MEDICINE 175 



look at the Bulletins of the Sleeping Sickness Bureau. (This admirable Bureau, in 

 July 1912, moved from Burlington House to the Imperial Institute: and it now is called 

 the Tropical Diseases Bureau.) 



Syphilis. Great help has lately been given, toward the detection and study of the 

 germs of this disease, the Spirochacta pallida, by the use of lateral illumination of a dark 

 microscope-field. The lateral rays of light are condensed by a parabolic reflector, and 

 the central rays are cut off by a diaphragm. The spirochaetes show white against a 

 black background. By the addition of micro-photography to this method of lateral 

 illumination, " living pictures " have been obtained for the cinematograph. 



For the diagnosis of past syphilis, and for the differential diagnosis between syphilitic 

 and non-syphilitic lesions, the Wassermann test is of great importance, and has already 

 become the subject of an extensive literature. See, inter alia, " The Wassermann Se- 

 rum Reaction and Ehrlich's Salvarsan," by Carl H. Browning, M.D., and Ivy Macken- 

 zie, M.B. (Constable, 1911.) See also a paper by Lt.-Col. Birt, in the Journal of the 

 R.A.M.C., September 1912, with a series of cases where, without the use of this test, 

 " treatment would have been inappropriate, diagnosis would have been haphazard, 

 prognosis mistaken, and the claims of .the patient against the public would have been 

 wrongly assessed." 



The discovery and study of Spirochaeta pallida made it possible to observe the direct 

 action of drugs on the living cause of the disease, under the microscope, and in the 

 blood and tissues of experimental animals: the disease was brought into line, for the 

 work of science, with other forms of spirochaetosis. In the latter half of 1909, came the 

 news of Ehrlich's discovery of "salvarsan." Ehrlich gives an account of his own work 

 in Die Experimented Chemotherapie der Spirillosen (Berlin, Julius Springer, 1910), by 

 himself and S. Hata. Ehrlich had long been working at the arsenical compounds, e. g. 

 atoxyl, arsacetin, in their bearings on syphilis: and, from these compounds, he and his 

 fellow-workers advanced to the discovery of salvarsan. This arsenical compound 

 (dioxydiamidoarsenobenzol, Ci2 Hi2 N2 Oa As2) has also been called "606," and Ehrlich- 

 Hata; a later modification is called neo-salvarsan, or "914." 



No event in therapeutics since the discovery of diphtheria antitoxin has caused more 

 wonder than the rapid and powerful action of this new weapon against syphilis. Even a 

 single dose is capable of bringing to a sudden end the manifest signs of the disease. To 

 be able to see;, under the microscope, the destruction of spirochaetes by one dose of 

 salvarsan, is to realise that the use of this " therapia sterilisans magna " is the greatest 

 advance that has been made, within the memory of man, in the fight against syphilis. 



It would be, in the common phrase, " too good to be true," if the use of this drug were 

 absolutely free from risk. Salvarsan is not a drug to play with. A careful estimate of 

 this risk has been made by Lt. Col. Gibbard, Major Harrison, and Lt. Cane: see the 

 Journal of the R.A.M.C., September 1912, for their paper on " Salvarsan and Neo-salvar- 

 san in the Treatment of Syphilis." They point out the shortening, by salvarsan, of the 

 period of " inefficiency " in Army cases of the disease. They refer as follows to the 

 element of risk in the use of salvarsan: " We may say at once that in 43 subcutaneous 

 or intra-muscular and 1613 intravenous injections, we have not experienced any un- 

 toward incident; while Wechselmann states that, in the course of over 12,000 injections, 

 he has not had any death which could be attributed to salvarsan. When we consider 

 that probably more than a million injections must have been given, all over the world, 

 fatalities amounting even to a fraction per thousand of the injections could not have been 

 concealed, and would have filled a prominent place in the literature." (For the whole 

 subject of syphilis, see Proc. Roy. Soc. Med., v, 9, October 1912: Supplement. Pp. 214). 



Tuberculosis. In July 1911 the British Royal Commission on Tuberculosis, after 

 no less than ten years of enquiry, issued its Final Report, founded not only on the 

 experimental work done at Lord Blyth's farms and elsewhere, but on a vast extent of 

 clinical, pathological, and statistical evidence. The principal findings of this Final 

 Report are to the following effect: (i) In many cases, human tuberculosis is identical 

 with bovine tuberculosis. (2) Tuberculosis is transmissible from mammals to man 



