An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![diversity ot opinion ;is to their mode of action prevails. A tonic eflect is again claimed as one of the causes of the good results obtained by the admin- istration of these preparations. The views held as to their melius operandi will depend upon the ])artieular theory of the tertiary stage which is adopted. However this may be, the clinical evidence is <{uite sufficient to justily the emph^yment of these drugs, and the })ropev methods of administering them may be epitomized as follows, beginning witli the a])pearance of the initial lesion: 1. Do not employ mercurial treatment until either by confrontation or by the development of constitutional symptoms the diagnosis of syphilis is assured. Mercury always retards the appearance of the secondary symptoms, and some- times prevents it altogether. As no venereal sore can with al)solute certainty be pronounced syphilitic, it is unwise to add an element of uncertainty to the case by delaying indefinitely the outbreak of unmistakable symptoms. There is sufficient evidence to prove that the subsequent course of the case is not materially affected by this delay. 2. When the time has arrived for the admin- istration of mercury, it is well to explain to the patient the necessity for long- continued treatment and to point out the risks of neglect. Having done this, in the majority of cases the most satisfactory method of giving the drug will be by the mouth, a useful preparation being the protiodide of mercury in pill form, in the dose of ^ to |^ of a grain, three or four times daily: I|i. Hydrarg. iodid. vir., gr. xx ; Confect. rosae, q. s. M. et ft. pill. no. Ix. If these should disagree with the stomach and produce dyspeptic symptoms, or should give rise to colicky pains and diarrhea, from -Jg- to -^ gr. of opium may with advantage be added to each pill. At the same time a saturated solution of chlorate of potassium should be given as a mouth-wash, to be used twdce daily as a prophylactic against salivation. 3. To ascertain the proper dose ol the drug in each individual case, continue gradually to increase the dose until slight tenderness of the gums or of the posterior molars is noticed. Then dimin- ish it to two-thirds, or even to one-half, of that dose, when its further adminis- tration for an indefinite period will be possible with no unpleasant results. 4. If the preparation selected agrees with the patient and controls the symptoms, and if there are no intercurrent complications, pursue this treatment contin- uously for two years. If, however, the protiodide gives rise to persistent bowel trouble, as it does in a small number of cases, substitute for it the bichloride in solution or in combination with a tonic: I^. Hydrarg. chlorid. corros., gr. iss; Tinct. cinchonse co., f§iv. M. et sig. One teaspoonful in water after meals. Hydrargyrum cum creta in one-grain doses four to six times daily is a very useful preparation in cases of gastro-intestinal irritability. A half-grain to a grain of Dover's powder added to each dose will often control any tendencv to diarrhea. In some cases of irritable stomach, or when it becomes desirable to intensify the mercurial influence, inunction should be employed, and it is a useful addition to the routine treatment of every case of svphilis. If once in six weeks or two months the administration of mercurv'bv the mouth be intermitted and a dram of mercurial ointment rubbed into different portions of the cutaneous surface once daily for a week, it intensifies the mercurial influence without affecting digestion or nutrition. The uncleanliness of the procedure and the almost certain eczematous ir^-itation of the skin](https://iiif.wellcomecollection.org/image/b21217014_0211.jp2/full/800%2C/0/default.jpg)
