Fumigations with mercurial vapor are occasionally used, especially for persistent and localized eruptions and for short periods of treatment but they are not suitable for debilitated subjects. They are given in the same manner as the domestic hot air bath. The patient, after thoroughly washing the skin, is seated naked on a cane-bottom chair, blankets thrown about him and a special vaporizing lamp containing thirty grains of calomel or forty grains of cinnabar is lighted and placed underneath the chair. Very soon free perspiration begins; in fifteen to twenty minutes the drugs are entirely evaporated. The lamp is then removed and after the patient is cooled off a little, he retires to bed with the same blankets wrapped about him. On the following day the patient should be warmly clad, wearing flannels next to the skin and take care not go get chilled. The bath can be repeated two or three times a week according to the effect desired or obtained, but it should rarely be employed for more than four weeks and should be discontinued at any time if it produces any ill effects.
Hypodermic injections – The administration of mercury hypodermatically is deservedly the most popular method. It allows of definite doses entirely under the control of the physician and neither irritates the stomach nor the skin. Against the hypodermic method there stands the element of pain and the possibility of abscess formation. These can be obviated by careful technic. If the inside of the needles and syringes are thoroughly cleansed before being boiled and the skin at the site of injection is rubbed with a sponge saturated with ether, dried and painted with tincture of iodin and the needle thrust deeply into the muscle, there will be no abscesses unless one is careless and contaminates the needle while giving the hypodermic. Both the soluble and insoluble mercurial salts are used but the latter produce greater and more persistent pain and are more liable to abscess formation because of their slower absorption. Among the soluble preparations, mercuric chlorid, in doses of 1/12 o 3/8 of a grain, is usually advocated. This may be deeply injected on alternate days, into the gluteous or trapezius muscles. Soluble mercurials such as the succinamid, albuminate, peptonate, carbolate, benzoate, sozoiodolate and others have been used as well as such insoluble compounds as the salicylates of mercury, calomel and metallic mercury (oleum cinereum). The salicylate is probably the most popular of the last group. Intravenous injections of mercuric chlorid (15 drops of a 1 to 1000 strength in normal salt solution is the usual dose) have been recommended. While the effect is rapid and may be painless, it presents little advantage over the intramuscular method.
The iodids of potassium, sodium or ammonium may be needed in any period of syphilis but ordinarily they are most useful in the late secondary or tertiary periods. Usually the first named salt is prescribed in 5 to 15 grain doses in some liquid medium, three times a day after meals. But when special organs are involved, it may be necessary to rapidly increase the dose to 60 or more grains three times a day. The action of potassium iodid is to subdue rather than cure syphilis and, in the secondary stage of the disease, it should be discontinued when it has accomplished its special work. In the tertiary period when there is a continuation or revival of cell products from syphilis without contagion, the iodid should be given longer to subdue the slower but more dense and persistent tendency to infiltration of the skin and other tissues. In tertiary syphilis mercury is still needed to complete a cure and the biniodid or bichlorid can be administered with the potassium iodid (mixed treatment) or better still, in alternation with the latter. The tendency of to-day is to treat all late secondary and many tertiary lesions of syphilis with salvarsan. Until more is known of the ultimate course of syphilis treated only with salvarsan, it is wisest to take advantage of its immediate action but not to rely upon it for the cure of syphilis.
Salvarsan, often known by its laboratory number “606” is a synthetic arsenical compound bearing the chemic name of dioxydiamidoarsenobenzol, introduced by Ehrlich in 1910. The form in which it is dispensed, a yellowish powder, contains 34 per cent. of arsenic but owing to its peculiar molecular form, arsenical poisoning is not developed. While this remedy may be used advantageously in any form of syphilis, at this early date it may be asserted that it is especially suitable to those cases that mercury has not relived nor prevented relapses, in the malignant and rapidly destructive forms, in severe ulcerations of the mucous membranes, in visceral, nerve and hereditary forms, in those cases presenting severe syphilitic cachexia, in latent cases in which the Wassermann test is persistently positive, in the early stages of tabes dorsalis and paresis, and in the earliest period to abort the regular course of syphilis. It can likewise be stated that salvarsan should not be employed in cases of severe non-syphilitic cachexia, myocarditis or other equally grave heart disease, advanced nephritis, or pronounced disease of the central nervous system.
There is much difference of opinion as to what will eventually prove the best method of salvarsan administration. The subcutaneous method may be dismissed by saying that it is the least efficacious mode. The intramuscular injection is commonly used because it is easier, demands less technical skill and incapacitates the patient less than the most successful method, the intravenous. The former is usually injected deep into the gluteal region while the latter is inserted in a distended vein of the forearm. The usual dose is 0.6 gram of salvarsan but it may be expedient to give fractional doses of 0.1 gram or more at intervals of three to six days rather than the full dose. The vehicles used in the intramuscular procedure are sterile water or a thin sterile oil while choice may be had of warm sterile water or warm normal salt solution for the intravenous method. The latter should be employed when possible because it exerts the most rapid effect on existing lesions, is more quickly eliminated from the system, is practically painless and does not produce tumefactions, but it should be done with all the skill, technic and surroundings of a surgical operation; in fact the patient should remain in the hospital two days so that the reactive symptoms of chill, fever, nausea, Diarrhoea, etc., which may appear in from one to six hours after the injection and which are more apt to follow the intravenous method, may come and go before his discharge.
Neosalvarsan whose laboratory number is “914” is a later preparation and more soluble. It is obtained by the addition of formaldehyd sulphoxylate of soda and while as efficient as salvarsan, is more useful because larger doses can be used at much shorter intervals besides permitting a much simpler technic. Hectin, containing 21 per cent. of arsenic, and sodium cacodylate, containing 35 per cent. of arsenic, have been used hypodermically with good success in a number of reported cases, including a few of my own.
Judging from my own experience salvarsan or neosalvarsan plus mercury and occasionally the iodids, presents the ideal treatment for syphilis. It seems as if the combination of arsenic and mercury affects the blood reaction more effectually than either remedy used alone. It is impossible to say with any exaction how many doses are necessary but ordinarily in the early period, three to five, at week intervals, plus a mercurial are sufficient, while in the later periods, three to eight, plus several mercurial courses may be essential. However, a single injection will often benefit if properly supported by other treatment.
External treatment – The unbroken lesions of the secondary period require no local treatment other than systematic cleanliness. For pustular eruptions and moist papules the use of boric acid or sublimate soap is advisable for local or general bathing. Ulcers resulting from pustular lesions may be induced to heal more rapidly by washing them with a mercuric chlorid solution (1:2000) and applying boric acid, calomel or aristol powders or an ointment consisting of calomel 33 per cent., lanolin 57 per cent. and vaseline 10 per cent. I have used mild fulguration and 10 second applications of solidified carbon dioxid with good results in many applications of solidified carbon dioxid with good results in many instances of sluggish ulceration of the late secondary or tertiary periods, combined with the mode of treatment mentioned just previously. The presence of syphilitic ulcers shows insufficient treatment. It may be that more mercury should be given or that mercury has been given and is ineffective. Such cases call for salvarsan, after which it is not uncommon to find the mercury- fast condition corrected.
Syphilitic lesions of the face or other exposed parts, which give rise to mental annoyance and suffering, may be stimulated to resolve by rubbing into them nightly a 2 to 10 per cent. ointment of ammoniated mercury. If not too extensive they can be treated and protected by being brushed over occasionally for a few days with a 2 per cent. salicylic collodion. Nodular infiltrations when situated in exposed or awkward positions may be gently rubbed once or twice a day with a 2 to 10 per cen. oleate of mercury ointment. Their permanent correction demands either material doses of the iodids or salvarsan followed by mercury.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war