Salvarsan—606.
Until very recent days mercury was our only anchor sheet in the fight against Syphilis, but in 1910 the great German scientist, Professor Paul Ehrlich, discovered that a certain chemical combination of arsenic, called by him Salvarsan, has a wonderful germicide effect on Spirocheta of Syphilis. Salvarsan is known also as 606, and its latest modification, Neo Salvarsan, is known as No. 914, because Ehrlich had to re-examine 605 different combinations of arsenic before he has developed and adopted 606, and he had to re-examine 913 combinations before he has adopted No. 914. At the time of its discovery the greatest enthusiasm prevailed, and it was claimed and expected by many that one injection of Salvarsan would be able to kill all the spirochetae in the body, and thus bring about a complete cure of Syphilis. Unfortunately, subsequent experience has shown that these expectations were unfounded. Salvarsan is a great remedy and one injection of it may heal up very rapidly most destructive syphilitic lesions, but neither one injection nor two nor three can with certainty produce a perfect and absolute cure of Syphilis.
General Treatment and Regime in Syphilis.
The consensus of opinion of the most reliable and competent of medical observers at the present time is that the best results in the treatment of Syphilis are obtained by combined use of mercury and salvarsan, beginning with a few injections of Salvarsan and following up with a thorough mercurial treatment. The great usefulness and striking healing properties of Salvarsan in Syphilis are particularly to be appreciated, because mercury is not tolerated by many patients beyond a certain limit. Push beyond this limit, mercury produces symptoms of mercurialism—chronic mercurial poisoning, manifested by swollen and painful gums, bad smell from the mouth, stomach disorders, diarrhea, etc., which may prove serious and even dangerous. One of the most important measures of prevention of mercurialism in a patient undergoing mercurial treatment is to keep the mouth and teeth in a clean and healthy condition.
One more drug should be mentioned, which, besides mercury and Salvarsan, is used more than any other drug in the treatment of Syphilis. This drug is Potassium Iodide, which is very useful and surpasses anything else in its remarkable quality to absorb deep-seated syphilitic tumors (gummata) of the tertiary period.
Besides these three drugs, which are called specific, because their action is almost infallible, there are very few drugs used in Syphilis, mostly tonics to build up and strengthen the system, weakened by syphilitic poison. The general regime in Syphilis is much more liberal than in Gonorrhea, both as to choice of food and drink and as to the permissible amount of physical exercise or pleasure. This is particularly true in the late tertiary period of Syphilis. In the acute secondary stage of the disease, moderation and a regular mode of life is absolutely essential for the favorable course of the disease. The use of alcoholic liquors at this stage is absolutely prohibited, but it is tolerated in moderation if no active symptoms are present. Smoking and chewing are also prohibited if any sores or patches are present in the mouth. As mentioned before, these mouth patches, as the sores of this period, are highly contagious, and the patient, for the sake of others, must have his own table utensils and all articles of personal use. He is also cautioned to avoid in every possible way a close physical touch with others.
Syphilis and Marriage.
The question, when can a syphilitic marry? is as momentous and difficult to answer as a similar question in Gonorrhea; in other words, this question means, When can a syphilitic be declared perfectly cured and free from any danger of transmitting the infection to his wife and children? Until very recent years, before the three great discoveries in the realm of Syphilis had been made (the discovery of Spirocheta, Wasserman blood test, and Salvarsan), the physicians adopted from experience a rule which proved to hold good in the majority of cases. This rule reads that no syphilitic should be allowed to marry before three years passed since the time of primary infection. This rule was adopted on the assumption that the effects of three years’ treatment and the natural weakening of the virulence (intensity) of the syphilitic poison with the age of the disease give a reasonable assurance of safety to the wife and offspring. It is true that in most of the cases the family was fairly well protected by the long duration of observation period, and remained free from the infection, yet the physician had no exact and definite basis for such prediction, and while the family was well, some of these men developed many years later various dangerous and incurable complications of the advanced Tertiary Syphilis. Fortunately, now, in the light of new knowledge at our command about Syphilis, we are able to gauge the condition of the patient as to the degree of his cure of Syphilis in a very exact and definite manner. One test, tho, is not conclusive, particularly if it be negative. Positive Wasserman test is a fairly good evidence that syphilitic germs, spirochetae, are still present in the body in a dormant, if not an active, state, but a negative test, to be conclusive, must be repeated several times, covering a long period of time under various conditions, such as before and after a course of treatment. It should be remembered that while different active lesions in Syphilis are controlled and cleared up under modern methods of treatment very rapidly, a perfect elimination of spirochetae from the system is much more difficult, and it is always a time-consuming procedure. There are many cases of Syphilis where, after the primary general rash, sore throat, and other symptoms of the early secondary period, no other active symptoms of any kind develop subsequently, so that the actual manifestations of Syphilis are limited to a very few weeks or months, but even in these cases should a blood test be persistently negative for a period of half a year’s time, at least another half year should elapse before a final blood test is made. In the mildest and most thoroughly treated cases, a year’s time should be the shortest waiting period for giving a permission of marriage. In many more cases, probably in the majority, this period must be extended to two or three years, and in a few cases of malignant or destructive character, even much longer than this.
Thus the modern methods of treatment have shortened enormously the period of active manifestation of Syphilis, and have placed in our hands powerful means to control and to check the most malignant and destructive syphilitic lesions, but the period of quarantine in regard to marriage is not shortened very much, though its estimation is made immeasurably more certain, definite, and reliable.
Syphilis can be considered at the present time as perfectly curable and readily amenable to treatment, provided a correct and early diagnosis is made and a thorough, systematic, and persistent treatment is administered.