Prophylaxis and Treatment
Prophylaxis.—The sole question is the avoidance of places infested with ticks, bedbugs and lice. In Africa, the habitations of the natives, where infected ticks may hide themselves in cracks in floors and walls, are to be especially avoided. As the tick feeds at night a night light is of value.
Destruction of the spirochaetes by salvarsan injection is important prophylactically as well as therapeutically—the reservoir of infection for lice or ticks being gotten rid of.
Treatment.—We have in salvarsan, or neosalvarsan, a specific. The drug should be given so soon as the spirochaetes are found—in the period of onset of the fever. If given at the end of the fever it may intensify the critical manifestations, especially collapse. Unless given early it does not abort the relapse. Neosalvarsan, being less toxic, is better adapted to the treatment of the icteric type of the disease. Atoxyl has practically no value in treatment and the same is true of antimony.
Conseil has treated cases with galyl and ludyl, in doses of 4 to 7 grains, with results as good or better than with salvarsan. The pains in the head and back are relieved by aspirin, although a hypodermic of morphine may be necessitated. Cool sponging and fresh-air treatment are desirable. On the whole, treatment, other than the specific one, is symptomatic.
Administration of the Arsphenamines.—Although arsphenamine (salvarsan) is probably the drug of choice when immediate therapeutic effect is desired, neo-arsphenamine is more popular because it is more simply prepared and administered, is tolerated better by the patient and has a slightly higher therapeutic index. It is, however, less stable, and both the powder and its solutions should be inspected carefully for signs of decomposition, namely, a darkening in color, a strong odor, and insolubility. Ampules containing either drug should be immersed in 95% alcohol for 15 minutes in order to detect any crack. Should a breach be found, or suspected, the ampule should be rejected.
Myocarditis, advanced non-syphilitic renal or hepatic disease, advanced arteriosclerosis and Addison’s Disease are regarded as generally contra-indicating the employment of these drugs. Cases in which the syphilis is of long standing should receive mercurials for at least a week prior to the first injection of arsenic, in order to avoid the possibility of activating lesions in vital organs (Herxheimer), and should be closely questioned regarding the occurrence of symptoms following previous injections (idiosyncrasy).
Prior to each injection, a patient should have a complete uranalysis, receive a cathartic on the evening preceding, and be allowed only liquids for the meal preceding. Subsequently to the injection, he should be allowed only liquids for the succeeding meal, and be retained under observation for at least twelve hours. Untoward symptoms following the injection are treated usually with epinephrin solution (0.6 to 1.2 cc.) or atropin.
Arsphenamines are administered intravenously, usually in the median cephalic or the median basilic vein at the bend of the elbow. This method requires aseptic technic throughout. All apparatus should be thoroughly washed before sterilization, since it is believed that symptoms may arise from substances extracted from glassware and rubber tubing. The water used must be distilled, preferably twice, and freshly boiled. The dose of arsphenamine is 0.3 to 0.6 gm., that of neo-arsphenamine is 0.3 to 0.9 gm. Until tolerance is ascertained, the dose should be small and not repeated in less than a week.