General Considerations

Scientific Methods of Treating Disease.—In trying to treat diseases caused by germs, the physician finds himself confronted by several different problems. Certain of these diseases run their course and the patient gets well or dies, pretty much regardless of anything that can be done for him. In certain others, because of our knowledge of the way in which the body makes its fight against the germ, we are able either to prepare it against attack, as in the case of protective vaccination, or we are able to help it to come to its own defense after the disease has developed. This can be done either by supplying it with antitoxin from an outside source, or helping it to make its own antitoxin by giving it dead germs to practise on. In the third group, the smallest of the three, we are fortunate enough to know of some substance which will kill the germ in the body without killing the patient. For such diseases we are said to have a "specific" method of treatment. Syphilis is one of these diseases. It is not to be understood that there is a sharp line of division between these three groups, since in every disease we try as far as possible to use all the methods we can bring to bear.[Pg 61] In pneumonia we have to let the body largely make its own fight, and simply help it to clear out the poisons formed by the germ, and keep the heart going until the crisis is past. In diphtheria, nowadays, we help the body out promptly by supplying it with antitoxin from an outside source, before it has time to make any for itself. We do the same thing for lockjaw if we are early enough. We practise the body on dead typhoid germs by vaccination until it is able to fight the living ones and destroy them before they get a foothold. The diseases for which we have specific methods of treatment are few in number, and each has associated with it the name of a particular drug. Quinin kills the germ of malaria, sodium salicylate cures inflammatory rheumatism, and mercury cures syphilis. To mercury in the case of syphilis must now be added salvarsan or arsenobenzol ("606"), the substance devised by Ehrlich in 1910, which will be considered in the next chapter.

The action of a specific is, of course, not infallible, but the failures are exceptional, so that one feels in attacking one of these diseases with its specific remedy as a man called upon to resist a savage beast would feel if he were armed with a powerful rifle instead of a stick. The situation in syphilis, for which there is a specific, as compared with tuberculosis, for which there is no specific, is incomparably in favor of the former. If we had as powerful weapons against tuberculosis as we have against syphilis, the disease would now be a rarity instead of the disastrous plague it is. Comparing the situation[Pg 62] in two diseases for which we have specifics, such as syphilis and malaria, malaria has lost most of its seriousness as a problem in any part of the world, while syphilis is rampant everywhere. Malaria has, of course, been extinguished not only through the efficiency of quinin, but also through preventive measures directed at mosquitos, which are the carriers of the disease from person to person. But allowing for this, if it becomes possible to apply mercury and salvarsan as thoroughly to the prevention and treatment of syphilis as quinin can be applied to malaria, syphilis will soon be a rarity over the larger part of the civilized world. To bring the specific remedies for syphilis and the patient together constitutes, then, one of the greatest problems which confronts us in the control of the disease at the present day.
Mercury

Mercury in the Treatment of Syphilis.—Mercury is, of course, familiar to every one, and there is nothing peculiar about the mercury used in the treatment of syphilis. The fluid metallic mercury itself may be used in the form of salves, in which the mercury is mixed with fatty substances and rubbed into the skin. Mercury can be vaporized and the vapor inhaled, and probably the efficiency of mercury when rubbed into the skin depends to no small extent on the inhalation of the vapor which is driven off by the warmth of the body. Mercury in the form of chemical salts or compounds with other substances can be given as pills or as liquid medicine.[Pg 63] Similarly, the metal itself or some of its compounds can be injected in oil with a hypodermic needle into the muscles, and the drug absorbed in this way.

Misconceptions Concerning Mercury.—The use of mercury in syphilis is nearly as old, in Europe at least, as the disease itself. The drug was in common use in the fifteenth century for other conditions, and was promptly tried in the new and terrible disease as it spread over Europe, with remarkable results. But doses in the old days were anything but homeopathic, and overdoses of mercury did so much damage that for a time the drug fell into undeserved disfavor. Many of the superstitions and popular notions about mercury originated at this period in its history. It was supposed to make the bones "rot" and the teeth fall out, an idea which one patient in every ten still entertains and offers as an objection when told he must take mercury. Insufficiently treated syphilis is, of course, what makes the bones "rot," and not the mercury used in treating the disease. Mercury apparently has no effect on the bones whatever. The influence of the drug on the teeth is more direct and refers to the symptoms caused by overdoses. No physician who knows his business ever gives mercury at the present time to the point where the teeth are in any danger of falling out.

The Action of Mercury.—The action of mercury on syphilis is not entirely clear. The probabilities are that the drug, carried to all parts of the body by the blood, helps to build up the body\'s resistance and stimulates it to produce substances which kill the[Pg 64] germs. In addition, of course, it kills the germs by its own poisonous qualities. Its action is somewhat slow, and it is even possible for syphilitic sores containing the germs to appear, especially in the mouth and throat and about the genitals, while the person is taking mercury. Just as quinin must be used in malaria for some time after all signs of chill and fever have disappeared, to kill off all germs lurking in out-of-the-way corners of the body, or especially resistant to the drug, so it is necessary to continue the use of mercury long after it has disposed of all the obvious signs of the disease, like the eruption, headaches, and other symptoms, in order to prevent a relapse. No matter in what form it is used, the action of mercury on syphilis is one of the marvels of medicine. It can clear up the most terrific eruption with scarcely a scar, and transform a bed-ridden patient into a seemingly healthy man or woman, able to work, in the course of a few weeks or months. Symptoms often vanish before it like snow in a thaw. This naturally makes a decided impression, and often an unfavorable one, on the patient. It is only too easy to think that a disease which vanishes under the magic influence of a few pills is a trifle, and that outwardly cured means the same thing as inwardly cured. Mercury therefore carries its disadvantages with its advantages, and by its marvelous but transient effect only too often gives the patient a false idea of his progress toward cure.

Methods of Administering Mercury.—As has been said, mercury is given principally in three ways at the present time. It can be given by the mouth, in[Pg 65] the form of pills and liquids, and in this fo............