Iodine and its preparations have by many authorities been held to be useful in the later and especially in the gummatous lesions of syphilis. There are patients who cannot take iodine to any extent without suffering from such disturbance of mucous membranes, especially in the nose and intestines, as to make it an exceedingly unpleasant remedy.
The iodides have not proved as successful as the mercurials; nevertheless, the combination is a popular one and sometimes of peculiar value. The potassium salt is the one generally used, as it is cheaper than the sodium compound. The latter, however, is less irritating and often more available. The lithium compound is ideal in some respects, but very expensive. The iodides may be given in large doses, to the extent of 30 Gm. or more (an ounce or more) in twenty-four hours. Large doses are sometimes necessary in the treatment of late syphilis of the nervous system. When it is necessary to put the patient rapidly under the influence of antispecific medication the combined use of these two drugs, as for example by mercurial inunction and the use of one of the iodides internally, will most speedily bring about the desired result. This result may be overreached, and sore mouth or other toxic manifestations may appear suddenly and unexpectedly.
The mercuric salts are soluble in solutions of the iodides, and what is known as mixed treatment is often employed. The salts may be combined in any desired preparation. Donovan’s solution is exceedingly valuable, the arsenic which it contains seeming to reinforce both the mercury and the iodine.
The iodides produce eruptions or rashes which strongly simulate both syphilitic and non-syphilitic skin diseases, and confusion may arise from their use. In those who are sensitive to the iodides, and in whom catarrh of the mucous membranes is easily produced, it is best to begin with small doses, increasing them as circumstances may warrant. Some patients cannot take iodine in any form. When iodides irritate the stomach they should be given in essence of pepsin.
Of the various vegetable remedies some are unreliable and of little value. Certain combinations can, however, be effected in some cases by which the value of the effective agents may be enhanced. Zittmann’s decoction or McDade’s formula will occasionally prove of service. In aggravated cases the former is believed to be the most effective of all methods of administering mercury. Tonics or any other medicines which may be called for in particular cases should be given judiciously. There is nothing in antisyphilitic treatment which precludes other treatment when needed.
CHAPTER XI.
CHANCROID OR VENEREAL ULCER.
Since the time of John Hunter and his pupils, who confused the three totally different and so-called venereal diseases, pathologists have drawn a distinct line between chancre, which is simply the initial sore of syphilis, and chancroid or venereal ulcer, which is a distinctly local lesion, often destructive, but never followed by constitutional disease, except of septicemic or pyemic type. It is usually found upon the genitals, about the foreskin, glans, and vulva, but may be met anywhere upon the body where infection has occurred. It is distinctly auto-inoculable, in which respect it differs from chancre.
Varying views have been held as to the minute agency concerned in the production of this lesion. The bacillus discovered and studied by Ducrey, in 1889, is now accepted as the exciting cause. This is 1.5 μ long and 1 μ thick, with rounded deep-staining ends and fainter-staining central portion, occurring with great constancy in chancroidal pus, less often in buboes than in ulcers, in and outside of the cells, and in chains. It is cultivated with difficulty, grows best on human blood, takes basic aniline stains, but is easily decolorized by alcohol or by Gram’s method. Characteristic ulcers can be produced by inoculating it, even in monkeys.
Chancroid begins, in twenty-four hours, as a red point or papule, which is quickly converted into a pustule and then into an ulcer. The borders of this ulcer enlarge, its depth increases, until after a few days it forms a more or less deep, often undermined excavation, irregular in contour, discharging grayish purulent material. In this respect it differs also from chancre, whose natural discharge is more like serum. In other words, chancroid is essentially destructive, chancre constructive, since the latter forms a new-growth which ordinarily has little or no discharge. When the necrosis of chancroid becomes extensive and tends to spread rapidly the ulcer is spoken of as phagedenic. This tendency to rapid local gangrene is the combined result, probably, of virulence of virus and lowered local or constitutional tissue resistance. It is consequently most often seen in alcoholics and prostitutes. In rare instances a surface larger than the hand may be rapidly destroyed, every particle of material sloughed being infectious.
In chancroids of the mild variety the discharge may dry upon their surfaces and scabs or crusts result, beneath which, when detached, the characteristic ulcer is present.