Treatment of Syphilis

The treatment of syphilis must be considered under three heads: First the hygienic, second the specific, and third the local.

Fygienic Treatment

The very first points to which the physician should devote his consideration are the condition of the patient's general health, his habits, and his surroundings. If his health is good, his habits correct, and his circumstances comfortable, it is only necessary that these conditions be preserved.

If, however, he is suffering from some previous disease, this should be relieved, or its effects obviated if possible. If he is intemperate, reformation is a fine qua non of successful treatment. Good health, good food, good air, suitable clothing, freedom from undue exposure to the elements, regular exercise, and methodical habits constitute more than half of the treatment, and combined with proper specific medication rob the disease of most of its terrors. Per contra, the absence of these essential elements will greatly impair the effects of otherwise judicious treatment, and not unfrequently lead to relapses, annoying alike to the physician and the patient.

Specific Treatment

This embraces the use of mercury, the only known specific and directly curative agent yet discovered, and of the iodides of potassium and sodium, and the chlorides of gold and platinum, for the relief of certain symptoms pertaining to the later periods of the disease.

The basis of anti-syphilitic treatment may be expressed by a single word, and that word is Mercury. That mercury, when properly admin-istered, cures syphilis is beyond a question; that it is the best known rem-edy for this purpose we firmly believe. The question, however, is frequently raised as to whether mercury, although curing the syphilis, may not produce effects nearly, if not quite as bad as the original disease. This will depend entirely upon the manner in which it is administered. Abundant experience has shown that if properly given it may be continued almost indefinitely, with the result of curing the disease, and without in any way injuring the health or constitution of the patient. On the other hand, it may be given in such a way as to produce the most disastrous consequences. Mercury, then, is to enter into the treatment. By many it is given sparingly and with hesitation, and is soon abandoned for the iodide of potassium. The majority of practitioners, however, rely pretty fully upon mercury in the early secondary stage, combine it with the iodide of potassium, under the name of "mixed treatment," in the intermediate period, and trust to the iodide alone in the management of ter-tiary lesions. Personally we use mercury in all stages, never employing the iodide if it can be avoided.

An interesting and at the same time important question arises at this point: How does mercury cure syphilis? Is it by some alteration of the constitution of the blood, and the consequent induction of nutritional changes, or is it by direct local action of the drug upon the lesion itself? The former is the more prevalent belief, but the latter, we think, is nearer the truth. Mercury cures the lesions by its particles being brought directly in contact with them, and, costeris paribus, the larger the quantity of mercury that can be made thus to act, the sooner the cure, provided the remedy be used in such a way as not to exhibit its own peculiar poisonous effects. Mercury, like every other specific remedy, as soon as it poisons, ceases to cure, and becomes, in addition, a very ready and potent agent of mischief. By these two principles the treatment is to be guided.

If the lesion under notice be a chancre (not a chancroid) it does not require cauterization, but instead a local mercurial application, and for this purpose we know of nothing better than the Hydrarg. Oxid. Nigr. Hahn. This is a black powder, and should be freely dusted upon the sore, and renewed as often as may be necessary. If this salt cannot be readily obtained, ordinary black or yellow wash will answer almost as well.

If, in addition to the chancre, there is induration of the inguinal and post-cervieal glands, and the diagnosis is absolute, give mercury internally. For this purpose we prefer the protoiodide given in pill or in trituration. Six centigrammes, or one grain given in divided doses, may be considered the average maximum daily allowance. The following formulae will bo found convenient:

Hydrarg. protoiod........................ 1. gr. xv.

Make 100 pills.

Hydrarg. protoiod......................... 1. gr. xv.

Sacch. lactis.............................. 9. gr. cxl.

M. Divide into 100 powders. Dose six powders or less per diem.

In some cases it will be found that the protoiodide, given as above, will produce symptoms of gastro-intestinal irritation. Under these circumstances the dose must be diminished, or the drug combined with a sedative, as follows:

Hydrarg. protoiod......................... 1. gr. xv.

Ext. lactucarii.............................4.

M. Make 100 pills.

Or,

Hydrarg. protoiod.,

Pulv. opii...............................aa 1. gr. xv.

Sacch. lactis.............................. 8.

Mix thoroughly, and divide into 100 powders.

Or,

Hydrarg. protoiod......................... 1. gr. xv.

Pulv. Ipecac. co........................... 9. gr. cxl.

M. Make 100 powders.