The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
When the nature of the primary lesion is positive treatment should
begin with the first visit of the patient to the surgeon. When there
is uncertainty regarding the character of the venereal sore, treatment
_may_ be postponed until the appearance of the first eruption. As
soon as this has appeared the treatment should be hastened. It is
necessary to begin with mercury. The patient’s mouth should be examined
by a dentist and all tartar removed from the teeth, especially from
the gingival borders, at which lines the gums are likely to become
sore when mercury is too freely used. All diseased teeth should be
extracted or filled, and the mouth and its contents should be put in
normal condition. The dentist should be informed as to the reason
for the visit. Smoking should be discontinued, especially when there
are mucous patches, since it is apt to irritate and make subsequent
lesions of the mucous membrane more likely to occur. The habits of the
patient should be regulated as to alcohol and other indulgences, and he
should be warned as to the infectious nature of the disease, _in order
that others may be protected_. In many instances tonic, even roborant
treatment may be advantageously combined with the antispecific. It will
be found that the anemia so characteristic of well-marked secondary
syphilis will improve materially under the influence of mercury alone.
Should the disease occur in a married person, or develop after
marriage, caution should be given as to the danger to offspring, and to
the other associate in the marriage relation, which might follow the
occurrence of pregnancy.
Mercury may be given by the _mouth_, by _inunction_, by _hypodermic
injection_, or by _fumigation_. The intent should be to get the
patient under its influence as rapidly as is consistent with safety.
The most effective of these methods to which patients will ordinarily
submit is that by _inunction_. This consists essentially in the use
of _mercurial ointment_ (blue ointment), of which 15 Gm. may be used
daily or nightly, which should be thoroughly rubbed into some area
of the body; the areas selected being changed at perhaps three-day
intervals, in order that irritation, which its prolonged use produces,
may be avoided. It takes considerable effort to so completely rub this
in as to make most of it disappear, and it can be done more easily
upon those parts of the body which are free from hair. It can be best
done by employing someone for the purpose, but patients can be easily
taught to use it themselves. There are upon the market, ointments
containing mercury made with other excipients than lard, which are less
uncomfortable to the skin and seem to be absorbed better; among these
is a preparation made with a petroleum compound called vasogen, which
may be procured in different strengths; that containing 33 per cent. or
50 per cent. is the best.
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