In syphilitic diseases of the brain and nerves the patient should be mercurial ized as soon as possible, and it is best to do this by inunction. Iodide of potas sium should be given in fairly large doses. Sixty grains should be given dur ing the day, this dose doing as much good as if 90 or 120 grains were given daily. The main point is to get the pa tient under the influence of mercury as soon as possible. James Taylor (Clin. Jour., May 3, '99).
Inunctions are useful in all stages. This method is the safest of all. The blue ointment of the United States Pharmacopoeia is the best preparation. The best time for treatment is the hour of retiring, in a room at an even tem perature. The early treatment—that is, prior to the secondary eruption—is of no value. The ideal end of treatment is to stop when the disease is cured. The cases of reinfection frequently reported are probably no cases of reinfection, but the remanifestation of the old condition, or due to failure in absorption. The chronic intermittent method of treatment hes no advantages over the symptomatic plan of treatment. B. Lapowski (N. Y. Med. &u., May 6, '99).
The treatment of syphilis must be long continued, for eight months or one year, and it is certain that most of the eases in the British navy and army do not re ceive treatment for nearly so long as this. By the intramuscular method treatment may he continued as long as necessary after leaving hospital, the men coming up for treatment once a week. Twenty thousand injections have been personally given with only 1 bad result, and in that case an abscess formed. The following prescription is preferred, as it causes but little pain-1 drachm of mer cury, 2 drachms of lanolin, and 4 drachms of carbolic oil (1 in 20); of this 10 minims are injected into the buttock. Major F. J. Lambkin (Brit. Med. Jour., Aug. 19, '99).
In using inunctions the patient should first be instructed to take a bath at 100° F., and then sponge himself with a 2 per-cent. solution of carbolic acid. After having divided the body into the follow ing 11 subdivisions, namely: 1 and 2, the arms, palms, and axillfe; 3 and 4, the legs and soles; 5, the neck and head; 6 and 7, the breast and abdomen; 3 and 9, the thighs, with groin and Scarpa's triangle; 10 and 11, the back from the seventh cervical vertebra to the lower part of the gluteal region. One or two
of the parts should be selected for fric tion, and from 40 to CO grains of freshly prepared and well-triturated blue oint ment used for each inunction. If one employs a rubber other than himself, he should anoint the hands with a simple cerate in order that lie may not absorb any of the mercury. If the patient's condition and physique are such as will permit, he should take 2 or possibly 3 Turkish baths a week. From 50 to 100 inunctions may be given with proper in termissions, and then they may be stopped for a shorter or longer interval, as indications and conditions require. In women taking this treatment, tonics should at the same time be given. Fumi gation treatment is not to be followed as a routine plan. The patient is en veloped in blankets, India rubber or Mackintosh covering lined with flannel and tight fitting around the neck, and calomel, 20 to 40 grains, with a Maury or Lee lamp used to volatilize the salt and generate steam at the same time. They should never be taken after meals, but preferably at bed-time, the patient at once retiring, if at all possible. The time consumed, as in the inunetion treat ment, is thirty minutes. R. R. Ca m pbe I I (Hot Springs Med. Jour., Pt. 15, '9;)).
A permanent mercurial plaster, con taining mainly calomel, for the treat ment of infantile syphilis, has many ad vantages. The digestive tract, even in the youngest and most delicate child, is not disturbed; the absorption continues constantly, and is not limited by care lessness or forgetfulness of attendants: the medication can be withdrawn at will. AI. H. Gillet (Jour des Prat., Sept. 29, 1900).
The tincture of iodine used in syphilis, giving it in 10- to 30-drop doses in coffee or red wine three times a day. In 20 per cent. of the patients the maximum dose that was well tolerated was 50 drops three times a day. Richter (Versam. Dentscher Naha-. u. Aerzte, Sept., 1901).
It is sometimes necessary to bring a patient under the influence of mercury very rapidly: e.g., in cases of syphilitic iritis, in which a few hours' delay might be fatal to the integrity of the eyes. In such an event calomel, in doses of grain every hour, will accomplish the de sired result. If necessary, ptyalism can be produced in this manner within twenty-four to forty-eight hours.