The entire period may be passed without the patient taking to bed or giving up business, and exposures to variations of weather. if met hr ordinary precautions, are harmless, and need not interfere with the treatment.
It is hardly necessary to point out that the patient should be placed under the most favourable hygienic conditions as regards food. fresh air, most moderate exercise, and abstinence from alcohol in every form, and the avoidance of all mental and physical overwork. Sexual indulgence obviously must be strictly forbidden. If tobacco be permitted at all it must be sparing in amount, arid only when the mouth remains in a healthy state.
Some surgeons believe that the system soon becomes accustomed to the continuous use of the drug, and they recommend its suspension for weeks or months, after which it is to be resumed in full doses. This is known as the interrupted method of treatment. The writef does not hesitate to advise the continuous plan, chiefly because he is satisfied that relapses and tertiary manifestations are less frequent when it is employed.
Inunction unquestionably is preferable to administration of mercury by the mouth, and the results are more uniform and lasting when this plan is scientifically carried out, hut there is considerable difficulty in pursuing inunction treatment at the patient's home or even in the best English health resorts. Inunction is much in vogue as a routine treatment on the Continent, especially at Aix, where the usual dose is about 75 grs. of Ointment (t in 3) rubbed in once a day for 20 minutes over the aides of the chest and abdomen and inner aspects of the arms and thighs. These doses would appear to be better borne there than at home. Oleate of Mercury or the Calomel Bath may be substituted. Where the Ointment is employed it must be rubbed into different parts of the body in succession, otherwise local irritation may super ene. Where the patient is com pelled to remain at his business. inunction is not easily carried out. hut where he can devote his full time to the cure of his disease, this method is preferable to all others. Where a rapid effect is desired, as in cases of neglected syphilis, or where pressing brain symptoms arise in the later forms of the disease, this method may be imperative, or wherever we wish to obtain the full physiological action of the drug [20 grs. may be then rubbed in twice daily.
An ordinary inunction course usually extends for about 6 weeks, hut this will always require repetition later on. Afterwards the administra
tion of mercury by the mouth in moderate closes should be kept up at intervals, in which case a further resort to inunction treatment may be avoided.
Welander's method of causing the patient to wear a mercurial shirt is based upon the erroneous idea that in inunction by the ointment the drug finds its war into the blood by inhalation of the evaporated metal. It may, however, prove a handy plan of treating the disease in some cases where inunction and secrecy are both necessary. Mercuriol, which is an amalgam of mercury, magnesium, and aluminium, is a very suitRble drug for Welander's method, as it decomposes under the heat of the body, leaving the mercurial vapour free for inhalation; it may he worn as a sachet.
Injection Treatment.—The practice of most specialists now is in favour of abandoning oral administration, and trusting entirely to deep muscular injections, as a much smaller amount of the metal is necessary, the dose can he scientifically gauged, and no stomach or intestinal disturbance is produced. The best site is a point in the gluteal region midway between the anterior spinous process of the iliac crest and the cleft of the buttock, and the liquid should be lodged deeply in the mass of the muscle. The most scrupulous antiseptic precautions must be maintained at each injection. As regards the selection of the mercurial preparation to be employed there is a considerable diversity of opinion.
Soluble salts as the Bromide, Cyanide, Oxycyanide, Lactate, Sozoiodolate, Succinimide, Asparaginate and Formamide have been employed, but the Sal Alembroth compound is the safest and most manageable of the soluble salts. It may be formed by dissolving 16 grs. Perchloride of Mercury and 8 grs. Ammonium Chloride in i oz. water. The dose of this solution of the double chloride of mercury and ammonium is 10 mins., which represent about 3 gr. perchloride. Bloxam found that after two such doses the physiological action of the drug manifested itself, and the effect could be kept up by one injection every seventh day. _His practice, however, was to inject once a fortnight after decided mercurialism had once become established, and to inject only once a month after the disappearance of the throat and glandular symptoms, and this was continued for 18 to 2.4 months, only 8 grs. perchloride being employed during the entire period of treatment.