Modern Clinical Syphilology: Diagnosis, Treatment, Case Study

Abstract

The 3rd edition of this work covers in an encyclopedic way every aspect of syphilology, yet contrives to remain practicable largely because of its excellent print, frequent summaries, and many lists of principles, rules, therapeutic indications, and "don'ts". The clinical signs and the differential diagnosis of early, late, prenatal, visceral and neural syphilis, are extensively yet compactly described; the less common manifestations of the disease are not overlooked; and the special therapeutic procedures appropriate to each condition are dealt with in detail. Due attention is paid to the peculiar psychological aspects of the disease and to the doctor-patient relationship. Many European readers, however, will not be readily convinced of the superiority of the "continuous alternating" treatment systems which the authors advocate in place of the "simultaneous intermittent" type of therapy. Even before the war the need was recognized for a system of treatment taking less time than the American standard scheme which occupies at least 1 year; and of course under war conditions the urgency of this need became even more apparent. Nevertheless we should not lose sight of the fact that the 5-day "massive" dosage method of arsenotherapy introduced to replace it, proved to be dangerous and produced a mortality rate of about 1/250 with, in addition, a relatively high proportion of relapses. - Circumstances which led first to the combining of the arseno-therapy with the administration of bismuth and then to a progressive lengthening of the period of treatment to 10 days and subsequently 12 weeks or longer. In any case the arguments for or against intensive dosage with arsenicals seem to have lost much of their urgency with the introduction of penicillin. Perhaps the point of greatest importance at present is to stress that primary sero-positive syphilis should be treated at least as vigorously as secondary syphilis as it is both more resistant to therapy and more liable to slow relapses. Twenty injections of arsenic and of a heavy metal represent the minimal amount of treatment required to control infection. Mapharsen has now become the most popular arsenical preparation in the U.S.A., but there is a notable absence of comparative articles on the results of the use of this and other preparations, and the permanence of its effects has yet to be established. At the moment its greatest merit lies in the fact that it provokes a considerably smaller number of reactions, especially nitritoid crisis than other preparations. In the treatment of cardiovascular syphilis and tabes, bismuth-sulpharsphenamine (bismarsen) seems to be well established. The last two chapters in this work are new. The first relates to syphilis in relation to Public Health and Military Medicine, and explains the mechanism of the working of the Public Health organisation in the U.S.A., and the reasons why it is unable to operate without compulsory sanctions. It also discusses the problems incident to syphilis in industry and in the Armed Forces. The second new chapter deals with current advances in syphilology and consequently treats mostly of the significance attached to the introduction of penicillin. A masterly survey of the known facts relating to the use of this drug and covering the period to August 1st 1944, is given. The principal points made are that while penicillin is a potent anti-syphilitic, it is too early as yet to estimate its final value. Its action in benign tertiary syphilis, however, is striking and complete, and it has certain advantages in neurosyphilis although it will probably require to be combined with fever therapy. In syphilitic women, its administration will prevent congenital syphilis in the child. When infantile syphilis has developed it is still of great value, but in cardiovascular syphilis its quick action may makes it dangerous. Finally, the problems which arise in follow-up studies are touched upon.