The treatment of venereal disease and scabies in the army : report.

  • Great Britain. Army Medical Department. Advisory Board for Army Medical Services.
Date:
1904
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Licence: In copyright

Credit: The treatment of venereal disease and scabies in the army : report. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    Question VIII. What is the most advisable course to be pursued iii the administration of the iodides in syphilis P What advantages may be expected from treatment by other methods than by the use of mercury and the iodides ? By whom. Report of Evidence. Lieut.-Col. P. M. Ellis, E.A.M.C. To determine the natural susceptibility of the patient to the iodides, as upon this the actual dosage should be based. Care should be taken that depression is not produced. Consistent with this, large doses should be given in cases of gummata and visceral lesions. The drug is not generally of much value in the early stages of syphilis. No other special treatment appears to be of much value. I find that in syphilitic rheumatism, as it is called, syphilitic pains, it is very useful. I would give it when there is actual infiltration, such as gumma, and when there are arthritic pains. I give it in those cases where there are severe arthritic pains. I give it in cases of periostitis and late secondaries. I give it alone frequently. Sometimes I combine it with other things. It would depend on the patient a good deal. Many of these patients are very cachectic, and then one is unwilling to give them mercury. As regards the next section of No. 8. I do not know of any other specific treatment. I should be unwilling to give up iodides and mercury altogether. If I had a severe cachectic case, such as I referred to, of such severity that he could not take iodides of mercury, I should devote myself entirely to attempting to improve his general health. I find in many of the cases of syphilis after long treatment in hospital that they improve when they are discharged, assuming that the cases are not severe and the patient can go about. I think cases with gummata in which you cannot give iodides or mercury are uncommon. Of course you would meet with them. You meet a man when he is broken down in health, and so forth, but in such cases there is generally combined some other condition, such as the presence of arthritic pains—what is called syphilitic rheumatism—and in such a case as that I treat the patient with alkalies. If I had the opportunity of seiiding such a patient to a convalescent home, or to th.e seaside, if there were such a thing possible, I should do so. I think that would be likely to be beneficial. These severe cases of syphilis abroad are usually invalided home, so it is not ol'ten that one sees these very cachectic cases, except at Netley. Lleut.-Col. H. R. Whitehead, R.A.M.C. I personally hold that the iodides are not required, or are not advisable until the later stages of the disease. I never think of giving them in the early stages. They are advisable in gummatous conditions, bone lesions, and later sore throats—the later secondaries. I have no experience of other methods. I would not like to give up mercury or the iodides. I do not hold at all by the so-called tonic plan of treatment. In a case of bad syphilis with gummatous lesions and cachectic to such a degree that you cannot treat him with mercury and the iodides, I have always in such cases stopped the mercury or iodide of potassium or both combined and tried to improve their general health by cod- liver oil and malt extract, with sea air and tonics; but I think the essential point in the treatment of all syphilis is either mercury or iodide of potassium if you wish to destroy the disease. I had a large experience at Netley of sending such a man to the seaside when I was assistant to the professor of surgery. We had a lot of syphilis, and the men did uncommonly well by the sea—cases sent home. Lieut.-Col. G. H. Sylvestee, R.A.M.C. I have not any j)lan. I confine iodides to late secondary and tertiary syphilis, according to the rule which has been emphasised in this country, in gummatous and late secondary lesions and in tertiary lesions, and large doses are sometimes required combined with mercury. But it depends on the condition of the patient, how he is. There are certain cases which will not stand mercury or the iodides, and I think tonics are good for them. We do keep them at Netley in the open air as much as possible. There is no scheme yet for systematically carrying out open-air treatment, but as a matter of fact we do treat many of them in that way. They sleep in a room at night. Lieut.-Col. C. A. Webb, R.A.M.C. Tertiary Manifestations.—Iodides should be given well diluted and continued for a long time. I do not think it is a j)ractice now in military hospitals to give a mixture of iodide of potassium and liquor hydrarg. perchlor.; it used to be, but I do not think it is now. My experience in Egypt has been with injection as the routine practice. In the early stages I would rather give mercury without the iodides. I do not know of any other methods of treatment of syphilis except the use of mercury and the iodides. I have no experience of any school where mercury is not given at all. In Egypt we used to occasionally send our cases to Alexandria from Cairo, but I think if anything the syphilis cases were not benefited at all by the change. The climate is damp at Alexandria, which is at the seaside, and this may have had something to do with it. Major and Bt. Lieut.-Col. >5. Hickson, R.A.M.C. In the administration of the iodide we give about 10 grains three times a day with some spirits of ammonia. We are guided to the administration of iodides by the stage of the syphilis. I do not give iodides in the early secondaries. 1 think authorities tell us to give it in the late secondaries and the tertiaries. I have no experience of other methods of treatment than by mercury and iodides. On the severely cachectic cases with bad gummatous lesions, I adopt, of course, dietetic treatment. Good diet, perhaps cod-liver oil and some tonics. If it is a gummatous lesion I would give iodides.