Therapeutics of syphilis : including preliminary observations with the Ehrlich-Hata preparation, dioxydiamidoarsenobenzol or salvarsan / by Victor C. Pedersen.

  • Pedersen, Victor Cox, 1867-1958
Date:
1911
Catalogue details

Licence: In copyright

Credit: Therapeutics of syphilis : including preliminary observations with the Ehrlich-Hata preparation, dioxydiamidoarsenobenzol or salvarsan / by Victor C. Pedersen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the main and that an increase thereof or a mainte- nance thereof to the full normal strength augments the body resistance against disease. The fourth warning to be given the general prac- titioner is that the diagnosis of syphilis is of im- portance. Without offense to the title and aim of this paper, it is well to point out that there are four stages of syphilis, requiring careful recognition: a. The primary or chancrous period, usually easy of determination from clinical appearances, the presence of the Treponema pallidum, the Noguchi or Wassermann reaction in the blood, and early lymphangeitis and lymphadenitis. b. The secondary period, likewise easy of recog- nition from the presence of signs of syphilis in the skin, mucous membranes, lymphatic glands, blood, and the like. c. The tertiary period, likewise diagnosticated easily, if symptoms are present. Usually a positive serum diagnosis is very helpful. d. A fourth or parasyphilitic period is aptly described by French authors, in which the infection of syphilis as an entity is absent, but in which the body damage and late sequels of syphilis are posi- tive and absolute. The most momentous period of all in syphilis as to diagnosis is that which, beginning with the second period and extending through the fourth, has no symptoms in virtue of competent and en- ergetic treatment. This period is called the most dangerous because it is exactly the period when so many family practitioners deny the existence of syphilis at any time in the patient, because at the moment of examination there are no symptoms of the disease. This leads the patient into a position of false hope and not infrequently to the insane asylum, or to his grave, when a continuance of the treatment might totally change or save him. I believe that the most important warning of this evening’s paper is to have all understand that the diagnosis of syphilis should be accepted and con- firmed by a good history, carefully taken, in virtue of which it has been ascertained that the previous diagnosis was given by a competent observer or in a first class institution. A diagnosis thus estab- lished is absolutely and amply proper grounds for a continuation of the treatment. Absence of clinical symptoms and even in manv instances of a positive Wassermann or Noguchi test are not grounds for withholding treatment, if the usual two or three years’ duration thereof have not been fulfilled. 5. The fifth axiom for the general practitioner concerns diagnosis also. He should realize that diagnosis of syphilis means not only a proof of the presence of the disease, but also an estimate of the effect that this dreadful scourge is having on the body of the patient. This repeats what has been said a moment ago that diagnosis, if conscientiously made, must comprise knowledge of the presence of the organism of syphilis, Treponema pallidum, sero- diagnosis, variations in body weight, changes in the quality of the blood, and in the condition of the kid- neys, and finally a reasonable measure of the re- sponse by the constitution to treatment. This appreciation of the effects of treatment is in a certain sense the most important detail, because without it, many elements in the subsequent treat- ment and management are not controlled. The sixth principle to state for general applica- tion is that every syphilitic must have a most care- ful physical examination, which cannot possibly be considered complete unless all details are duly in- vestigated. This physical examination cannot be re- corded as conscientious and final, unless it includes bacteriology, haematology, and urology, together with a minute investigation of the body as a whole, beginning with the skin and ending with the nervous system. One need not take time in this paper to describe the details of such an examina- tion ; it should be borne in mind, however, that it cannot be made too conscientiously and searchingly. It is very easily possible to make it superficial, hasty, and negligent of some little thing which may mean much to the patient and the doctor. In the end re- sult, due attention must, therefore, have been given to the general condition, nutrition, and digestion, lungs, heart, vessels, blood, lymphatic system, skin, and nervous system, which includes the various re- flexes of the pupil, ocular muscles, and fundus. A rapid and convenient suggestion, though not proof of anaemia, may be made with Tolquist’s scale. If the findings of this method so indicate, a more posi- tive and scientific proof of anaemia may be secured. The seventh title for discussion in the interest of the nonspecialist concerns the time of beginning treatment. Probably many in this audience were taught never to begin the treatment of syphilis until the appearance of the rash proved the diagnosis be- yond controversy, This was sound doctrine for the days when it was established, respected, and taught, namely, in the prebacteriological epoch. Although for centuries syphilis has acted the part of a bac- terial disease the nature of the organism was not proved until the Treponema pallidum (Spirochccta pallida) was discovered by Hoffmann and Schau- dine in 1906. To-day, therefore, it is as sound doc- trine to delay treatment of tuberculosis until signs of systemic loss of ground by the patient against the disease are present, as to delay treatment of syphi- lis until the signs of systemic invasion are present as exemplified in skin and mucous membrane le- sions. I would lay down the rule that no one should attempt to treat syphilis at all who has not in his office a first class microscope with a dark field illu- minator, or a bacteriological outfit, suitable for staining the Treponema pallidum. This diagnosis must be made at the first visit if possible. If there is doubt, a thin section of the lesion of a chancre or a deep scraping of a mucous patch duly mixed with one per cent, sodium citrate in sterilized salt solu- tion, may be sucked into a capillary tube and sent to a competent pathologist for confirmation. Thus treatment may be begun on the day of or within a very few days of the first visit. Combined with the finding of the organism there should be present also by preference a Noguchi or Wassermann comple- ment fixation test, and clinically a more or less typi- cal lymphadenitis and lymphangeitis. How terrified would you and I feel if we were told to-day that we were the victims of syphilis,, but that treatment would have to be delayed from six to seven weeks until the organism had spread through our systems
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