WILLIAM F. PETERSEN 1099 



have been thoroughly studied, in this country particularly by Brown and Pearce/ 

 The non-specific treatment may either activate or depress the symptoms. Thus Noel 

 found that malarial fever might activate the lesions while Kyrle^ and a number of 

 later clinicians have shown that protein therapy is of material aid in making arsenical 

 or mercury therapy more efifective,^"' and others have altered the course of the 

 disease by protein injections without specific treatment, or by malarial inoculation 

 (Weirauk, Shamberg)/"'" 



In the treatment of syphilis in the secondary and tertiary stages we are obviously^ 

 dealing with a focal reaction, the mechanism of which has been discussed in the pre- 

 vious section. Under certain conditions we may activate a lesion. Under such con- 

 ditions the organisms may be flooded into the blood stream. Scharber" describes the 

 flooding of the blood stream with typhoid bacteria whenever a typhoid carrier 

 was given a non-specific injection. Presumably a similar effect takes place with 

 syphilitic lesions. The Jarisch-Herxheimer reaction is a clinical expression. In the 

 later stages of syphilis the virus seems very susceptible to the destructive agency of 

 the body fluids and seems able to exist only in tissues largely protected from direct 

 contact with the plasma (Finger).'^ 



Apparently it is this latter factor which plays a role in the treatment of paresis. 

 The meninges become more permeable after a non-specific injection (Kafka-Walter- 

 Flatau),''''5 and with that increase there is an increased penetration of anti-substances 

 into regions normally deficient. Use is made of this phenomenon in the combined 

 method of treatment whereby the non-specific reaction is immediately followed by 

 the use of arsenicals or mercury. 



There seems, furthermore, some important difference in the manner of reaction of 

 the body to the malarial fever and that following a milk injection. Donath and Heilig"" 

 have recently shown that there is an increase in amino acids in the serum of patients 

 at the height of the reaction to non-specific therapy but not during the malarial chill. 



' Brown, Wade, and Pearce, Louise: Arch. Derm, and Syph., Dec, 1920; Jour. Amer. Med. 

 Assoc, 77, 1619. 1921. 



^ Noel, P.: Jour, de vied. Bordeaux, 51, 515. 1920. 



sKyrle: Wien. kl. Wchr., 30, 707. 1917; ibid., 37, 1105. 1924. 



•» Kalberlah, Fr.: Milnch. med. Wchr., 69, 114. 1922. 



sMulzer: Kl. Wchr., 5, 2347. 1926. 



^ Dujardin, B., and Decapps, N.: Arch, internal, de med. exp., i, 539. Liege, 1925. 



7 Greenbaum, S. S., and Wright, C. S.: Arch. Derm, and Syph., 12, 858. 1925. 



* Ahlswede, E.: ibid., 8, 854. 1923. 



9 Bering, F.: Munch, med. Wchr., 73, 2016. 1926. 

 '° Weirauk, H. V.: Ohio Slate Med. Jour., 22, 305. 1926. 

 " Shamberg, J. F., and Rule: Jour. Amer. Med. Assoc, 88, 1217. 1927. 

 " Sharber, G.: Wien. kl. Wchr., 39, 1325. 1926. 



'3 Finger: Discussion in the "Foreign Letter," Jour. Amer. Med. Assoc, 88, 1825. 1927. 

 "• Flatau, E.: Rev. neurol., 33, 521. Paris, 1926. 

 ■sFranck: Sch. med. Wchr., 54, 168. 1924. 

 •* Donath, J., and Heilig, R.: Wien. kl. Wchr., 39, 353. 1926. • T_' ' C •"" 



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