A really effective treatment of the child by means of the admin istration of mercury to the nursing mother is inconceivable, especially since the latest investigations of Somma have shown that mercury is not excreted with the milk.
The child requires no special care of the mouth during treatment with mercury, as the adult does. Salivation never occurs, to say noth ing of mercurial stomatitis. The administration of mercury not only rapidly drives away all symptoms of syphilis in those infants, but likewise raises, noticeably, the haemoglobin content of the blood.
The iodides are useless in the treatment of infantile syphilis. In syphilitic recurrence in the second or third year in the form of affections of the central nervous system and of the bones the iodides can be used internally as an aid to the use of mercury by inunction. About 0.3-0.5.
Gm. gr.) of sodium iodide should be given daily. The sub cutaneous and intramuscular injections of iodipin can be dispensed with entirely. The treatment of individual important local affections must not be neglected.
Treatment of Rhinitis.—Local treatment is demanded if there is considerable nasal obstruction and much secretion. I have had the most satisfactory results with cotton tampons attached to a string, painted over with a 5 per cent. red precipitate ointment. Such tam pons are placed alternately in one nostril and then the other, being left for one hour at a time. The nostril is first cleansed each time, with a moist cotton swab. Excoriations in the vicinity of the nostrils are powdered with the following: 13, Calomel 5 3 iss Zinci oxidi 5 3 iss Amyli 50 3 x If the nose is so obstructed that breathing and nursing are inter fered with, it is Nv ell to put several drops of a 1-5000 adrenalin solu tion, in weak boric acid, into the nostrils a number of times a day. If there is a profuse purulent secretion, an effective remedy is found in the instillation into the nostrils of 10 per cent. perhydrol (Merck) or painting with 2 per cent. creosote glycerin.
Treatment of the Skin Affections.—This differs in no way from the customary treatment of skin lesions in acquired syphilis. Moist condylomata in the genito-anal region are best dusted with calomel powder and then covered with a layer of absorbent gauze that has been dipped in 5 per cent. salt solution. After the new skin has formed, the hypertrophic papules are to be covered with emplastrum cinereum. Unna's mercury-guttapercha plaster mull, as made by Beiersdorf of Hamburg, is peculiarly adapted to the local treatment of syphilitic skin lesions in children. Encasing the end phalanges of the fingers, or toes, in paronychia, with this plaster, gives extraordinarily good results.
It is best not to give any local treatment for the crusty, wide-spread syphilide. The bichloride bath, as an addition to the internal treatment, is of great value in this condition.
Ulcerations are to be covered with sublimate gauze and then collemplastrum cinereum spread on this.
Diffuse Skin Infiltrations require no local treatment, but cating skin inflammations do. Furuncles and abscesses must be opened as soon as possible, and erosions of the umbilicus must be treated erly, best by cauterization with silver nitrate. It. is a general rule that collections of pus, wherever localized, must he removed without delay. Treatment of the Lesions of Mucous Membranes.—Since we have discussed nasal affections, and since other lesions of the mucous branes are very rare in early hereditary syphilis, there is not much more to be said here. Affections of the mouth and pharynx require painting with a 1 per cent. solution of bichloride of mercury, or a 10 per cent. silver nitrate solution. Local treatment of the laryngeal affections is impossible in early childhood.
Treatment of Bone Lesions.—Local treatment is not necessary. The bone swellings and the accompanying disturbances of motion are among the most satisfactory lesions in hereditary syphilis from a thera peutic standpoint. Phalangitis alone reacts a little less rapidly to the administration of mercury than do the corresponding early lesions of the lung bones.
2. Treatment of Recurrences of Hereditary Syphilis During Early use of inunctions is here the treatment. pre ferred. This should be continued at least till all symptoms have disappeared no matter whether the syphilitic manifestations are of a gummatous of or a condylomatous nature. It is a good plan not to stop the inunctions at once after cessation of all symptoms but to follow them by a course of internal administration of the protiodide, giving 2 cg. (1 gr.) a day for two or three weeks. On account of the greater tendency to condylomatous and ulcerative affections of the mouth and pharynx, local treatment with such caustics as silver nitrate, biehlor ide of mercury, etc., is commonly needed. In affections of the central nervous system it is advisable to administer, simultaneously with the inunctions, sodium iodide internally 0.2-0.3 Gm. (3-7,i gr.) per day and to keep up the latter for from four to six weeks after cessation of all nervous symptoms. Isolated swellings of certain parts of bones call for the application of mercurial plaster in addition to the combined use of iodides and mercury.