The detection of spirochzetes in the secretion of the sore at once places the diagnosis of the nature of the chancre beyond doubt, in which case there never should be a hesitation about instituting mercurial treatment after one or more injections of Salvarsan.
Duhot has published his results of the abortive method by injections of Grey Oil; these show that when active mercurial treatment was instituted before the twelfth day after the appearance of the chancre, there were no further symptoms in 95 per cent. of the cases and the serum reaction was proportionally negative.
Wassermann Reaction.—The bearing of the result of this test on treat ment is a very important matter, and in its discussion it must be recog nised that during the entire primary stage of syphilis a positive reaction is not obtainable in more than 4o or at the most 5o per cent. of cases, and in early chancres as a rule there is no reaction. Therefore, as regards early abortive treatment, the test must be regarded as practically useless. probably because the spirochmtes arc localised in the sore and neigh pouring lymphatic glands. In the secondary stage, before mercury or salvarsan has been employed, a positive reaction may he obtained in 95 per cent. of the cases: this result is, however, of little practical importance, as by this time the signs of the disease are obvious and unmistakable.
The presence of a positive reaction is regarded as indication for active mercurial or salvarsan treatment, even when these drugs had been previously exhibited. though Mcl )onagh affirms that the presence of the reaction only signifies that the patient probably has had syphilis, and that it does not indicate active disease requiring treatment. During active mercurial treatment, when carried out for several months, the positive is usually replaced by a negative reaction, but this must not be regarded as evidence of a cure, since a short time after the suspension of the drug the reaction is liable to become again positive. Therefore, before the final cessation of mercurial treatment, the blood should be again examined after a 6 or 4 weeks' suspension of the metal, during which iodides should be freely administered in order to secure elimination of any mercury retained in the system, when, if a positive reaction occurs, the mercurial treatment is to be resumed. The patient should only be
regarded as cured when a negative reaction is obtained after the lapse of (1 or o months from the cessation of treatment. Even in these cases by " reactivation that is, by a few mercurial or colloidal mercury with sulphur injections—the reaction 4.111 often he made positive again.
Treatment of the Stage. When the case presents itself in the first instance in the secondary stage, the exhibition of mercury in full doses continuously is clearly indicated for a period of 9 months at least, commencing after an injection of salvarsan. Any mercurial preparation may be employed, as Ifydrag. cum Creta in doses of about io grs. daily, which may he safely pushed as long as the gums show no signs of swelling or ulceration, or ,', gr. Perchloride may be given three times a day.
I t will generally he found necessary after a month or 6 weeks to diminish the dose slightly for a short temporary period to insure that salivation may not suddenly supervene, but when possible the mercurial treatment should not he entirely suspended. The aim of the surgeon should he to introduce continuously as much of the drug into the system as can safely he accomplished without affecting the gums markedly, and if a short rest be compulsory Iodides may be advantageously administered. These should also he combined with the mercury after the lapse of 3 or 4 months from the appearance of the primary sore, and it is a good plan to suspend the iodides for each alternate month of the treatment during the later stages of the secondary period whilst mercury alone is being given. At the end of 9 months, if all goes on satisfactorily, a 3-months' course of iodides in full doses may he substituted for the mercury, which should afterwards be prescribed in short courses from time to time till the end of the second year according to the indications obtained by resorting to the Wassermann reaction. Ey this time in ordinary cases the cure may be considered as accomplished, hut it will often be necessary to resort to mercurial courses for short periods for another 12 to 24 months, and some times for even a longer time.