If the drug be given in a less vigorous fashion for a longer period, pallor and debility may result, due to depreciation in the quantity and quality of the red blood-corpuscles, defibrination of the blood-plasma, and increased tissue-waste.
A certain degree of these effects is avoidable in the treatment of syphilis; but it should be our chief aim to keep them within bounds, and thus avoid the danger of producing permanently jurious effects. Such effects as great pallor, wasting and debility, pustular or vesicular eruptions, with fever known as "mercurial fever" and marked tremors, may result from the action of mercury, and that, too, without the occurrence of ptyalism: the characteristic effect of large doses of mercury. On the other hand, small closes of mercury, in various ca chectic or anwinic conditions, particu larly during the sequehe of syphilis, stim ulate hoematogenesis and rapidly and markedly increase the quantity, while improving the quality of the red corpus cles and fibrin, thus lessening hydrmia.
Iodine is another remedy that experi ence has shown to be curative in syphilis, and is second only to mercury. Iodine, in the form of the iodides, especially, is invaluable, more particularly in late syphilis. The iodides—of which potas sium iodide is the type—act in two ways in the cure of syphilis, viz.: first, by their own intrinsic power of producing fatty degeneration and elimination of morbid products, especially toxins; and, secondly, by liberating, exciting to re newed activity, and eliminating the mer cury that is stored up in the tissues, thus assisting its action. It is evident that the first of these effects is the most im portant, for the iodides have a most pow erful effect in resolving the products of inflammatory changes or adventitious deposits, irrespective of their cause. This, in the face of the argument that iodine can cure syphilis only by liberat ing mercury from the tissues, and that it is the mercury, and not the iodides, that produces the curative effects. That this is incorrect is shown by the beneficial effects of the iodides in late syphilis when mercury has never been administered.
It is the writer's opinion that treat ment should begin as soon as the diag nosis is established. The duration of the initial lesion is thereby shortened, and secondary symptoms moderated, if not prevented. To save the patient from lesions upon the body or face is desirable, and only to be accomplished by early treatment.
The mildest and least irritating form of the drug is the mercurous iodide: the green or protiodide. It is best given in pill form, beginning with doses of, on the average, 1/5 grain, thrice daily. This dose is to be continued for several days, and then increased one pill per still in divided doses—until the gums come slightly tender or the stomach and bowels disturbed. The writer generally gives the drug until the gums are slightly affected, and then gradually lessens the dose until the patient is taking about half the amount necessary to produce slight physiological effects. This, as Keyes terms it, is the patient's average dose, and is usually from two to four pills, of the strength mentioned, daily. This should generally be continued—with cer tain intervals of rest—throughout the course of treatment. It is often well to substitute from time to time some of the other mercurials for the mercurous iodide.
It is the physician's duty to tell his patient that if he wishes to get well he must take remedies for at least three years, and if any doubt exists at the end of that time he had best add another year, especially if he has matrimonial inten tions. As already stated, no syphilitic patient should he permitted to marry under three years from the appearance of the chancre. In the case of women a still longer period is advisable.
In the event of pregnancy, when the father is syphilitic at the stage when the disease may be transmitted, and when the mother is healthy, two classes of cases are considered: (1) when the pregnancy is the first one, supervening shortly after marriage; (2) when sev eral previous pregnancies have resulted disastrously in abortion or in early death of the child. The child can be safe guarded by antisyphilitic treatment of the mother, even when she is healthy. The cardinal points of treatment are that the treatment should be begun as soon as possible after the onset of preg nancy, and that mercury is the best, drug to administer. If the iodide is given in conjunction with mercury, all the better. Inasmuch as it is not an adult, but the fmtus, that is being treated, small doses should be given. The treatment should be continued dur ing the whole time of pregnancy. Four nier (Sem. Med., Nov. 30, 'OS).