The new iodine compounds, as Iodipin or lodinal (6o mins. 25 per cent.), Sajodin (25 grs.), lodalbacid (zo grs.), Iodival (15 grs.), etc., are much praised.
Where iodides cannot be tolerated by the mouth, lodipin may be employed by inunction or by hypodermic injection, and by the latter route Tiodine may be administered in 3-gr. doses, and the older salts have been used for their local action by the method of Cataphoresis.
When very large doses of the iodides are considered necessary, it is well to stop the administration of mercurials for a time, and it appears prob able that a small proportion of arsenic diminishes the tendency to skin eruptions.
The following combination may be used: Sodii lodidi 3iv.
Potassii Iodidi 3iss.
Ammortii Iodidi 3iss.
Liquoris Fowleri 3ij.
Spirit. Ammon. Aromat. 3iss.
Liquor. Sarsa Co. Conc. ad 5xx. 3fisce.
Fiat mistura. Capiat cochleare magnum post cibos ter in die cum cochleare magno aqua.
The iodide treatment may require in some cases a longer period than the original mercurial course. Some patients may be kept upon it, with occasional breaks, for 2 years. It must be persisted in till every trace of the local affection has long disappeared. Gowers lays great stress upon the dangers of iodides when administered for longer periods than a few weeks at a time. The writer has seen large doses administered for i to 2 years without a break, and no ill-effects whatever were observable. It is well, however, to give a rest of El days every 2 or 3 months when the symptoms are not urgent.
It is hardly necessary to emphasise the necessity for close attention to the state of the general health in tertiary syphilis. Change of air to the seaside and a long sea voyage may be necessary in tedious cases.
The treatment of tertiary syphilis has undergone considerable change since the discovery of spirochetes in the seat of the lesion long after these were supposed to have been destroyed in the system. Bence the advocacy of a few salvarsan injections followed up by more active mercurial treatment. In this connection the following paragraph has special significance: Syphilis y the Nervous System.--A complete change in the treatment of syphilitic nervous phenomena has taken place since the discovery that mercury and salvarsan reach the cerebrospinal system in infinitesimal amounts when administered by the mouth, skin, muscles, or veins. This has given rise to the treatment of these lesions by injection of the drugs into the spinal canal by means of Salvarsanised or Mercurialised Serum. The procedure is described under the headings of Paralysis, General, of the Insane and Locomotor Ataxia.
Congenital is in this form of the disease that the most marvellous effects of Salvarsan have been demonstrated, though death has followed in infants suckled by the mother after receiving an injection of the new drug. Even when all goes well with the infant, the salvarsan cannot be relied upon to prevent relapses, and Mercury will always be necessary. o'o75 to 0'1 so grm. is injected into the veins of infants by Veeder and Jeans, who follow two such doses up by courses of grey powder.
By the judicious use of mercurials, as in ordinary syphilis, success is likely to crown the efforts of the physician in the most unpromising cases. Failure is too often caused by timidity in pushing mercury. It must be borne in mind that children hear large doses of the drug safely, and the writer elsewhere (" Pharmacy, Materia Medica, and Thera peutics," Toth Edition) has pointed out that it is almost impossible to do harm with Grey Powder to infants poisoned by syphilis as long as their tissues are saturated with the syphilitic virus, as this latter acts as a vital antidote to the mercury. Salivation is almost impossible, and it may
be laid down as a safe rule that it may be pushed as long as the child continues to thrive.
1 to gr. of Grey PowderImay be given three times a day for several days to a 3-months' old infant. Then the same dose once a day may be continued for many weeks. If the physician have doubts about pushing it further, he should make careful weighings of the patient, and any steady diminution of weight will be a strong indication that the treatment should be suspended. The writer is satisfied of the truth of the following state ment which he made many years ago: " Weak, emaciated infants bear larger doses when poisoned with syphilis than they can when afterwards apparently cured and fattened; but if, after a period of neglect, syphilitic symptoms come on markedly, then they bear very large doses again." Weak Mercurial Ointment may be smeared upon a flannel roller wound round the abdomen. The movements of the body rub in the drug as in the ordinary operation of inunction, hut the physician has no guide to the amount absorbed. The writer has had excellent results by using a roller saturated with Cod-Liver Oil, to which a small quantity of the ointment has been added. Over this a broad binder of mackintosh is applied, and the oil renewed every morning or evening without changing the roller. Marked increase of weight always follows this simple but invaluable plan.
Mercurial treatment may be suspended from time to time, but should not he discontinued for at least r year. Cod-Liver Oil and Syrup of Iodide of Iron, to which a small quantity of Iodide of Potassium has been added, should be given at various opportunities during the course.
The mother may be permitted to suckle the child in most instances, but she should be always placed on a mercurial course, and in mild examples of congenital syphilis the mercurial treatment of the mother may meet all the necessities of the case, but it is much safer always to supple ment this by an independent mild course administered directly to the infant.
It is, of course, out of the question to put the child to the breasts of a healthy wet-nurse, owing to the danger of infecting her through the nipples. If hand-feeding must be adopted, unusual care will have to be taken during the first 6 or 9 months, and beef juice should be given at least once a day.
When syphilis is known to exist in either parent, the treatment of the mother during pregnancy is of vital importance, and the writer has never seen a case of death from congenital syphilis where this was skilfully carried out.
Hereditary Syphilis.—Many recent reports prove that children first coming under the notice of the physician at any age from late infancy up . to puberty suffering from the effects of neglected syphilis, as shown by the various stigmata, epileptic convulsions and mental deficiency, may improve markedly under Salvarsan and Mercurial treatment. If the mental condition is beyond the degree of feeble-mindedness, treat ment is of no avail. With the family history and a positive Wassermann, Gordon advises Mercury and Iodides under the age of five years, and after this age the same treatment preceded by Neosalvarsan. Salvarsanised Serum was injected intraspinally in those feeble-minded who had reached the ages of fifteen and sixteen.