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The five day treatment of early syphilis warrants special consideration at this time, for it has certain undeniable advantages. It apparently "cures" a majority of patients, it affords rapid control of infectiousness, it gives no opportunity for lapse in treatment and there is a considerable saving to the patient in both time and expense. An effective "speed-up" method of treatment is desirable at this time, for it may be anticipated from statistics of past wars and the experience of England in the last year that there will be a sharp increase in syphilis. The question of the safety of the method has been the greatest drawback to its general adoption, for the incidence of cerebral reactions, some fatal, far exceeds the recorded incidence of similar reactions from standard treatment. Proponents of the five day method suggest, however, that the reports of fatalities from conventional treatment are not a true reflection of their actual incidence, and furthermore that the risk involved with the rapid method is far out¬ weighed by the serious late complications of syphilis which result from inadequate standard treatment.At the Cook County Hospital the five day method was instituted as a clinical experiment to corroborate the promising results of Chargin, Hyman and Leifer.1 From August 1940 to January 1943, 481 cases were studied. The therapeutic results thus far have been encouraging. There were no fatalities in the group, although there were 3 instances of cerebral reactions.In the beginning of the study mapharsen was the sole drug employed and it was administered by continuous intravenous drip. At the end of the first year our statistics indicated failures from one course of such treatment in approximately 12 to 15 per cent of the cases.In the hope of reducing this percentage of failures, the technic was then modified so that a bismuth compound was administered in addition to the maphar¬ sen, daily intramuscular injections of soluble bismuth being employed in order to retain the "five day" feature of the treatment.Though the interval is perhaps too short to permit a conclusive statement, it appears that the incidence of failures from one course of treatment has thereby been reduced from 15 per cent to approximately 4 per cent.The earlier failures, it was noted, occurred almost entirely in persons who had reported relatively late with eruptions of secondary syphilis. At first, therefore, bismuth was administered only to those with eruptions of secondary syphilis, but it was soon apparent that the bismuth was well tolerated, there being no increase in untoward symptoms. The concurrent use of arsenic and bismuth was then established as routine for all cases of early syphilis. It is of interest that Clausen, Longley and Tatum 2 later presented evidence from experiments with animals which indicated that the therapeutic effects from combining arsenic and bismuth were enhanced, "additive" to use Tatum's expression, and the combina¬ tion caused no increase in toxic effects. CLINICAL MATERIALThe entire group numbered 481 pat...
The five day treatment of early syphilis warrants special consideration at this time, for it has certain undeniable advantages. It apparently "cures" a majority of patients, it affords rapid control of infectiousness, it gives no opportunity for lapse in treatment and there is a considerable saving to the patient in both time and expense. An effective "speed-up" method of treatment is desirable at this time, for it may be anticipated from statistics of past wars and the experience of England in the last year that there will be a sharp increase in syphilis. The question of the safety of the method has been the greatest drawback to its general adoption, for the incidence of cerebral reactions, some fatal, far exceeds the recorded incidence of similar reactions from standard treatment. Proponents of the five day method suggest, however, that the reports of fatalities from conventional treatment are not a true reflection of their actual incidence, and furthermore that the risk involved with the rapid method is far out¬ weighed by the serious late complications of syphilis which result from inadequate standard treatment.At the Cook County Hospital the five day method was instituted as a clinical experiment to corroborate the promising results of Chargin, Hyman and Leifer.1 From August 1940 to January 1943, 481 cases were studied. The therapeutic results thus far have been encouraging. There were no fatalities in the group, although there were 3 instances of cerebral reactions.In the beginning of the study mapharsen was the sole drug employed and it was administered by continuous intravenous drip. At the end of the first year our statistics indicated failures from one course of such treatment in approximately 12 to 15 per cent of the cases.In the hope of reducing this percentage of failures, the technic was then modified so that a bismuth compound was administered in addition to the maphar¬ sen, daily intramuscular injections of soluble bismuth being employed in order to retain the "five day" feature of the treatment.Though the interval is perhaps too short to permit a conclusive statement, it appears that the incidence of failures from one course of treatment has thereby been reduced from 15 per cent to approximately 4 per cent.The earlier failures, it was noted, occurred almost entirely in persons who had reported relatively late with eruptions of secondary syphilis. At first, therefore, bismuth was administered only to those with eruptions of secondary syphilis, but it was soon apparent that the bismuth was well tolerated, there being no increase in untoward symptoms. The concurrent use of arsenic and bismuth was then established as routine for all cases of early syphilis. It is of interest that Clausen, Longley and Tatum 2 later presented evidence from experiments with animals which indicated that the therapeutic effects from combining arsenic and bismuth were enhanced, "additive" to use Tatum's expression, and the combina¬ tion caused no increase in toxic effects. CLINICAL MATERIALThe entire group numbered 481 pat...
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