LOCAL TREATMENT OF THE CHANCRE. —Important in this connection is (1) to avoid caustics, (2) to avoid grease, and (3) to keep the parts as dry as possible and perfectly clean. Another important point in the management of severe chan cre is the maintenance of rest. Move ment and friction are often responsible for serious complications of chancre. That sexual intercourse should be inter dicted goes without saying.
The only exceptions to the rule regard ing caustics are mixed sores, with a min imum of induration, and exulcerated sores that become sluggish and refuse to heal after induration has nearly or quite disappeared. In the first instance pure carbolic acid followed by fuming nitric acid is admissible, but the tery, preceded by cocaine, is better. In sluggish ulcers stimulation with silver nitrate may be warrantable.
The old-time black and yellow washes are serviceable, although the part cannot be kept dry under their use. A solution of mercuric chloride, 1 to 1000, is very useful. A plan recommended for the ap plication of the bichloride is to wash the lesion with a weak solution of common salt. Calomel is now sprinkled upon the part, a small amount of nascent and active bichloride being thus formed. The writer has used this plan for con dylomata quite successfully. The best absorbent for the dry treatment is the powdered oleate or stearate of zinc.
Simple calomel is also serviceable.
The following local treatment for soft chancres has proved very successful in many cases. The ulcer and the sur rounding skin is first washed over with soap and water, and then with per chloride lotion. After this the chancre is frozen with chlorethyl, and the super ficial layer of the chancre is removed with a sharp razor. The hmmorrhage is controlled by touching the raw surface with a stick of nitrate of silver. The wound is covered with iodoform powder, and a zinc-oxide plaster is applied. This plaster should be renewed every twenty four hours. The treatment is usually continued for four or five days. Unna (Monats. f. prakt. Derm., 26, 6, '93).
Sodium sozoiodolate is of great value in soft chancre. It is quite free from smell, and is not poisonous. At first it should be mixed with some inert power and it is apt to cause a smart burning pain when applied, but after a few days the affected part grows less sensitive, and the pure preparation may be applied freely. Grivzoff (Berl. klin. Woch., No. 50, '99).
Reports based on fifty eases of syphilis, most of which were seen at the beginning and kept under observation for from twenty to forty years. No case is in cluded in which less than sixteen years had passed since the last symptoms.
They show that syphilis is curable in all its stages, but it is in the secondary period that a cure is most frequently obtained. While mercury and iodide of potassium are the main factors in the cure, there are others which assist: i.e., a robust constitution and an absence of Hereditary or acquired taint of any kind. The natural power of resistance, which varies in each organism, is also an im portant factor. V. M. Tarnoyski (Russki Arkhiv Patologi, etc., Jan. and Feb., 1900).
In all forms of tertiary syphilis of the pharynx the combination of iodide of potassium internally and mercurial in unction is especially useful, and should be employed at the earliest possible op portunity. In tertiary ulceration a good deal may be done locally to arrest the disease and to promote healing. The surface of the ulcer should be care fully cleansed and insufflated with iodo form, or in some cases with heated calo mel. In cases in which there is much pain the insufflation of orthoform will be attended with results most grateful to the patient. One insufflation will often relieve pain for as long as twenty four hours. Both nitrate of silver and chromic acid are also useful applica tions. The best method of applying either of them is to fuse a little of the pure drug on to a probe, and, having cleansed the surface of the ulcer, to paint it on. Last, the patient may be given for use at home a gargle com posed as follows:— R Chlorate of potash. 10 grains. Black wash, '/, ounce.
Water, to 1 ounce.
This is most useful for the relief of pain and for cleansing the throat. As regards the treatment of adhesions, the less the operative interference, the bet ter for the patient. It is never wise to resort to operation unless there are very strong reasons for trying to relieve the obstruction, such as rapidly increasing deafness, constant and intense earache, or great discomfort to the patient aris ing from the nasal stenosis. Should op eration be considered absolutely neces sary every conceivable device will have to be tried for maintaining a larger opening. From observation on a great number of cases it is most surprising how great an amount of contraction may exist and yet cause comparatively little discomfort. When the opening is so small as to cause symptoms, it is generally sufficient to pass dilating in struments regularly and in increasing sizes in order to render the patient quite comfortable, and this the patient can be easily taught to carry out for him self. C. A. Porter (Lancet, Jan. 26, 1901).