FIFTH CONGRESS OF THE GERMAN DERMATOLOGICAL SOCIETY
British Journal of Dermatology
THE subject chosen for debate on the second day was The Injhence of early Mercurial Treatment of S,ypliilis i n precenting Tertiary Manifestatioiis. The conclusions formulated by Professor CBSPARY, of Konigsberg, were :-(1.) Statistics have not shown definitely that Fournier's " chronic intermittent " method of treatment protects any better from tertiary symptoms than other methods. (2.) Persistent and energetic dosage with mercury is accompanied by unjustifiable risks. (3.) The reporter
... The reporter practises and recommends so-called " symptomatic " treatment in mild secondary forms. If some secondary manifestations or tertiary symptoms develop, he always endeavours to carry out a course of treatment after Fournier's method, provided there is no contraindication for it. Professor NEISSER, of Breslau, in an elaborate and able paper, expressed the following views :-(1.) Tertiary manifestations of syphilis, just like the papular lesions of the early period, are produced by an organized virus (syphilis bacteria) ; but the virulence of these bacteria is so modified-at least in the later years of the disease-that they are not infective for healthy individuals, and they are only capable of acting and of causing new formations in an organism already saturated with them. (2.) The following points must be borne in mind in considering the ztiology of the tertiary symptoms. (a.) The special causes of any given tertiary process, i.e., the causes of its localization; such are (1) remains of the virus in the seat of the primary or preceding secondary lesions ; (2) accidental provocation of the virus from trauma or pathological processes. ( b ) The general causes which favour the persistence of the virus in the body, e.g., alcohol, marasmus, malaria, etc., which diminish the power of resistance of the organism, but especially the insufficient, or too late administration of mercnry. (3.) The real and most potent aetiological factor in the production of tertiary symptoms is the lack of proper mercurial treatment in the early period. T h e following are thepoints f o bear in m i n d in a properly conducted mercurial treatment:-(1) it must be instituted early, and indeed begun with the first manifestations, as soon as the diagnosis is certain ; (2) it must, in the first instance, be applied with great energy ; (3) it must be carried out for a long time, generally for more than three years, in alternating energetic and mild courses of treatment, separated by sufficient intervals.