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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    furnished by a given patient, it seeems advisable to cease the treatment temporarily or to modify it. In this way I find that the average patient has about one month’s rest from treatment in the year, which is ample, and, being determined by direct indications, is in my opinion wiser and safer than guesswork or. arbitrary rules. This brings us to the final subdivision of this paper which I trust will be accepted in the spirit of a preliminary report on personal observations with the new arsenical preparation of Ehrlich-ITata, dichlordioxydiamidoarsenobenzol. Historically, to Professor Conrad Alt, of Ucbt- springe, in September, 1909, were delivered speci- mens of this arsenical preparation. Bertheim, a colleague of Ehrlich, chemically produced the sub- stance; a Japanese, Hata, a pupil of Kitasato, es- tablished the effect of the preparation on animals. Especially, Hata established the facts' that a single injection will cure relapsing fever in rats and mice and that syphilis in rabbits is wonderfully relieved. The odd term “606” arose from the fact that pre- viously 605 different preparations of the same chem- ical class had been tried and discarded. In man the first injection was given in Uchtspringe by Hoppe. The scientific precaution, however, was taken to try it first on a larger animal, a dog, as to toxicity. To the honor of our profession be it noted that two physicians without the disease received a dose of the medicine by injection in order to prove still further its harmlessness in man. Fortunately all they suffered was pain and swelling for several days. Ehrlich’s description is probably correct that the drug has active parasitotropic powers but is not organotropic. It seems to me that the logical points of this part of this paper must include forecare of the patient before the injection, the preparation of the drug for the injection, the surgical technique of the injec- tion, the range variations and repetitions of doses, the reactions to the injection, the aftercare of the patient, and finally a brief description of the cases within the writer’s experience, which will include a brief discussion of the effects of the drug on the various stages of syphilis as reported in literature. (a) Forecare of the patient is so closely synony- mous with selection of the patient as proper for the injection that we will not divide these two topics. It is needless to add also that all the points given under the previous topics of diagnosis and manage- ment, in brief, that everything which can possibly be known about the syphilitic patient must be known before dichlordioxydiamidoarsenobenzol is exhibited. The present consensus of opinion from existing ex- perience is that this preparation should not be given in the presence of advanced progressing organic disease: a true statement which includes particular- ly organic lesions of the heart, arteries, kidneys, and nervous system. The reason is probably that syphilitic lesions of this type have already produced cellular changes which no power on earth can im- prove or alter. Another reason, particularly with regard to advanced nephritis, is that the action of the kidneys in eliminating the arsenic may in- duce an exacerbation of the disease and death may follow. Ehrlich did wisely and well in not giving the drug prematurely for universal use by the pro- fession, simply because had he done so no such careful discussion of cases as proper to receive it would ever have been reached. “We could not see the woods for the trees,” in other words the records of accidents and failures would have been so nu- merous that this drug, which may be wonderful in its benefits to man, would have been distrusted if not discarded. (b) The preparation of the drug is important. At the present time that recommended openly by Ehrlich is a modification of the original method of Alt. This I employ in the following manner: Every implement is sterilized in boiling distilled water for at least five minutes; the drug is then rubbed up carefully with ten c.c. of the recently boiled distilled water until a perfect solution is ob- tained. This requires fully ten minutes of patient work and is greatly aided by the hot pestle and mortar and the hot distilled water. After this pre- liminary solution has been obtained, sterilized nor- mal sodium hydrate solution is added, about 2 c.c. for a dose of 0.6 gramme of the drug. The sodium hydrate solution throws down a peculiar stringy precipitate, looking a little like yellow vaseline in water. The mixture is then rubbed up until all precipitation stops. After that the sterilized nor- mal sodium hydrate solution is again added, drop by drop, until the fluid is perfectly clear. This re- quires at least another five minutes, and is again greatly facilitated by the hot pestle and mortar. From time to time, more hot, boiled, distilled water may be added until the total fluid is increased to 20 c.c. An injection of more than 10 c.c. into each buttock adds greatly to the pain. For this reason 1 use a 10 c.c. antitoxine syringe for the purpose of measuring the fluids used in preparing the drug and then for the injection, with the re- sult that I now usually give a trifle less and never more than 20 c.c. total. While the last stage of preparing the medicine is being completed the skin of the patient should be cleansed, preferably with tincture of green soap, alcohol, and iodine. The iodine is daubed over an area about one inch in diameter at a point one inch above the imaginary horizontal line passing through the upper limit of the intergluteal cleft, about three inches outward from the cleft. This, in my opinion, is the safest point to use, as the injection is then well above the exit of the great sacrosciatic nerve. One may parenthetize the statement that cases of paralysis of this nerve have been reported due to injecting mercury too deeply and too low down into the buttock. The position of the patient is preferably flat on his face, and a precaution never to be forgotten is that one finger of the operator must be on the gluteus about to receive the injection, determining whether the patient hardens the same or not. If the muscle is held rigid the injection must cease momentarily until the patient relaxes it. Injection into the rigid muscle is extremely painful and moreover forces the injection within the muscle into the fat and in part even upon the skin. Just after the injection, gentle massage for about twenty minutes should be given the part by the nurse. The