RUPIA.
As one of the manifestations of syphilis, this must be treated constitu tionally as well as locally. Whether the limpet-shell crusts appear in the late secondary or in the tertiary period, the internal administration of Mercury will always as a rule be necessary, since the skin lesions respond but slowly to Iodides, but Iodides are always clearly indicated in con junction with mercurials. Rupial eruptions, according to Hutchinson, usually occur in syphilitic patients after mercury has been given in too large doses, and has disagreed and been wholly laid aside.
Donovan's solution is the best preparation for routine internal treat ment, and may be given in the full dose of 20 mins. thrice daily after food. Salivation should be avoided and the mercurial administration must be stopped as soon as the first signs of gum tenderness show themselves; then Iodides in ro to zo gr. doses may be given for several weeks. One dose of Salvarsan may be injected before commencing mercurial treatment.
The crusts should be softened with a Boric Acid poultice and the cleaned ulcers dressed with Calomel or weak Red Precipitate Ointment or Black Wash. Very indolent or spreading sores should be curetted and lightly touched with the strong Pernitrate of Mercury solution.
Occasionally rupia will be met with in cachectic subjects which will tax all the skill and patience of the physician. The writer has seen such cases in Fournier's wards which defied all treatment till the Serum from healthy dogs was administered hypodermically. He has had the recent experience of one case where the ulcerations spread so deeply that death from exhaustion was only prevented by the administration of a Vaccine prepared from the secretion of the ulcers. All such intractable cases appear certainly to be instances of a dual infection caused by the admission of some destructive organisms to the ulcerated surface. and hence the importance of the use of an autogenous vaccine and the continuous disinfection of the ulcerated surface. Severe rupial ulceration will demand in all cases the most careful attention to the general health of the patient and a diet as varied and strengthening as the digestive powers of the patient will permit. The liability to relapses will justify the physician in recommending a long ocean voyage in severe cases.