If You have Syphilis…

During the Victorian period, syphilis was little short of an epidemic (it has even been referred to as the “third plague”). During WWI, syphilis became an enormous problem for the soldiers on the Western Front, resulting in a public health campaign. But what happened once you actually had the disease? In today’s post, we will look at the effects of cure: the injection of Salvarsan 606.

The Disease:

Syphilis caused open and weeping sores called chancres–these did not itch or cause pain, but were incredibly unsightly. They affected soft tissue, but could also inflame joints and destroy mucous membranes. Transferred through sexual contact but also in-utero from mother to child. Secondary stage often involved rashes to the hands and feet. At its worst, is could eat away material from the scalp and skull, erode nasal tissue or destroy the nose completely causing horrific disfigurement.

The Cure:

Salvarsan was the first organic anti-syphilitic. It was distributed as a yellow, crystalline, hygroscopic powder–one that was unstable. This naturally complicated administration, as the drug needed to be dissolved [1]. The suffering patient would lie face down. Salvarsan, melted in a vacuum with a small amount of methyl alcohol, is mixed with 25 c.c. distilled water and two c.c. of 1/10th caustic soda. The acidic solution is injected into each of the buttocks “deeply, slowly, and gently” [2]. The injection is described as horribly painful, the pain sometimes lasting for six or more days and narcotics were sometimes used to control it.

There were additional side effects—rashes, liver damage, and “risks of life and limb” (literally) [3]. Some physicians denounced 606, resulting in the “Salvarsan Wars” where Ehrlich and Hata were vilified. In a kind of harkening back to the Contagious Disease Acts and similar legal means employed in the Victorian period to control the disease, some even claimed that Frankfurt Hospital had “forced prostitutes to undergo Salvarsan treatments” [4]. Ehrlich was eventually exonerated.

Additional Treatments, from 1915:

Treatments could be (1) Local or (2)General. In local treatment,  the chancre (or sore) would be excised and cauterised, or frequently bathed with types of solutions. Rubbing in a mercurial ointment will hasten the disappearance of any syphilitic skin lesion. For joint affections a dressing is applied. For chronic ulcers, the use of a mercurial ointment and the local application of salvarsan for those on the leg or to the tongue. For general treatment, there were three drugs: mercury, iodine and arsenic.[5] Arsenic?? Yes! Salvarsan is an arsenic-based drug (and mishandling of the injection could and did result in arsenic poisoning on occasion).

So Why Do It?

Despite the risks, there was no denying the results! Working better and faster than mercury, lesions disappeared in days.

In the picture above, we have an image of papulo-crustaceous syphilide. In the next image, the same eight days after injection. In the last, three weeks after injection. There are many additional cases presented in the work of Wechselmann, many in color. So, terrifying and painful though it may be, for many, the Salvarsan 606 shot was entirely worth it.

REFERENCES

[1] Arsphenamine. Princeton. <http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Arsphenamine.html>

[2] Wilhelm Wechselmann. The Treatment of Syphilis with Salvarsan. New York: Rebman, 1911.

[3] Paul Ehrlich and the Salvarsan Wars, PROTO, Spring 2010 <http://protomag.com/assets/paul-ehrlich-and-the-salvarsan-wars>

[4] Ibid.

[5] J. E. R. McDONOUGH FRCS, “The Treatment of Syphilis in 1915.” <http://www.vlib.us/medical/syphilis.htm>