The treatment of early syphilis by intensive and semi-intensive arsenotherapy.

In the treatment of early syphilis, recent years have witnessed changes not only in the arsenical preparations employed but-which is equally important-in the length of the actual treatment period. The exigencies of wartime with the consequent need for the conservation of man-power, together with the ever-shifting population demanded by industry, have given an impetus to the study of short-term intensive treatment. Efforts have been made tQ curtail the time phase over which treatment is spread, because the defaulter rate varies directly with the length of the treatment period, The arsphenamines and neoarsphenamines are being replaced, for the time being, by various arsenoxide preparations, namely, Mapharsen in the United States df America and Mapharside and Neohalarsine (arsphenoxide tartrate) in Great Britain. The various forms of intensive therapy applicable to early syphilis are at present sufficiently numerous to warrant the conclusion that this therapeutic approach to early syphilis is still in the experimental phase. There are, for example, treatment with Mapharsen and fever therapy (Jones and his colleagues; Thomas and Wexler); the administration of Mapharsen by the intravenous-drip method over a period of a few.days (Co-operating Clinics ofNew York, etc.); the 10-day syringe method of treatment (Schoch and Alexander2); the 20-day (Schoch and Alexander') or 30-day (Goldblatt) treatment in which c6nsecutive daily injections of Mapharsen are given; thrice-weekly injections of Mapharsen (with or without bismuth) over a period ranging from 7 to 12 or from 9 to 12 weeks (Eagle); and the 16 weeks' (Schaffer and Salchow) treatment schedule and the 26 weeks' course of concurrent Mapharsen and bismuth adopted by the Army of the United States. These schemes provide an array of treatment schedules from which a standard treatment may emerge in the course of time. This forecast assumes, however, that penicillin may.not fulfil its early promise of being the most valuable antisyphilitic therapeutic agent yet discovered. The possibility of combined arseno-penicillin therapy cannot be ignored. It will be noted that the degree of intensity in treatment varies considerably in the different schedules mentioned above. With a view to formulating a broad classification, the term, hyper-intensive,may be applied when treatment is condensed into a few days, say 10 at the most; the term, intensive, could be applied to those therapeutic measures administered over a period of 20-30 days; perhaps' the expression, semi-intensive, would best describe the relatively leisurely treatment given over a period of 7-12 weeks. Our series of I120 cases therefore falls into the latter categories, approximately 72 per cent coming within the intensive group. The hyper-intensive systems were avoided deliberately, because apparently good results'are often achieved at the expense of an admittedly big percentage of complications and a relatively high mortality rate.