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 vaccination1, or we are able to help it to come to its own defense2 after the disease has developed. This can be done either by supplying it with antitoxin from an outside source, or helping3 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 killing4 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 pneumonia5 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 promptly6 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 malaria7, sodium8 salicylate cures inflammatory rheumatism9, 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 savage10 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 tuberculosis11, 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 disastrous12 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 rampant13 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 thoroughly14 to the prevention and treatment of syphilis as quinin can be applied15 to malaria, syphilis will soon be a rarity over the larger part of the civilized16 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 peculiar17 about the mercury used in the treatment of syphilis. The fluid metallic18 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 vapor19 inhaled20, 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 remarkable21 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 superstitions22 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. Insufficiently23 treated syphilis is, of course, what makes the bones "rot," and not the mercury used in treating the disease. Mercury apparently24 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 entirely25 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 stimulates26 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 lurking27 in out-of-the-way corners of the body, or especially resistant28 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 eruption29, 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 marvels30 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 thaw31. This naturally makes a decided32 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 form is not infrequently incorporated into patent medicine blood purifiers. Mercury in pills and liquid medicine has the advantage for the patient of being an easy and inconspicuous way of taking the drug, and for that reason patients usually take it willingly or even insist on it if they know no better. Even small doses taken in this way will hide the evidences of syphilis so completely that only a blood test will show that it exists. If it were true that large doses taken by mouth could always be relied on to cure the disease, there would be little need for other ways of giving it. But there is a considerable proportion of persons with syphilis treated with pills who do not get rid of the disease even though the dose is as large as the stomach can stand. Such patients often have all the serious late complications which befall untreated patients. It seems almost impossible to give enough mercury by mouth to effect a cure. Thus pill treatment has come to be a second-best method, and suitable only in those instances in which we simply expect to control the outward signs rather than effect a cure.
The mercury rub or inunction, under ideal conditions, all things considered, is the best method of administering mercury to a patient with the hope of securing a permanent result. In this form of treatment the mercury made up with a salve is rubbed into the skin. The effectiveness of the mercurial33 rub is reduced considerably34 by its obvious disadvantages. It requires time to do the rubbing, and the ointment35 used seems uncleanly because of its[Pg 66] color and because it is necessary to leave what is not rubbed in on the skin so that it discolors the underwear. The mercurial rub is at its best when it is given by some one else, since few patients have the needed combination of conscientiousness36, energy, and determination to carry through a long course. The advantages of the method properly carried out cannot be overestimated37. It is entirely possible in a given case of syphilis to accomplish by a sufficient number of inunctions everything that mercury can accomplish, and with the least possible damage to the body. Treatment by mouth cannot compare with inunctions and cannot be made to replace them, when the only objection to the rubs is the patient's unwillingness38 to be bothered by them. The patient who is determined39, therefore, to do the best thing by himself will take rubs conscientiously40 as long as his physician wishes him to do so, even though it means, as it usually does, not a dozen or two, but several hundreds of them, extending over a period of two or three years, and given at the rate of four to six rubs a week.
The giving of mercury by injections is a very powerful method of using the drug for the cure of syphilis. It reduces the inconvenience of effective treatment to a minimum and has all the other advantages of secrecy41 and convenience. It keeps the patient, moreover, in close touch with his physician and under careful observation. Injections by some methods are given daily, by others once or twice a week. The main disadvantage is the discomfort42 which follows each injection for a few hours. For[Pg 67] any one who has one of the serious complications of syphilis, injections may be a life and death necessity. Mercurial injections are a difficult form of treatment and should be given only by experts and physicians who are thoroughly familiar with their use.
Like every important drug in medicine, mercury is a poison if it is abused. Its earliest effect is on the mouth and teeth, and for that reason the physician, in treating syphilis by vigorous methods, has his patients give special attention to the care of their mouths and teeth and of their digestions43 as well. Mercury also affects the kidneys and the blood, if not properly given, and for that reason the person who is taking it must be under the care and observation of a physician from time to time. Only the ignorant undertake to treat themselves for syphilis, though how many of these there are can be inferred from the amount of patent medicine and quack44 treatment there is in these fields. Properly given, mercury has no harmful effects, and there is no ground whatever for the notion some people have, that mercury will do them more harm than a syphilitic infection. Improperly45 used, either as too much or too little, it is capable of doing great harm, not only directly, but indirectly46, by making it impossible later for the patient to take enough to cure the disease. The extent to which some overconfident persons fail in their efforts to treat and cure themselves explains the necessity for such a warning.
Effect of Mercurial Treatment on the Blood Test.—The effect of mercury on the Wassermann blood test for syphilis should also be generally understood.[Pg 68] In many cases it is possible, especially early in the disease, by a few rubs of mercurial ointment, or a few injections of mercury, or even in some cases by the use of pills or liquid medicine, to make a positive blood test for syphilis negative. But this negative test is only temporary. Within a short time, usually after treatment is stopped, the test becomes positive again, showing that the mercury has not yet cured, but simply checked, the disease, and that it may at any time break out again or do internal damage. It must be understood that a negative blood test just after a patient has been taking mercury has no meaning, so far as guaranteeing a cure is concerned. It is only the blood test that is repeatedly negative after the effect of mercury wears off, which shows the disease is cured. Yet many a syphilitic may and does think himself cured, and may marry in good faith, or be allowed a health certificate, only to become positive again. He may then develop new sores without his knowledge even, and perhaps infect his wife, or may himself in later years develop some of the serious consequences of the disease.
Whenever one talks to a person who knows something about the advances in knowledge in the past few years about the treatment of syphilis, and goes into detail about mercury, the odds47 are two to one that he will be interrupted by the question, "But what about '606'?" Before talking about salvarsan, or "606," it is well to say here that this new drug, wonderful though it is, has in no sense done away with the necessity for the use of mercury in the[Pg 69] treatment of syphilis. Mercury has as high a reputation and is as indispensable in the cure of syphilis today as it was four centuries ago. It has as yet no substitutes. We appreciate every day, more and more, how thoroughly it can be depended on to do the work we ask of it.[8]
[8] A drug known as the iodid of potash (or soda) is widely used in the treatment of syphilis, and especially of the late forms of the disease, such as gummas and gummatous sores. It has a peculiar effect on gummatous tissue, causing it to melt away, so to speak, and greatly hastening the healing process. So remarkable is this effect that it gives the impression that iodids are really curing the syphilis itself. It has been shown, however, that iodids have no effect on the germs of syphilis, and therefore on the cause of the disease, although they can promote the healing of the sores in the late stages. For this reason iodids must always be used in connection with mercury or salvarsan if the disease itself is to be influenced. It is occasionally difficult to get patients to understand this after they have once taken "drops," as the medicine is often called. Otherwise the use of iodids in syphilis is of medical rather than general interest.
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1
vaccination
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| n.接种疫苗，种痘 | |
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defense
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| n.防御，保卫；[pl.]防务工事；辩护，答辩 | |
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helping
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| n.食物的一份&adj.帮助人的，辅助的 | |
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killing
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| n.巨额利润；突然赚大钱，发大财 | |
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pneumonia
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| n.肺炎 | |
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promptly
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| adv.及时地，敏捷地 | |
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malaria
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| n.疟疾 | |
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sodium
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| n.（化）钠 | |
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rheumatism
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| n.风湿病 | |
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savage
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| adj.野蛮的；凶恶的，残暴的；n.未开化的人 | |
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tuberculosis
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| n.结核病，肺结核 | |
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disastrous
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| adj.灾难性的，造成灾害的；极坏的，很糟的 | |
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rampant
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| adj.(植物)蔓生的；狂暴的，无约束的 | |
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thoroughly
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| adv.完全地，彻底地，十足地 | |
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applied
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| adj.应用的；v.应用，适用 | |
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civilized
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| a.有教养的，文雅的 | |
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peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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metallic
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| adj.金属的；金属制的；含金属的；产金属的；像金属的 | |
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vapor
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| n.蒸汽，雾气 | |
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inhaled
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| v.吸入( inhale的过去式和过去分词 ) | |
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remarkable
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| adj.显著的，异常的，非凡的，值得注意的 | |
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superstitions
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| 迷信，迷信行为( superstition的名词复数 ) | |
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insufficiently
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| adv.不够地，不能胜任地 | |
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24
apparently
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| adv.显然地；表面上，似乎 | |
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entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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26
stimulates
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| v.刺激( stimulate的第三人称单数 )；激励；使兴奋；起兴奋作用，起刺激作用，起促进作用 | |
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lurking
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| 潜在 | |
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resistant
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| adj.(to)抵抗的，有抵抗力的 | |
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eruption
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| n.火山爆发；（战争等）爆发；（疾病等）发作 | |
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marvels
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| n.奇迹( marvel的名词复数 )；令人惊奇的事物（或事例）；不平凡的成果；成就v.惊奇，对…感到惊奇( marvel的第三人称单数 ) | |
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31
thaw
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| v.（使）融化，（使）变得友善；n.融化，缓和 | |
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decided
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| adj.决定了的，坚决的；明显的，明确的 | |
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mercurial
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| adj.善变的，活泼的 | |
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considerably
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| adv.极大地；相当大地；在很大程度上 | |
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35
ointment
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| n.药膏，油膏，软膏 | |
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conscientiousness
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| 责任心 | |
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overestimated
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| 对（数量）估计过高，对…作过高的评价( overestimate的过去式和过去分词 ) | |
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unwillingness
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| n. 不愿意，不情愿 | |
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determined
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| adj.坚定的；有决心的 | |
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conscientiously
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| adv.凭良心地；认真地，负责尽职地；老老实实 | |
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secrecy
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| n.秘密，保密，隐蔽 | |
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42
discomfort
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| n.不舒服，不安，难过，困难，不方便 | |
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43
digestions
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| n.消化能力( digestion的名词复数 )；消化，领悟 | |
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44
quack
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| n.庸医；江湖医生；冒充内行的人；骗子 | |
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45
improperly
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| 不正确地，不适当地 | |
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indirectly
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| adv.间接地，不直接了当地 | |
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odds
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| n.让步，机率，可能性，比率；胜败优劣之别 | |
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