Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Tertiary Syphilis.+ These symptoms appear from one to two years after
contagion and may continue to break out from ten to fifteen years, or
more. The characteristic lesions are certain late eruptions on the
skin, periostitis and nodes on the bones, and growths in the
subcutaneous tissue, muscle, and viscera, especially the liver and
spleen. These growths, in the viscera and other parts, which are so
characteristic of syphilis in its later stages, are known as gummata.
They consist of a substance like granulation tissue, with a varying
proportion of cells. In early stages they are grayish, gelatinous, and
transparent, but the cells undergo fatty change and caseation takes
place, so that the centre becomes yellow, and the circumference
develops into fibrous tissue, which contracts like a scar tissue.
Sometimes gummata break down completely, and suppuration, with
destruction of the tissues in which they are situated, takes place;
thus caries and necrosis not infrequently follow nodes on the bones.
+Treatment.+ Mercury is the drug of great benefit in syphilis. This can
be administered either internally, by inunction, or by injection. Of
all the preparations to be given internally, protiodide of mercury, in
one quarter grain doses, three times a day, is to be preferred.
+Inunction+ represents the most efficient way of administering the
mercurial treatment, when the stomach is intolerant of drugs, or when
administered by the mouth in full doses, they do not favorably modify
the symptoms. The patient is instructed to take a warm bath, and the
mercury is then well rubbed in over the inner surface of the forearm
and arm and alongside of the chest for fifteen minutes. Either the
oleate of mercury, 10 per cent., or the ordinary mercury ointment is
commonly employed; the former is more clean, but less efficient. The
rubbings should be done by the patient, should be made over a large
surface of the body, and should be performed thoroughly; one dram
(4.0) of blue ointment is rubbed in daily. For the injections, a 10
per cent. salicylate of mercury in olive oil is to be preferred; 10 to
15 minums of this solution is to be injected into the buttocks, three
times a week. The dose is gradually to be increased until 30 drops are
employed. Recently salvarsan (606) in 0.6, or 10 grain doses is given
either intravenously or intraspinally. Neosalvarsan (914) is to be
similarly given. The latter has the advantage in that sterile water is
used, and that, as a rule, there is no reaction from its injection.
Iodide of potassium in large doses (60 to 90 grains) three times a
day, is also to be given.
+Tuberculosis.+ Tuberculosis is an infectious disease due to the
deposition and multiplication of the tubercule bacillus in the tissues
of the body. It is characterized either by the formation of
tubercules, or by a wide spread infiltration, both of these conditions
tending to caseation, sclerosis, or ulceration.
A tubercular lesion may undergo calcification.
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