ARTICLE


‘Arsphenamine, the constituent of the drug Salvarsan, destroyed Treponema pallidum, the causative organism of syphilis’


against both treatments and many scholars reported that both treatments were often administered together, rather than as single remedies. However, mercury treatments held sway


for around 300 years, even showing a revival in the1860s when mercury preparations began to be given by injection, despite the knowledge of the side effects of these treatments. In Victorian times the advent of commercial potions to treat almost anything was rife and many preparations were offered to treat syphilis, including potassium iodide, which was described in The Lancet in 1835. The first great breakthrough in the


treatment of syphilis involved the use of arsenic compounds in the 20th century, although arsenic had first been cited as a cure as early as 1498. In 1909, Paul Ehrlich and Sahachiro Hata created ‘Compound 606’, an arsphenamine that was the constituent of the drug they called Salvarsan. This was shown to destroy Treponema pallidum, the causative organism of syphilis infections. The use of bismuth as an effective treatment was described by Sazarac and Lavaditi in 1921, who used tolerable doses to treat their patients, although Balzer had first described its use in 1899. Undoubtedly, the turning point in the


treatment of syphilis was the use of the antibiotic penicillin, first described by Alexander Fleming in 1928. Following the work of Chain and Florey to purify the substance for safe human use, commercial production was possible. Mahoney, Arnold and Harris successfully treated four cases of syphilis in 1943 in the USA with the newly produced drug. This treatment found rapid acceptance especially by military doctors throughout the forces during the Second World War. The effectiveness of penicillin was demonstrated against all stages of the infection and in a timescale of a few weeks, compared with the years of treatment with previous remedies.


SYPHILIS IN THE ARMY AND ROYAL NAVY


The year 1493 seems to be pivotal in relation to the first incidence of syphilis, when Columbus and his sailors returned to Europe from the Americas, although this is a contentious point even to this day. The disease grew to epidemic proportions among knights and foot soldiers alike, reaching Italy


720 THE BIOMEDICAL SCIENTIST Columbus connection


Not all historians agree that syphilis was a new disease, as many believe that it was already present in the Old World when Columbus and his men returned from the Americas. The arguments for and against are complex. What everyone does agree on is that the form of syphilis that spread at the time was much more dangerous and deadly than it had been in the past or was to become in the future. Spread by sexual contact, it was highly contagious and caused pustules, pain, and itching of the


and Spain by 1494 and arriving in England by 1497. It had catapulted the disease from beyond the ocean into an epidemic that would last more than 500 years. In 1903 the Advisory Board for Army Medical Services requested an inquiry into ‘The Treatment of Venereal Diseases in the Army and to Inquire into the Treatment of the Itch (Scabies)’. The final report was published in February 1906 under the title ‘The Treatment of Venereal Disease and Scabies in the Army’. The plan of investigation was a) to ascertain the exact references and records at headquarters dealing with the subject, and b) to classify this information. This involved methods of prevention and measures adopted for prophylaxis. Treatment by mercury was quoted as being the only known drug that had a distinct effect in curing the disease. The evidence gained by experience was, at that time, unanimously in favour of mercury. It included intramuscular injection, injection of soluble salts, intravenous injection of mercurial salts, administration by mouth and in mercurial baths.


skin, often spreading all over the body. These symptoms were followed by intense pains and a deterioration of the bones. This stage of the disease often ended in death. A possible explanation for these symptoms is not that they were caused by a new disease, but by a more virulent or deadly form of a long-occurring organism. This is not an uncommon phenomenon among bacterial infections, a modern-day example being that of toxic shock strains of Staphylococcus aureus arising in the 1980s.


Other methods recorded administration by application of plasters, use of iodides, heat and the open air. Other drugs and methods of treatment were secondary. In every case of non-mercurial treatment, results appeared to be unsatisfactory. Army records appear to report the first incidence of syphilis among the men in 1881. Records from 1888 show that 30% out of a strength of 101,695 personnel to be infected with venereal diseases (including syphilis, soft chancre and gonorrhoea). Of these, 41 were constantly sick and 6% were invalids. The number of candidates for recruitment that were refused on account of syphilis per 10,000 offering for enlistment ranged from 160 in 1870 down to 16 by 1910. Testing was by the original method of


Wassermann, Neisser and Bruck (1906) for the WR, with modifications considered for patients under treatment “to recognise the last traces of Wassermann substance”. The final report concluded with a design for a treatment block and a schedule for existing hospitals. “The measures to be adopted in each case must be carefully considered and adapted to existing conditions, with due regard to efficiency and economy”. A Royal Commission on Venereal Disease was established in 1916 to consider syphilis, gonorrhoea and soft chancre. The report contained a memorandum on the results of treatment of venereal disease with Salvarsan and Neo-Salvarsan in the Royal Navy. A total of 4203 cases were treated and 9912 injections were given. The course of


‘Enzyme-linked


A newborn infant displaying the pathological morphology indicative of ‘congenital syphilis’.


immunosorbent assay automated methods give increased specificity and sensitivity, and to this day remain in use for blood screening’


DECEMBER 2013


CDC/Dr Norman Cole


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