Ragazzoni injects 5 mins. of a solution of Red Iodide of Mercury made by dissolving gr. with sufficient amount of Sodium Iodide in i dr. water.
Theoretically it would seem that if any of these soluble salts be injected they should be employed in very much smaller doses and more frequently —at least every second day, though in practice the above-mentioned intervals are said to be quite satisfactory.
Insoluble salts are, however, much more frequently employed, as, owing to their slow absorption from the muscular tissue, a more uniform effect is continuously being exerted upon the spirochmtes. The favourite injection is Grey Oil prepared accordng to Lambkin's formula by rubbing up oz. pure mercury with 2 oz. anhydrous lanoline, and adding car bolised (2 per cent.) liquid paraffin to 5 fluid oz. The maximum dose of this compound is lo mins., which contain 1 gr. lig, and the injection should not be repeated at shorter intervals than every seventh or eighth day. Little if any pain follows the injection. Lambkin's Mercurial Cream is of the same strength (to per cent.), and contains a specially prepared fatty basis derived from palm oil.
Calomel in suspension in sterilised olive oil is also much used; it always causes considerable pain; gr. in 17 mins. is the usual weekly dose. By adding Creosote and Camphor to the injection pain may be prevented. It is claimed for this injection that it is much more active or speedy in its effects, and Lambkin's routine is to start the treatment with a calomel injection every week for a month, and then to resort to the mercurial cream.
Intravenous injections are recommended in malignant or very grave cases of nerve syphilis. The best salt for this purpose is the soluble Cyanide, which has been injected into a vein at the elbow in doses of -' gr. 20 mins. r per cent. solution. This salt is very poisonous, and may cause purging and albuminuria.
As a rule the injection method of treating syphilis by mercury (and by salvarsan) is contra-indicated in Bright's disease, in structural heart and liver affections, and in alcoholic subjects.
S already stated, the universal practice in treating syphilis in its primary and secondary stages consists in a combination of the salvarsan and mercurial methods, though the details of the routine vary greatly in the hands of different experts. Some prefer salvarsan, the
majority use neosalvarsan, the intravenous route being always preferred owing to the pain following intramuscular injections.
Lloyd Jones and Gibson describe the method carried out in the British Army. Two injections of grm. salvarsan arc given during the first week and one of mercurial cream; second week, one of salvarsan and one of cream; third week, one of cream; fourth week, one of salvarsan O'4 grm. and one of cream; fifth and sixth weeks, one of sal varsan o'5 grin. and one of cream; seventh week, one of salvarsan o's grm. and two of cream. By the eighth week the disease has practically dis but if a positive Wassermann exists Iodide of Potassium 3o grs. daily are given for a fortnight, and if still positive, three injections of cream and three or four of saivarsan (a total of r2 grins.) are administered during the eleventh, twelfth and thirteenth weeks. The treatment of syphilis affecting the nervous centres will be referred to later on.
Serum treatment has proved a failure, but the writer has seen un mistakably good results from the injection of dog's serum in tertiary ulcerations many years ago carried out in Fournier's wards as suggested by Professor Richet in Paris.
Complications and local manifestations rarely require special treat ment, as these usually steadily disappear under the action of mercury when skilfully employed by any of the methods already detailed.
Skin eruptions on the face may be hastened in their disappearance by the local application of a mild mercurial ointment as Calomel or White 20 grs. tor oz. Lanoline. Where the skin eruption is very formidable the calomel bath may be resorted the patient sitting upon a cane-bottomed chair, or with his body in a chamber devised for the purpose. As he receives a vapour bath, calomel is sublimed by the heat of the lamp which boils the water, and it is deposited in fine dust over the surface of his skin, after which he lies down in dry blankets. The Turkish bath during the mercurial course is also believed to hasten the disap pearance of the rash.