Results of salvarsan therapy in malignant syphilis praecox, syphilide of the palms and gumma of the tongue / by Herman F.L. Ziegel.

  • Ziegel, Hermann Fred Lange, 1876-
Date:
1913
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Credit: Results of salvarsan therapy in malignant syphilis praecox, syphilide of the palms and gumma of the tongue / by Herman F.L. Ziegel. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    nished by her obstetrician, Dr. Thomas H. Cherry, at the time of writing there is a living foetus.' Three years after Mr. B.’s primary infection, a scaly eruption appeared on the palms which, when the patient first came under observation three years ago, had been unsuccessfully treated with ointments. The Weissermann reaction was positive. One month after a series of twelve intramuscular injections of the salicylate of mercury, the eruption disappeared, but the Wassermann reac- tion was still positive. One month later the eruption reappeared. A new series of twelve intramuscular injections of the salicylate resulted in temporary local improvement. But two months after the last injection of the second series the eruption was returning, and the Wassermann reaction was positive. It is to be noted, then, that after mercurial treatment there was a temporary favorable effect on the syphilide, but persistence of a positive Wassermann reaction. Some months previously, Fordyce ’ had reported a similar case successfully treated with salvarsan. Accordingly, an intramuscular injection of 0.5 gm. of salvarsan in iodipin suspension was given and repeated in two weeks. Even before the second in- jection the palms had become soft and free from scales, and up to date, during a jieriod of over two 5'ears, there has been no recurrence. Though at the time of writing the skin over the palms appears to be normal, because of a recent doubtful Wassennann report, and as a precautionary measure the patient is now being given a series of salicylate of mercury injections. As to the serum tests, nine days after the second salvarsan treatment the Wassermann reaction was for the first time reported negative; twice subse- quently it was negative. These serum tests were performed simultaneously and independently at the Rockefeller Institute and by Dr. J. J. Hertz; there were no discrepancies. In July, 1912, Dr. W. J. Heimann also found the Wasser- mann reaction negative. The last serum tests, performed March 25, 1913, by the New York Board of Health and by Dr. J. J. Hertz, were reported ± by the former and negative by the latter. Whenever it was practicable during the past year, the writer has asked two serologists to perform the serum test independently. In fourteen examinations which were thus checked up, there was absolute correspondence in all but two instances, and in the latter there were but slight discrepancies. Conclusion. This case corresponds closely with the one re- ported by Fordyce, and serves to confirm his experience that in a scaling syphilide of the palms, salvarsan is the specific of choice because of the greater rapidity and permanence of the therapeutic effect in this con- dition. Gumma of the Tongue. During the summer of 1905, a physician engaged in general practice in New York City failed to make it a rule to wear rubber gloves in his obstetric work. On the skin over the middle phalanx of the right index finger appeared a small papule, which subsequently increased in size, .suppurated and was excised by Dr. Charles A. Elsberg. There remained an indolent ulcer which, when it maturated, from time to time was incised and curetted. In the meantime there had de- veloped chilliness, intermittent fever, a lymphangitis extending up the dorsum of the hand to the forearm, and enlargement of the right epitrochlear and axillarj- nodes, those in the armpit being about as large as hazelnuts and very ‘ Since this report was submitted for publication an apparently perfectly healthy baby was born. * ^ *Jour. Am. Med. Assn., 1910, Iv, p. 1174.