This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
In most of the later manifestations of this disorder, sulphurous waters have a good reputation, but, in my opinion, without sufficient reason. At Aix-la-Chapelle, for instance, the treatment is conducted mainly by mercurial inunction, and the sulphur-waters used locally and internally, can only be considered adjuvants to this more powerful remedy. I think they serve mainly to cleanse and stimulate the skin, to regulate the action of the bowels and viscera, and to counteract any injurious effects that might arise from the mercury (v. p. 170). They have, perhaps, a further use for diagnostic purposes, since it is said that obscure symptoms really due to old or latent syphilis manifest themselves more fully under a course of the waters, and thus give the necessary indications for treatment by iodides or mercury. Dr. Wetzler gives several instances of this (op. cit.), and I have no doubt of its possibility.
I must say also that I have seen advantage from the use of sulphide of calcium in syphilitic laryngitis, notably when mercury had been previously taken to saturation.
It is probable that iodine acts in this disease, much as it does in metallic poisoning, by assisting the elimination of a morbid material. It has been maintained, indeed, by Dr. Basham and others, that its influence is best seen in cases which have been previously treated by mercury; and Dr. Budd and Dr. Garrod have given instances in which mercurial influence was dormant until excited by the administration of iodides, when profuse salivation occurred, and recovery ensued. But there can now be no question that the drug has curative powers of its own, independent of mercurial action; they are evidenced especially in the later, or tertiary stages of constitutional syphilis, when either the mucous membranes are affected, as in deep ulceration of the fauces, or the bones are attacked with periostitis or nodes, or the skin suffers with rupial or lupoid eruption, or the brain-membranes are thickened, or gummatous deposits are formed in any of the viscera. In such conditions it usually acts far better than mercury, although this latter drug is more advisable in some eye-inflammations, such as iritis; and again, in a certain proportion of undefined syphilitic cases, an iodide of mercury will give better results than either medicine alone.
By causing the absorption of deposits and thickenings in various parts of the body, iodides cure, at the same time, many secondary and dependent symptoms, such as nocturnal pains, neuralgia, paralysis, dulness of sense or intellect, and convulsive paroxysms. The dose of iodide of potash is a matter of much importance, and need be limited only by the susceptibility or idiosyncrasy of the patient, and the progress of the disease; it may vary from 1 or 2 gr. up to 60 gr., two or three times daily, and the best results have sometimes been obtained from heroic doses, when ordinary ones have failed.
Elliotson gave 30 to 60 gr., or more, for a dose (Lancet, i., 1832), and Ricord commonly prescribed the same amount. Sir A. Cooper, Drys-dale, Pollock, and others, have given instances of the value of such quantities (British Medical Journal and Lancet 1867-68); and more recently Dr. Buzzard has pointed out the importance of large doses, especially in syphilitic affections of the nervous system (Lancet, i., 1873).
In hereditary syphilis I prefer mercurial treatment, though infants generally bear iodides well.
Mr. Berkeley Hill has stated that the iodide of ammonium or of sodium will sometimes cure when the potassium salt has failed, and this fact should be remembered in practice (British Medical Journal, ii., 1871).
In the later stages of syphilis, or when relapses are frequent, and mercury or iodides are not well borne, hydropathic treatment is a useful resource, tissue-change being promoted by the wet sheet and free water-drinking. Good results are also derived in this disease from the eliminant influence of the Turkish-bath, and the occasional use of this during a mercurial course is always advisable.
The former reputation of this acid as a cure for syphilis (Medical Quarterly Review, 1835) in Vienna, need be mentioned only as an historical fact (Nothnagel). The aqua regia may, however, prove of service in chronic cachetic conditions.
In the later stages of syphilitic cachexia, when the blood-condition is impaired, and elimination by the liver and skin is often inefficient, the acid used internally and in the form of bath has been recommended: a spare but nutritious diet should be enjoined in these cases.
Several writers, chiefly American, have strongly recommended the internal and external use of the sulphites in the later stages of syphilis (Ranking, ii., 1868). I have had no occasion to prescribe them, but have found the acid locally applied most useful in throat and other ulcerations. Dr. Purdon has recorded an illustrative case (British Medical Journal, i., 1868).