SYPHILIS.
Prophylaxis.---.1s regards the preventive treatment of syphilis, the subject is in the main a question of morals, and may be summed up in the single word—purity. Prophylaxis becomes a practically professional problem in those cases where the marriage of an individual who has suffered from sy pinlis is contemplated. There is still much difference of opinion regard ing the interval which should elapse between the time of contracting the disease and that at which marriage is permissible. The trend of opinion is against the shorter period of Iwo years laid down by I futchinson, even when the most energetic treatment has been carried out, and gradually the interval of three to four years has come to be regarded as a safe practical rule for the majority of cases. The presence of the Wassermann reaction affords sonic guide, but cannot be said to be conclusive; though the reaction may he absent in some cases, still the disease can be pro pagated by these individuals, whilst it has been found that patients showing a marked reaction may not be able to infect their wives and may he capable of producing healthy issue. Nevertheless, it will be wise in all cases where it positive reaction is found to submit the patient to further energetic treatment till a negative is substituted for a positive reaction. In all doubtful cases the other tests should be employed also, as the colloid gold, and Inetin reagents.
In all cases of old syphilitic infection, the mother during pregnancy should have several short mercurial courses to make assurance doubly sure. The new-born infant, if syphilis exists in its blood or tissues, will give a positive reaction as soon as tested, and such an infant should not he put to the breast of a healthy wet nurse. It is claimed for Salvarsan that it has specific action, when administered during pregnancy, in prevent Mg abortion and curing the disease it) the ketus.
The importance of prophylaxis is seen in those cases where the surgeon or aci•oucheur receives it finger wound in operating on a syphilitic patient. Tile experiments of M etchnikoff have demonstrated the fact that a 3o per cent. Calomel Ointment, when rubbed into the site of the inoculation, will effectually prevent infection when the application is made within an hour after receiving the wound. Hence any suspicious accidental wound or abrasion should be promptly treated by a thorough local inunction.
Calomel Cream, 33 per cent., has been employed in the Navy. and Power reports that the incidence of syphilis is thereby reduced.
Abortipe problem is intimately associated with the treatment of the primary sore. There is no evidence that syphilis has ever been aborted by excision of the chancre alone. The successful instances where operation has been carried out were always treated by active mercurialisation at the same time, hence it is impossible to say that the satisfactory result was not due to the drugs employed.
It is therefore advisable for the surgeon to content himself with such local treatment of the primary sore as past experience has shown to promote early healing and resolution of the induration. The best routine application is Black Wash applied on lint which should be frequently changed. When much moisture is present. as in sores on the female genitals, the chancre may be dusted over with Calomel.
Iodoform is a favourite routine application, and but for its tell-tale odour it would be universally employed. When the sore is situated inside an elongated prepuce it may be advantageously selected, as the prepuce prevents its volatilisation.
Should healing be slow, a sluggish chancre may he lightly touched with strong Liq. Hyd. Pernit., and any tendency to spreading may he checked by an application of fuming Nitric Acid. Mixed sores are best treated by Iodoform powder. Dry chancres on the skin of the penis can be most conveniently dressed by the application of a piece of Emplastrum Hydrargyri.
Constitutional treatment with the intention of producing abortion of the disease has attracted much attention, since the possibility of effecting this was stoutly maintained by Hutchinson. When a single intravenous injection of Salvarsan is administered during the early primary stage. the spirochzetes often entirely disappear from the secretion of the chancre with in 24 hours and the induration begins to melt away. The most remarkable proof of the abortifacient efficacy of the drug is afforded by the experi ments on apes. When one of these animals was infected locally by the syphilitic virus and injected with Salvarsan the spirochetes were so entirely destroyed that it was found possible to establish a fresh attack of syphilis 4 weeks afterwards by inoculating with the virus again.