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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    April 29, May 6, and May 13, 1g.11. Including Preliminary Observations with the Ehrlieh-Hata Preparation, Dioxydiamidoarsenobenzol or Salvorsan* By Victor Cox Pedersen, A. M., M. D., New York. Mr. President, and Fellow Members of the Medi- cosurgical Society of New York:—It is a peculiar pleasure and honor to be invited to read a paper on so important a topic as the therapeutics of syphilis before a society like ours, comprising personal, pro- fessional friends who have reached or are reaching positions of prominence and importance in the medical community of our city. This paper is based on personal experience gained in genitourin- ary work in the outpatient department of the New York Hospital and the House of Relief, and as at- tending genitourinary surgeon at the People’s Hos- pital, New York. It seems, therefore, fitting to suggest a series of practical points on the subject with more or less the authority of a specialist. By your leave, therefore, the paper will be planned on this basis. The first point of practical moment for every practitioner to remember is, as already pointed out in another paper (1), by the writer: “In general, the treatment of syphilis must recognize the three broad types of invasion met with, namely: First, the benign form from which patients fully recover, go on to have healthy children, and live fully un- affected bv the disease. Second, the relapsing form not infrequently benign in general characters, but severe and uncertain enough to tend toward recur- rence of symptoms, unless the patient is careful of himself and the physician is duly watchful. Third, severe form of infection leading to great deteriora- tion of health and not infrequently to death, more or less attributable to the syphilis itself, its com- plications or its sequels. In modern days, owing to early diagnosis and better management, this form is fortunately uncommon. Hereditary syph- ilis is the product of the last two forms as a rule.” It is to be remembered that the second or re- lapsing, and the third or grave form of syphilis may defy all known forms of treatment or their combinations or correlations. The second dictum for full recognition by all is, that the treatment of syphilis is not merely a mat- ter of medication, but also a matter of manage- ment. In'other words, it is better to treat the pa- tient as a diseased human being than to treat the disease as having a certain victim in its clutches. Someone has aptly said “It is well to realize not only what kind of disease the patient has, but also what kind of patient the disease has got”: very bad English, but a very great truth. This means * Read by invitation before the Medicosurgical Society of New York, January 21, 1911. Copyright, ign, by A. R. that in managing a syphilitic, various details must have constant attention by physician and patient. In general, the life habits must be in moderation those of the athlete as to regular hours, exercise, diet, etc. Bad habits should be reduced to their minimum, with special reference to alcoholism, smoking, and eating. The hours of exercise, work, and sleep should be, as far as possible, well bal- anced. The systemic condition of the patient should ever be a matter of concern. Strength and resist- ance should be maintained at the highest possible level, and nutrition, exemplified by body weig-ht and the condition of the blood, should be fully in mind. Tonics in the form of medicinal and nonmedicinal measures should always be available. In all patients the facts of loss of weight, the onset of anaemia, and the invasion of nephritis should be observed and known. Of the several guides as to how the patient is doing clinically, the foregoing, therefore, are the most important in the early stages. The weight of the patient should be observed every week; later every fortnight, and finally once a month. The blood should be simi- larly examined for anaemia, and also for that new blessing, the complement fixation test discovered ■by Wassermann, and greatly improved by Noguchi. The nephritis of syphilis is a much more constant and important entity than even syphilographers ap- pear to recognize. This is not due to medication as many claim; otherwise one would see hardly any escape in common experience. The writer has frequently observed patients with marked kidney lesions before any treatment of the syphilis had been taken which improved or even disappeared under treatment and relapsed with a decline of treatment and with a return of the syphilis; also cases which never develop nephritis no matter how hard the mercurial and iodide treatment is pushed; also cases of nephritis which, like the syphilis itself in the given patient, is comparatively unaltered by treatment either to increase or decrease the symp- toms. Various German authors have also reported cases of nephritis of nonsurgical type greater in one kidney than in the other during active syphilis. A third practical point which I have proved to my satisfaction is that in the general management of syphilitics better progress is made if the so called alkaline measures of treatment are applied, namely, the drinking of the various alkaline mineral waters with or without well known alkaline mixtures. This probably seems to recognize the fact that al- kaline is the normal reaction of the body fluids in Elliott Publishing Company.