hunt. He expressed his wonder to me at the marked effect the treatment had on his disease, and he was no less grateful for it.
The next case-T. H.-an officer, aged 32, had contracted the disease at the end of the year 1888. The history showed, that he had had a hard sore, followed by a papular eruption, and ulceration of the tongue and mouth. He had been under the internal treatment, more or less, since he first contracted
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Iritis. This, it appears, was of a recurring nature. He was also covered with a papular eruption, which was very obstinate. I began injections 12.1.92, and continued to give one weekly for two months, when all symptoms had quite disappeared, and he was in good health. He was discharged to his duty, but attended for a weekly injection for two months longer. There was no fresh outbreak of the disease.
I have the notes of all the cases I treated by this method, but do not think it necessary to quote any more. I will only remark that in all I have had similar success. My custom was to discharge a man to his duty as soon as all active symptoms of the disease had subsided, and to see that he attended at the hospital one day a week for an injection. He did this for two or three months longer, when he was probably cured. In all the cases I treated thus I had no recurrence of the disease months later.
The soldiers got great faith in the treatment, as is shown from the fact that if by any chance a man was unable to attend on the regular day for an injection, he invariably came of his own accord on the following day.
I had one case, that of a soldier, who was the subject of chronic syphilitic orchitis. He had been under treatment in hospital many times for it; but, in spite of everything, the testicle remained enlarged. On hearing from his comrades of the success of the hypodermic treatment, he came and asked me if he might attend with the other men for injections. He did so for nearly six months. Before the end of that time his testicle was quite normal in size, and his health had improved very much.
During the period from September, 1891, to October, 1892 (including all cases), I gave close on one thousand injections of the Mercury and Lanolin preparations. In none did an abscess follow. In fifty slight induration remained at the site of injection for a few days. There was absolutely no pain, nor any other inconvenience following the operation.
As to the preparation used, viz., "Dr. Althus' Mercurial Cream," the composition of which is given in an earlier part of this paper, at first I was supplied with it by Messrs. Savory and Moore, but later on the materials for it were indented for and supplied by Government, and the preparation was made up at the dispensary in the Station Hospital, Shorncliffe.
In dispensing it, it is necessary to rub the Mercury with the Lanolin without heat.
There is one drawback to the preparation, viz., that in cold weather it is apt to become semi-solid, rendering its use very difficult, and heat must only be applied with great care, as, if it be too great, the metal will fall to the bottom. This can be partially obviated by keeping it in a warm cupboard, and in very cold weather adding a little more oil to it.
Before using, it ought to be well mixed with a glass rod kept for that purpose.
The syringe I use is one supplied to me by Messrs. Krone and Sesseman, Manchester Square, London. It is very simple; made of vulcanite all through. The piston is graduated into minims. The needle is fitted into a vulcanite socket, which goes on to the syringe, but is quite distinct, and can be easily detached a very necessary arrangement, as it has to be removed when filling the syringe. This little syringe is an excellent instrument: it costs 28. 6d. The one I originally bought, and which I have used all through, is now as good as ever.
The needles cost 6d. each, and it is necessary to be supplied with a good stock of them, as I very soon discovered that to avoid pain the needle must be perfectly sharp, and free from all corroding." As soon as a needle becomes the least tarnished, or blunt, it ought to be disused. At the same time, the keenness of the needle can be retained by occasionally passing it through fine sand- paper.
I may here state that another advantage which the mercurial cream has over the Perchloride or Sal Alembroth solutions is that it does not corrode or tarnish the needle, and with it I have gone on using one needle for a month at a time, whereas a needle lasts a very short time with the other solutions.
As to the site best suited for injections, I have found the Gluteal region the best, although I have sometimes injected into the Deltoid.
Before injecting, the needle ought to be disinfected by dipping it into a Boracic solution.