(A number of allied and possibly identical compounds have been intro duced during the war period owing to the difficulty in procuring the original salvarsan or neosalvarsan; these are known as Novarsenobenzol, Galyl, Luargol, Kharsivan, Neokharsivan.) The permanency of the cure in human syphilis by Salvarsan can only be demonstrated by time, and even its most enthusiastic advocates recommend that it should he in most cases supplemented by Mercurial treatment. It seems almost certain that primary syphilis can be aborted by a few injections of sal•arsan. but no surgeon would venture to recom mend that any case should be so dealt with finally. There is always the great risk of those spirochetes in the non-vascular areas escaping the lethal action of the drug. Hence, even where abortion of the disease in the primary stage has apparently occurred, a six-months or longer period of mercurial treatment should invariably be instituted.
The routine methods of using Mercury in syphilis will he first described.
The abortive treatment by mercury has been placed upon an unassail able looting, and advances in pathology and diagnosis have simplified the therapeutic problem. The great objection to starting an active mercurial treatment of syphilis in its primary stage was the question of uncertainty of diagnosis. At this early period it was impossible to be con fident that the local lesion was truly syphilitic, and the idea of commenc ing with full closes of the metal, which would have to be continued for a long period in the blind belief that the patient had become infected, was rejected by most practitioners.
By a careful examination of the secretion from the sore, the spirochete may he at once recognised by employing dark-ground illumination or by mixing Chinese ink with the discharge before examining it under the microscope. As soon as the parasite has been detected, abortive treatment by mercury can be confidently commenced and persisted in till the patient can he safely assured that the disease has been cured. Hutchinson stated " that if treatment he faithfully carried out, syphilis may be wholly suppressed, and the patient may never know anything about his malady beyond its primary symptoms. In many cases he may come to doubt the diagnosis on account of the completeness of his cure." Of the truth of this statement the writer is perfectly satisfied by clinical observation, and he accepts the principles of the abortive plan, by aid of mercurials, without any reservation as one of the most certain and brilliant advances in therapeutics.
As soon, then, as a patient presents himself with an indurated chancre, he should be placed under small doses of mercui y, as 5 grs. Plummer's Pill, morning and evening, 2 grs. Grey Powder in pill three or four times a day, or 2 grs. Blue Pill, or gr. Perchloride, or gitt Green Iodide thrice daily.
The following combination has many advantages: . Hydrargyri cum Creta gr. iss.
Quinime Sulphatis gr. i. Adv. 0 pii gr. A. Miscc.
Fiat pilula. Mute c. Sumal tenant pater in die fast cibos.
In a fortnight or three weeks the chancre is markedly changed for the Letter, and the induration is greatly reduced and rapidly disappears as the system gets under the influence of the antidote. The treatment should he steadily persisted in for about i year, the gums being watched closely, and the dose diminished upon any marked sponginess or ptyalism. In Aix, where the closest attention is given to every detail that facilitates the admission of the largest amount of the drug into the system without affecting the gums, great care is exercised by the use of tooth-powders and astringent mouth-washes to keep the gums in a healthy condition. The following is used extensively at Aix-la-Chapelle: R . Lrq. Aluminii Acct. (P.G.) Aqua? Flor. Aurantii ad 5viij. ill isce.
Fiat lotio ore, sage. utenda.
A i per cent. solution of Alsol (Aceto-tartrate ofaluminium) acts in the same manner.
Where the writer has witnessed failures from mercurial treatment he has been generally able to trace these to the nervousness of the physician, who was afraid to continue the drug for a sufficiently long period in sufficient doses, or to the carelessness of the patient, who ceased to take it. Seldom,.if ever, has he chanced to see injury done by overdoses, unless in the hands of quacks or irresponsible persons. He is therefore led to con clude that much greater injury is done by withholding the drug than by giving it too generously.
As long as the patient continues to gain in weight or steadily keeps to his normal standard of weight there is little danger to be feared from the action of the drug upon the system. Accurate weighings should be accomplished once a week or once in a fortnight in the physician's study after the patient has been taking the drug for several months. Under this abortive treatment the rash may not appear at all, or if it appears it is so much modified as not to be easily recognisable. The same may be said of the sore throat and other phenomena. It is therefore advisable, if not imperative, that mercury should be given as soon as an indurated chancre comes under notice, without waiting for the appearance of the rash or sore throat. Should mercury be given before induration appears in the sore ? In other words, given a sore, which may not be syphilitic, are we justified in waiting for changes to take place in it to settle our diagnosis before ex hibiting mercury ? Ilutchinson thought it possible to cause abortion of the primary stage itself. Whether this is correct or not need not deter the physician from beginning small doses of mercury when he considers that such treatment cannot possibly do the patient any harm.