Volume 12

Encyclopaedia medica / under the general editorship of Chalmers Watson.

Date:
1899-1910
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Encyclopaedia medica / under the general editorship of Chalmers Watson. Source: Wellcome Collection.

    29/546 (page 17)
    secretions, now acid, now alkaline, aided as they are by the unknown action of the intestinal micro-organisms, may alter the chemical constitution of the mercurial preparation so as to make it a violent irritant. Mercury in long-continued doses is a depressing remedy, and is especially badly borne by those who are predisposed to tubercle. In syphilis, mercury must be given for many months, and in sufficient doses. Other considera- tions, therefore, have to enter into the course of treatment besides that of the particular form in which the drug is to be administered. The hygiene of the patient both locally and generally must be carefully attended to, and he must be maintained in the pink of condition, so far as his circumstances will allow. The surgeon must become thoroughly acquainted with the physical, mental, and moral peculiarities of his patient, for in the case of a prolonged course of treatment he will often have need to deal with every aspect of his character. The local hygiene will consist in a careful regulation of the teeth by a competent dentist. Tartar should be removed, caries should be arrested, and every cause of local irritation should be averted. The patient should be told plainly that the irritation of smoking tends to promote the forma- tion of mucous patches in the mouth, and that by their presence he may infect others. The function of the alimentary tract should be brought to the highest level of perfection by correcting dyspepsia and relieving constipation, whilst the most strict moderation is enjoined both in eating and drinking. The general hygiene consists in warning the patient against any excess, whether of fatigue or luxury. Eegular habits, early hours, and moderate exercise will amply repay the patient by shortening the term of his cure, and these simple means have built up the reputation of many a spa as a syphilis-curing watering-place. Indeed, the only way to secure these advantages to a patient is often to send him to such a place, for so long as he stays at home he will take no care of himself. I think it is best to begin the administration of mercury in syphilis by the method of internal administration, and of all the preparations of mercury it is certain that for English use grey powder or hyd. cum cret. is the best. It is easily carried about in a compressed form, each tabloid containing three grains. The patient should be ordered to take a tabloid three times a day directly after a meal. Perchloride of mercury comes next in favour, and it has the advantage that it can be readily prescribed with iodide of potassium when it is considered advisable to give the two drugs together. The dose is a drachm of the solution of perchloride of mercury, containing a sixteenth of a grain of hyd. perchlor., in an ounce of chloroform water. The protiodide of mercury, hyd. iod. viride, or hydr. iod. flavum, is also very largely used in the treatment of secondary syphilis. The dose is a quarter or a third of a grain given three times a day directly after food, the quantity of the drug being increased during the first fortnight to a grain and a half or two grains thrice a day. It may often be usefully combined with 2 to 4 grains of the green extract of hyoscyamus. Tannate of mercury in half-grain doses with sugar of milk has attained considerable repute, but its action must be watched rather more carefully than the other preparations, as it may cause much gastro- intestinal disturbance. Many other preparations of mercury have been brought forward from time to time, calomel and blue pill being the older forms; carbolate, salicylate, and alanilate the more recent; but they do not seem to be so satisfactory in their actions as those recommended above. Zittman's method of giving mercury is described at page 22. It must VOL. XII 2