One of the most outstanding characteristics in the treatment of syphilitic patients with bismuth, as with mercury, is that the metal is excreted rather slowly by the body. Thus, for a long time after the treatment is finished, a considerable amount of the metal remains in the body, maintaining an antisyphilitic effect.
In dealing with the retention of bismuth, a clear distinction should be made between totally differing conditions :
Deposits of bismuth remain at the site of intramuscular and subcutaneous injection, and are gradually absorbed at a varying rate, thus maintaining an intensive antisyphilitic effect. Numerous investigations, chemical as well as radioscopie, have shown that such deposits may contain large quantities of bismuth, especially if bismuth compounds of low solubility, suspended in mineral or vegetable oils, have been used, thus delaying the absorption considerably. Under these conditions, deposits of bismuth may remain unabsorbed for a long time, even years, probably because they are gradually becoming encapsulated by the surrounding tissue. For this reason, it has been possible in many cases to inject considerably larger, even very large, doses of these preparations without causing the well known symptoms of intoxication. There are, in this respect, substantial differences between the various bismuth
LOMHOLT S. RETENTION OF BISMUTH IN THE ORGANISM IN THE TREATMENT OF SYPHILIS. Arch Derm Syphilol. 1929;19(6):891–900. doi:10.1001/archderm.1929.02380240026003
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