TREATMENT OF SYPHILIS IN CHILDHOOD 1. Treatment of Early Hereditary Syphilis.—Shall every child of syphilitic parentage be treated, no matter whether it has symptoms of syphilis or not, at birth? I would answer this question by saying that only those should be treated that have evident syphilitic symp toms, among which are to be classed not only skin affections, but also diseases of the nose, of the bones and of the viscera. A. Fournier holds the view that the healthy child of a recently syphilitic mother should certainly be treated, but that the healthy child of a mother with an older specific infection need not be treated. I recognize but one indication for antisyphilitic treatment in the newborn and young infant, i.e., manifest syphilis, -no matter whence it comes.
The only effective therapy of early hereditary syphilis is admin istration of the preparations of mercury. In the front rank should be placed the internal use of the yellow iodide of mercury (protiodide), introduced as a therapeutic agent in infantile syphilis by Forster and L. M. Politzer, and now used exclusively at my clinic. We prescribe: divided into 10-15 powders, stirred in milk, and give to children 3 such powders a clay, until all symptoms of syphilis have disappeared; after this we continue 2 powders for two weeks and then one powder for the same length of time. If extensive crusty and moist skin lesions are present, we use in addition baths of bichloride of mercury 1 Gm. (15 gr.) to 20 litres (5 gallons) of water and leave the child in this for 15 to 20 minutes.
Other preparations of mercury are calomel, hydrarg. tannic. oxydul., or a preparation much used in England, hydrargyrum cum creta (gray powder), all of which, however, are not to be compared with the pro tiodide in their effectiveness aganist syphilis.
French physicians, as for example at the Clinique Tanner, use very extensively, the so-called liquor van Swieten, made as follows: The use of this preparation is all the more unjustifiable, in that it contains 10 per cent. alcohol.
Mercurial inunctions, too, are frequently used in treating syphilis in infancy. We have almost wholly abandoned its use during the first
few months, as has also Finkelstein, but use it in preference to other preparations in syphilitic recurrences during the second and third years, especially in affections of the central nervous system. For inunction we may use the mercurial ointment, 10 per cent. colloidal mercury, mercury resorbin, or mercury vasogen. One gram of the ointment is rubbed in daily for 5 minutes. The skin that is to be rubbed should first be washed with warm water and soap, and after the rubbing it is to be covered with a layer of absorbent gauze. In order to avoid irritation, a new area of skin must be chosen each day for the inunction.
The presence of bullous and crusty skin lesions, as well as bone af fections contraindicates the use of the inunctions.
Subcutaneous injection of soluble mercury preparations offers no advantage over the other methods. The intravenous injection of sol uble mercurial salts is still less to be recommended. The method intro duced by Welander of using a little hag and the merkolintschvrz of Blaschko patterned after it, I have abandoned as less efficient than other methods. The application of large pieces of various mercurial plasters to the back, as recommended by Unita and E. Lang, is a very effective method, but is apt to produce an undesirable skin irritation..
Since there is more at stake in the treatment of hereditary syphilis. than of the acquired form, as the former is usually a matter of life and death, it is desirable to use only one method of treatment which we know will produce the desired result without. causing other disturbances.. From this standpoint I can recommend only the internal administra tion of the protiodide, and the inunction method, under the conditions described. The protiodide is especially well borne by the gastro-intes tinal tract of children and only very exceptionally causes transient diarrhwa. I have, myself, never had occasion to stop, nor interrupt, the treatment with protiodide.