Wechselmann W (1910)
Über die Behandlung der Syphilis mit Dioxydiamido-arseno-benzol [On the treatment of syphilis with dioxy-diamido-arseno-benzol]. Berliner Klinische Wochenschrift 47:1261-1264.
Email to someoneTweet about this on TwitterShare on FacebookPin on PinterestShare on LinkedIn

Key passage(s)

wechselmann-title

wechselmann-kp1

Translation

[From a lecture delivered to the Berlin Medical Society on 22 June 1910]

“The brilliant work to which [Paul] Ehrlich has dedicated himself almost incessantly during recent years had the aim of describing systematically and testing experimentally chemical remedies that cure infectious diseases…Ehrlich has had hundreds of such drugs examined in animals infected with trypanosomes and spirochaetes and has achieved excellent cures with some of them. It was however a triumph of science when he was able to announce in November of last year that diamidoarsenobenzol, tested by Hata, briefly named Preparation 606, could lead to a rapid cure, in rabbits, of large primary lesions teeming with spirochaetes. This happened after administering a single effective dose that cleared the lesions of spirochaetes within 24 hours. It was clear that the therapy of syphilis was therewith wrested from the level of empiricism and brought to a firm natural scientific approach. Ehrlich has now indicated very precisely the cautionary measures under which a clinical trial has to be performed when a drug has been thus examined [in animals]…”

wechselmann-kp2

Translation

“The questions which one had naturally to ask when examining a new preparation were:

1. Does it have a specific effect in syphilis, and if so, does it exceed the that of already known drugs;
2. does it cure syphilis;
3. is the eventual risk of the drug in an acceptable balance with the size of its [beneficial] effects?

Concerning the first point, there can no longer be any doubt at all, even when judging with the greatest scepticism, that the new drug acts on the symptoms of syphilis in all infectious forms with a speed and thoroughness which no other drug so far known can match, even approximately. We have tried this out in 80 cases and the effects occur with the certainty of an experiment…

The curative effects are so rapid that one cannot demonstrate patients because after a few days there is no longer anything to be seen on them, and they leave the hospital. I am therefore showing you this patient, who has large ulcerated plaques on the tonsils and numerous eroded papules on the penis and scrotum, and I shall show him to you again in 8 or 14 days, cured. As a parallel case I am showing you this girl, who had severe papules on the tonsils, the arcus palatoglossi and the labia pudenda, was injected 8 days ago [with Preparation 606], and is now completely without signs.

I will concentrate now on cases which allow a comparison [the effects of Preparation 606] with the effects of mercury.

You see here a wax preparation [moulage] of a young girl with a small, papular, lichenoid chancre, which usually responds to therapy only with difficulty.

Ida H., 20 years old, 8 weeks ago, ulcer on labia pudenda. Then very dense, widespread, very rough, micropapular, lichenoid exanthema, which usually responds to therapy only with difficulty. Widespread scleroderma, syphilitic tonsillar angina, plaques on the tongue. Papulae on the labia majora.

On 19 April, injection of 0.3 of Preparation 606. On 22 April, obvious involution. On 26 May, papulae cured, plaques of exanthema cured. Regression proceeded steadily, so that after 3 weeks there only remained small pigmentations in and below the level of the skin.

For comparison I show you patient Tr., with exactly the same physical signs of syphilis, whom we submitted to a 5-week treatment with mercury ointment, after which the exanthema hardly changed, only becoming slightly more livid. 8 days ago an injection of Preparation 606 was given, [and there is] now obvious involution…

We have not so far observed any recurrences, but the period of observation is still too short. Even so, the initial cases, 2 children, have been observed continuously for about 3 months. This question, as well as the question of whether the preparation can cure syphilis with a single blow, can only be solved by continuous observation, as well as the question of whether such a dramatic cure depends on the dose, as is probable…

We are aware that everything I have presented today still leaves many gaps; however, this is inevitable in such a new situation. We shall have to continue working quietly and critically in order to determine the exact indication and contraindications of the drug. However, one may safely say today that Ehrlich’s genius has won a big battle in the war against syphilis. But because the path which has led to today’s results has been based on firm scientific experimental foundations, we can be quietly confident that this path is the right one, and express our hope that it will lead us to final victory.”

wechselmann-kp3

Translation

“We have not so far observed any recurrences, but the period of observation is still too short. Even so, the initial cases, 2 children, have been observed continuously for about 3 months. This question, as well as the question of whether the preparation can cure syphilis with a single blow, can only be solved by continuous observation, as well as the question of whether such a dramatic cure depends on the dose, as is probable…

We are aware that everything I have presented today still leaves many gaps; however, this is inevitable in such a new situation. We shall have to continue working quietly and critically in order to determine the exact indication and contraindications of the drug. However, one may safely say today that Ehrlich’s genius has won a big battle in the war against syphilis. But because the path which has led to today’s results has been based on firm scientific experimental foundations, we can be quietly confident that this path is the right one, and express our hope that it will lead us to final victory.”

Translation by Ulrich Tröhler