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PEDERSEA'- THERAPEUTICS OF SYPHILIS. Injection as a method of treatment is undoubtedly the best of all if the physician will only study the proper details and if the patient can be convinced that the pain it sometimes Generic Viagra 150 Mg causes is worth while. Is it not in a sense significant that the Ehrlich-Hata preparation is to be given by injection? To dis- cuss minutely the various advantages of injection in syphilis would make this paper repeat a pre- vious contribution (i). It is fitting to say, however, that the gluteal region is the region of choice, and that it should be divided into eight or ten points of injection, two inches apart, each to be taken in turn from dose to dose so that it is ten or twelve weeks before the starting point is used again. I regard it as professional stupidity to use much the same point repeatedly at frequent intervals. Ne- crosis or abscess formation Generic Viagra 150 Mg must occur in such in- stance.*-, sooner or later. Since writing the fore- going article, the writer has decreased the interval between the doses from seven to four or five days, and has increased the Generic Viagra 150 Mg strength of suspension of salicylate of mercury from lo per cent, to 667^ per cent, or 10 grains in one c.c. Thus, a tenth of a c.c. fone and one half drop) of the suspension will deliver one grain of the medicine. The quan- tity of fluid injected and the secondary nodes are greatly decreased. Combined or alternating method of treatment is the term applicable to that form which recognizes that all other forms must be employed in turn for some patients in order to keep them controlled. For example, if a given injection is painful beyond the usual experience, one may turn to ingestion or inunction until the painful node disappears. I have seen patients in whom this alternation was enacted week by week and who did not do well in any other way. It is extremely important to remember this. otherwise the patients will not improve at all under treatment, or, becoming discouraged, pass to the care of another practitioner. Mixed treatment is the term commonly Generic Viagra 150 Mg applied to the addition of potassium iodide to the mercury in whatever form the Generic Viagra 150 Mg latter has been exhibited. I believe Generic Viagra 150 Mg that under this heading there should also be included the addition of arsenic to the mercury alone or to the mercury and potassium Generic Viagra 150 Mg iodide or to the potassium with the mercury excluded. I am personally, however, Generic Viagra 150 Mg apt to give mercury with the iodide followed by mercury with arsenic the next week, thus alternating the iodide and the ar- senic more or less regularly from week to week. This Generic Viagra 150 Mg is particularly valuable in patients whose di- gestions are rapidly upset by the iodide. The period at which mixed treatment is commonly taken is the later months of the secondary period and prac- tically always in the tertiary period. Many then omit mercury altogether in the later manifestations of the disease. I believe this to be a mistake and am urgently of the opinion that whenever the diag- nosis of syphilis Generic Viagra 150 Mg has been established, mercury should always be administered, as it is up to the present time the one fully established curative measure against the disease, aside from the great possibilities of dichlordioxydiamidoarsenobenzol. The therapeutic ladder for giving potassium iodide is no doubt so familiar to all as hardly tu hear repeating. Nevertheless, in consultation work I find so many practitioners who do not climb this ladder carefully that the following points must usually be described : The usual initial dose is five grains three times a day. After this has been well borne the dose is increased one grain each day until the total increase of ten grains is reached, thus: first day five grains, second day six grains, third day seven grains, etc, until fifteen grains are given on the tenth dav three times. A recession of five grains is then made a grain at a time day by day so that on the fifteenth day ten grains three times a day are being taken, thus: eleventh day fourteen grains, twelfth day thirteen grains, thirteenth day twelve grains, fourteenth day eleven grains, fifteenth day ten grains three times a day. From this point of ten grains another ascent of ten grains is made so that on the 25th day twen- ty grains three times a day are being taken. Then Generic Viagra 150 Mg a descent of five grains is made in just the same way as previously. The writer adopts the little plan of not increasing the dose for a whole week whenever a total advance of thirty grains is made Generic Viagra 150 Mg — the patient uses the dose thus secured, by fixed advances of thirty grains each. In this wav is it possible gradually to give large doses of iodide without disordering the digestion. Not uncom- monlv one finds patients who suflfer iodism from small but not from large doses of the iodides. In such individuals it is well to begin the medication with thirty grains, from which ascent is then ni^de as described. It is true in the periods of temporary indigestion from medication of this kind that good manage- ment plays itself a part in holding the patient up to the discipline of good treatment and in control- ling the disease indirectly. This statement means that the patient will not be discouraged by tempo- rary indigestion. In this management the use of alkalies must not be forgotten. Periods of rest from the treatment of syphilis have for many years been prescribed. I believe in such periods of rest but am reasonably convinced that most practitioners exaggerate their necessity. I believe the indication for the period of rest lies not in some theoretical rule but rather in observing the signs given from patient to patient, as to the effect of the medicines upon his system and the disease. Again we repeat the rule that we treat the patient as well as the disease. I believe that one may tliouglitfully ask the question. May not the terrible record of syphilis as to insanity or or- ganic nervous disease in the community be parth due to the blind following of such rules which would of course mean entirely deficient treatment? Are we not dealing with an infectious disease, a veritable scourge on the face of the earth com- parable to tuberculosis in its ravages? \\^e do not give the tuberculous periods of rest from treat- ment, excepting for special indications furnished bv the disease and not by theoretical rules. Why should we deviate from this rule of common sense Generic Viagra 150 Mg in syphilis? Personally, Generic Viagra 150 Mg therefore, I give the medi-