our present position as regards the subject of treat-
ment of syphilis would appear to indicate: First —
.\n early and intensive salvarsan or neosalvarsan
medication, with a view, if 6 mp methotrexate possible, to curing the
disease at once, or, failing in this, to remove the pa-
tient from the category of infective methotrexate for ms menaces at the
earliest moment. Second — To supplement this with
a vigorous and intensive mercurial treatment in
earlier cases of from six months to a year, and in
later cases of a somewhat methotrexate pharmacology longer methotrexate india period ; the pa-
tient's condition methotrexate 12.5 mg to be checked up clinically during
this period, and following the treatment, by means
of Wassermann and luetin reaction tests, if the lat-
ter be proved accurate, and finally, by means of a methotrexate cream
provocative salvarsan administration, as before out-
lined, to establish the fact of a cure.
The mercurials and iodides. Just a word con-
cerning the older remedies and their administration.
First, month medication. While cases have un-
doubtedly occurred in the practice pharmacology of methotrexate of many of my
auditors of cured syphilis, as proved clinically and
by laboratory tests, it is none the less a fact that day
by day new cases are being recorded of patients who
have set up. probably, as the result of such treat-
ment, a marked antagonism to all forms of medica-
tion. This statement applies with special force to
yellow mercurous iodide, which drug is more en-
titled to place in the history of medication rather
than in its present day practice. It ton often pro-
duces an immunity in the spirocluctcc to the germi-
cidal action of the mercurv.
Augus. -M. wMl DOUGLAS: SURGICAL LVDICATIONS OF GASTROIA'TLSTINAL SVMI'IOAfS.
359
Second, mi.vcil trcatuwiit, so called, still consti-
tutes a fair titlcover ; in other words, an interval
treatment, or adapted perhaps to particular cases.
It should not, however, he regarded as a niutine
measure.
Third, inunctions. The value of mercurial in-
unctions may not be gainsaid, and when it can be
properly carried out as to purity of product, methotrexate canada thor-
ough disintegration of its globules, methotrexate b12 and the proper
frictional application, this method still constitutes a methotrexate and ms
most i^otent remedial agent in the treatment of this
disease, and particularly so with children, as its ad-
ministration carries with it no terrors.
Fourth, intramuscular iiwrcurialication. methotrexate 2.5 mg tablet Here
we have two ty])es of preparations to deal with, the
soluble and the insoluble. Of the soluble prepara-
tions, there are many ; most of which I have tried
only to return to the bichloride. It suftices to state
that two points may well be borne in mind in the
preparation of a solution for hypodermatic use :
First — Dissolve the mercuric chloride in the propor-
tion of grain ^ to two c. c. of an isotonic normal
salt solution, as in this event a practically painless
injection is assured. Second — To massage the
parts gently but firmly for from five to ten minutes,
thus reducing to a minimum the topical methotrexate possible formation
of indurated nodes. The advantages of soluble drugs
are : First — relative painlessness : second — intensity.
The disadvantage is too rapid elimination, necessi-
tating too short intervals methotrexate sodium 2.5 mg between treatments.
Insoluble injections. Included under this cate-
gory may be briefly mentioned in the order of
their intensity : Calomel in oily suspension ; gray
oil {huile grisc of the French) ; salicylate of mer-
cury in oily suspension, preferably in oil of sesame.
Calomel in suspension constitutes undoubtedly the
most jxjwerfully methotrexate usp intensive of all the mercurials. It
should not be used as a routine measure, as it is
quite painful and not unattended methotrexate injection cost with danger.
Rather reserve it for the urgent type. Of the
others, salicylate of mercury suspended in oil of
sesame will be found a most effective routine meas-
ure. In a ten per cent, suspension, one c. cm.
will be the equivalent of \]A grains. The advan-
tages in the employment of this type will be found
in the fact that treatments are, as a rule, needed
only at intervals of once in four to seven days as
the methotrexate 7.5 mg case may be ; that a more or less constant ab-
sorption is going on during this time ; and that it
is perhaps the least painful of the insoluble prepara-
tions.
C0NCLU.S10N.
To summarize the foregoing, one might connote
the following, as points of importance:
First. Treatment .should be begun at the moment
diagnosis is certain.
.Second. To assure success it must be as inten-
sive, both from an arsenical and mercurial stand-
point, as the history of the case and the patient's
physical condition warrant.
Third. The time heretofore wasted in discon-
tinuing treatment and the Wassermann test during
the earlv months of the disease mav be methotrexate 17.5 mg very well
employed, and to the patient's benefit, in endeavor-
ing to eradicate the disease.
Finally, and this i>oint cannot be too strongly em-
phasized, that in the treatment of this disease, not
only from the standpoint of the methotrexate rxlist physician's own in-
tegrity and his bounden duly to Mniety, but als(j of
ihe welfare of his patient, he should under no cir-
cumstances attempt to treat a dise.ise of such wide-
^pread effect and sinister influence without having
given much study to the present conception of the
management methotrexate generic name of the disease.
In my own city a wides])read hos])ital movement
is on foot in an endeavor to have ;ill luetic patients
referred to a special department for the treatment
of syphilis. Such a departiuent is not to be attached
to some other s])ccial department, but to have a
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