Another rapid and efficacious method is Lewin's method of hypodermic injec tion. From to grain of mercury bichloride, in combination with grain of morphine and a small quantity of so dium chloride, is dissolved in 15 minims of distilled water, and injected into the cellular tissue, preferably of the buttock, once or twice daily; a minute dose of cocaine may be advantageously combined with the injection.
Taylor advises a mixture of calomel and sodium chloride, 5 parts of each, sus pended in 50 parts of distilled water. Of this fluid an ordinary hypodermic syr ingeful may be injected every eight or ten days. The sides of the buttocks and the back beneath the shoulder-blades are the best sites for the injections.
Eighty-four cases of syphilis were treated by the intravenous injection of cyanide of mercury. The arm is ren dered aseptic by washing with a solution of carbolic acid; a rubber tourniquet is applied to the upper part of the arm to make the veins stand out. A fine needle of an hypodermic syringe, containing 20 minims of a 1-per-cent. solution, is then introduced into the chosen vein in the direction of the blood-stream. The tourniquet being removed, the fluid is injected into the vein, the needle is with drawn, and an antiseptic swab applied to the point of puncture for a few min utes. Such an injection is repeated every morning, unless some contra-indication exists. In the eighty-four eases treated in this manner, the complications met with were very slight and rapidly disap peared. All the cases with but one ex ception showed very marked and rapid improvement. The average stay in the hospital per case was 23.2 days. In the worst eases other adjuvants, such as cod liver-oil, iron, and correct diet, were re sorted to. In all eases special attention was paid to the general health. In the tertiary and some of the rupial cases the iodides of sodium and ammonia were used. All cases on being discharged from the wards were advised to undergo a further and prolonged course of the ordi nary methods of treatment in the out patient department of the hospital. Ar thur Chopping (Lancet. Feb. IS, '99).
The direct introduction of mercury into the blood exercises a most useful in fluence and improvement takes place al most at once. Small doses should be given at first and gradually increased. If, however, too large doses are used, or it is continued too long a time, mer curial anaemia may develop. Careful antiseptic precautions should be main tained. Lindstroem (Presse Mod., May IS, '9S).
The intravenous method for treating syphilis should be regarded as an excep tional measure, of infinite value when other recognized methods have failed— in glossitis. phagedamism—and in eases
demanding rapid action, or early intense thercurialization—malignaney. It should be reserved fur lesions of exceptional se verity where other methods of medica tion have failed. In the differential di agnosis of certain neoplasms in suspected tertiary syphilis, or in the presence of the numerous psendophenomena or gran e symptoms of obscure origin, intravenous injections of mercury constitute the only thorough test, of infinitely greater value than iodides. Dudley Tait (Jour. Amer. Med. Assoc.. June 17. '99).
Injections of sublimate, 1-1000 to 1-5000, into a vein are safe. The injec tions are out of place in persons affected with sclerotic blood-vessels. Condyloma Louis syphilitic manifestations readily yield to this method, and their disappear ance is more prompt than after subcu taneous injections of sublimate. No toxic effects have been noted, either in the mouth or intestines. Relapses are more frequent than after the hypodermic method. The intravenous method is not recommended for general use, but is in dicated in cases of intolerance toward other methods. A. Lichatchew (Vratch, xxii, No. 44, 1901).
For females with very weak stomachs, and in children, the gray powder or hydrargyrum cum creta is an excellent mercurial preparation.
It is an almost universal custom to use iodine and its preparations only in the late periods of the disease, and chiefly in tertiary lesions; but it will be found also that in many cases of obstinate second ary lesions they will not yield until the iodides are given. It is well to give a few weeks' course of the iodides from time to time, throughout the course of mercurial treatment. A small amount of the nas cent mercuric iodide may be given at the same time if thought best. In precocious syphilis, in which destructive skin and mucous lesions or nerve-changes come on early in the disease, the iodides are some times our chief reliance. It is in late syphilis, however, that the iodides will be found most reliable, especially if com bined with mercury in the form of "mixed treatment." Gummy lesions re quire an excess of the iodides; but, in all cases after the lesions are under con trol, a prolonged mild mercurial course should be instituted. This is the proper method of treating the deeper lesions of the brain, spinal cord, bones, viscera, and testicle, tubercular lesions of various kinds; the various scaly eruptions; and those later syphilides that tend to aggre gate themselves in groups or become par ticularly obstinate.