Treating Syphilis With Gold (Aurum)

M. Chrestien, of Montpellier, and later, M. Legrand, have reported many cases of both primary and secondary syphilis cured under the influence of gold, and Trousseau observes that such results are now well proven and incontestable. Chancres and condylomata have got well under this remedy in a manner not likely to be due to nature, and in my own experience its efficacy has been still better seen in the later developments, such as ulceration in the nose and larynx, cutaneous syphilides, hard nodes, etc. It is said to cure without local applications, but often an "unguentum auri" has been used in addition. Gold may especially be employed in long-standing cases with chronic periostitis, and when mercury has been already given to saturation.

Dietrich, while denying to gold any true anti-syphilitic power, thought it most valuable for mercurial cachexia (journal des connaissances med Chir., 1840), but this has not been corroborated by many observers. Auric fever may occur during a course of the remedy, and for a time the general health may suffer, and the local manifestations may be more irritable, but on lessening the dose, pyrexia subsides, and good effects are more conspicuous.

Treating Syphilis With Copper (Cuprum)

Aime Martin and Oberlin have recently published the resuits of fifty cases of secondary and tertiary syphilitic affections treated with sulphate of copper; in many of these it is said to have acted more promptly than mercury; only in one patient vomiting took place on the first day, but very soon the metal was borne well; a green margin of the gums without an inflamed state of the mucous membrane was observed in a few cases, but disappeared soon; the remedy was given in solution, and 4 to 8 or 12 milligr. were used daily. To a full bath 20 grammes were added (Gazette Medicale de Paris, November 15, 1880). Zeissl has tried copper in syphilis, but his results were only partly satisfactory (Wien. Med. Presse, November 29, 1880).

Treating Syphilis With Mercury (Hydrargyrum, Quicksilver)

In 1497 Gilinus first employed mercury in the treatment of the then epidemic of syphilis, borrowing his practice from that of the Arabians in skin diseases, and using only external applications, by friction, bath, or fumigation. Several serious accidents that occurred from the remedy as used by empirics contributed to discredit it, and in 1517 it was almost entirely superseded by guaiacum. Not long afterward, however, the internal administration of corrosive sublimate, red precipitate, and calomel became general, and by the time of Boerhaave was carried to such excess that mercurial treatment was not considered thorough and satisfactory till it secured the ejection of three or four pounds of saliva in twenty-four hours. But some protest against such abuse was not wanting, and between mercurialists and anti-mercurialists sprung up a controversy which has lasted to our own time. In the early part of this century a reaction of opinion against the extravagant use of the drug in syphilis became general - thanks mainly to Rose and Guthrie, Thom-son and Abernethy - and it was proved that syphilis sometimes tended to spontaneous cure, and yielded to non-mercurial treatment. Later on, an important distinction was made out between the soft or non-infective, and the hard infective sore, and professional opinion pronounced strongly in favor of mercury for the latter, while allowing it unnecessary in the former, and in gonorrhoea. This was clearly evidenced in the report of the Admiralty Commissioners on the subject, which records the opinions of forty eminent practitioners (1864). Among others, Sir James Paget called mercury "a specific - if the patient could take it well; in favorable cases it would prevent secondary symptoms, and at least it would shorten their duration." Mr. Hutchinson speaks of it as a "true vital antidote, and if given early, as really stopping the development of symptoms, and absolutely curing the disease." While agreeing in the main with this conclusion, I do not discard wholly the use of mercury in soft chancre, for I find that small doses cause the sore to heal more quickly than any other medicine.

Constitutional syphilis is commonly divided into three stages, fairly well distinguished as primary, secondary, and tertiary, and the best period for giving the remedy has been much discussed. Some have maintained that its early exhibition only defers the appearance of secondaries, and it is better for these to appear and then to give mercury till they disappear; but the best authorities favor early commencement. Ricord gave mercury - generally the iodide - so soon as the hard chancre was distinctly diagnosed, and insisting on a year's continuance of treatment, was satisfied that he prevented secondary symptoms. Barallier supported the same conclusion after much experience among sailors. The majority of British surgeons follow this practice at present, and it seems to me the right one.

On the other hand, most are agreed that in tertiary stages of syphilis, mercury is not a desirable remedy, and Dr. Wilks finds a reason for this in the different processes which occur at different periods of the malady. In the primary and secondary periods, plastic lymph is being effused, but in later stages degeneration is going on; mercury causes absorption of the effused products, but its further action can only assist degeneration, induce cachexia, and be thus injurious (Guy's Reports, vol. ix.). As clinical evidence of this, if any were needed, reference might be made to the cases recorded by Mr. Hutchinson, where phagedaenic ulceration in delicate subjects distinctly increased under the influence of mercury (London Hospital Reports, vol. ii.). Also, if any syphilitic sore be much inflamed, or if aggravated dyspepsia, anaemia, phthisis, or albuminuria is present, special treatment for these conditions must be instituted independently of mercury. Pregnancy has been, by some, considered a bar to due mercurial treatment, but, in my opinion, the danger of miscarriage in the mother, and of injury to the infant, are greater from syphilis than from mercury.

In any case, a moderate use of the drug must be the rule. It is true that Trousseau and Pidoux blame a relaxation of the old methods for what they consider the present gravity of the disorder; but the large majority of the best authorities, including Ricord, Sigmund, and Hutchinson, deprecate full mercurialization, and find the best effects from small doses continued for a long time. Sigmund states that of nearly 9,000 patients treated in the Vienna Hospital, 8,500 showed no sign of salivation, but were cured as permanently as those salivated (Medico-Chirur-gical Review, July, 1858). Slight tenderness of the gums may be safely and properly produced as evidence of systemic influence, and a method, sometimes successful, is to give fractional doses (1/12 gr.) of calomel every hour; given in this manner, 3 gr. may suffice for the purpose (Law, Dublin). In all forms of tertiary syphilis, rupia, and deep ulcerations, especially of mucous membranes, tongue, and fauces, gummata, visceral syphilis, and most syphilitic nerve-affections, the great remedy is not mercury, but iodide of potassium, though in hereditary syphilis mercury is still to be preferred.

In syphilitic iritis and retinitis, the early and sufficient use of mercury is perhaps more clearly indicated than in any other •inflammation, and they are the only conditions in which Ricord held even salivation justified. Watson has graphically described how effused lymph in the anterior chamber may be seen to "melt away," under the influence of the drug; but unfortunately, this is evident only in syphilitic cases. I often combine with its internal use, collyria of corrosive sublimate, 1 to 2 gr. in 6 oz. of water with opium, or an ointment of ammonio-chloride with belladonna for frictions round the orbit, with good success; but the same treatment cannot be depended upon in rheumatic or traumatic cases.

In syphilitic laryngitis also, mercury must be promptly and freely used, for in acute cases life is rapidly endangered by the disease. Syphilitic infants, as a rule, develop only a subacute form of this disease, which may be treated less actively by moderate frictions with very satisfactory result. (For catarrhal laryngitis, mercury is not indicated.)

Treating Syphilis With Kalium (Potassium)

By those who decry or discourage the use of mercury in syphilis, the chlorate of potash is much depended upon as a substitute, especially in infantile forms of the disorder (Drysdale: Dublin Press, December, 1862). I believe that it may contribute to the healing of ulceration in this as in other cachexiae, but I cannot attribute to it special anti-syphilitic power. More has been claimed for the bichromate, and it seems to have proved sometimes useful, especially in ulcerated throat (syphilitic) and in iritis; a pill containing 1/10 to 1/6 gr., with opium, is the best way of giving it, for its solution is apt to nauseate. In large doses it is an irritant poison, and its action as a remedy has not been well proved nor extensively tried. I have myself been greatly disappointed with its effects in some obstinate cases of syphilitic disease.