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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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