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Arsphenamine jaundice and the recognition of instrument-borne virus infection
1Hepatitis and Retrovirus Laboratory, Virus Reference Division, London, UK.
Abstract:
Soon after its introduction in 1910, intravenous arsphenamine treatment for syphilis was found to be complicated by jaundice. The underlying cause, unsterile syringes and needles, was eventually recognised in the early 1940s, mainly through the efforts of British Army investigators. The infection most often transmitted was probably hepatitis B virus (HBV), but the high mortality in a few of the outbreaks of arsphenamine jaundice suggests that variants of HBV, or other hepatitis viruses, were sometimes involved. Fifty years later, at a time when there are estimated to be over three hundred million carriers of HBV in the world and probably at least as many hepatitis C virus carriers, and when the World Health Organisation estimates that there have been 17 million infections with human immunodeficiency virus, the lessons learnt around 1945 about the need to use sterile instruments and needles for all injections and venepunctures remain highly pertinent.
Insights
Unsterile injection equipment caused jaundice outbreaks in the early 20th century, likely due to hepatitis B virus (HBV) transmission. These historical events underscore the critical need for sterile practices in all medical procedures to prevent viral infections.
Area of Science:
- Medical History
- Infectious Diseases
- Public Health
Background:
- Intravenous arsphenamine, introduced in 1910 for syphilis treatment, led to unexpected jaundice complications.
- Early 20th-century medical practices often involved non-sterile syringes and needles for injections and venepunctures.
Observation:
- Jaundice outbreaks linked to arsphenamine treatment were identified as stemming from unsterile injection equipment.
- British Army investigations in the 1940s were pivotal in recognizing the cause of these iatrogenic infections.
Findings:
- Hepatitis B virus (HBV) was the most probable agent transmitted through contaminated equipment, causing significant morbidity.
- High mortality in some outbreaks suggests the involvement of HBV variants or other hepatitis viruses.
- The historical link between unsterile practices and viral hepatitis transmission was firmly established.
Implications:
- Lessons from the 1940s regarding sterile instruments remain crucial for preventing viral infections like HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
- The ongoing global burden of viral hepatitis and HIV highlights the persistent importance of adhering to strict sterilization protocols for all invasive procedures.
- Ensuring sterile equipment for injections and venepunctures is a fundamental principle for patient safety and infection control worldwide.