270 ILLINOIS STATE ACADEMY OF SCIENCE 



indicating an early involvement of the central nervous 

 system, and it is probable that patients who later suffer 

 from disease of the central nervous system are recruited 

 from the ranks of those who suffer such early involve- 

 ment; hence the necessity of examination of the spinal 

 fluid in all cases of syphilis, with treatment especially 

 directed to combating this invasion. 



Unfortunately for our problem as to the treatment of 

 paresis in state hospitals, the patients do not come to us 

 until their behavior as the result of brain involvement 

 has become so bad as to necessitate their separation from 

 home and society. This means that, given an average 

 duration of. three years from the appearance of symp- 

 toms to the death of the patient, the state hospital has 

 to deal with patients who are well along in the course of 

 the disease, probably two years at least upon the aver- 

 age. Obviously considerable structural change has taken 

 place and therapy is thus rendered so much the more 

 difficult. The infected organism lies in the brain sub- 

 stance itself and is exceedingly difficult to reach with 

 any drug known to us at the present time. 



The history of the treatment of paresis is one of many 

 therapeutic gestures and relatively small accomplish- 

 ment. Fortunately for the paretic and unfortunately for 

 the establishment of facts concerning cures, the disease 

 is subject to spontaneous remissions in from eight to ten 

 per cent of cases. Thus the patient who is apparently 

 quite demented and about ready to die may without ap- 

 parent cause or following an attack of erysipelas or other 

 intercurrent infection, make a remarkable improvement 

 which may last anywhere from a few months to many 

 years, but inevitably the patient dies of his disease sooner 

 or later — unless intercurrent disease carries him off 

 meanwhile. For this reason statistics concerning the re- 

 sults of various treatments are unreliable unless observa- 

 tion is carried on over a long period of years, or a very 

 high percentage of remissions are secured in a consider- 

 able group of treated cases. 



It is unnecessary to recite the long history of the treat- 

 ment of paresis here. Very naturally the discovery by 

 Ehrlich of the arsenical known as salvarsan aroused 



