286 CHEMOTHERAPY 



the patient must actually have been cured, since reinfection in the 

 active syphilitic is not possible. To this it might be objected that 

 the new chancre was in reality not a new infection but a relapse, 

 analogous to the neurorelpases referred to above. But as Ehrlich 

 remarks, the neurorelapses occur after a period of from two to five 

 months, so that if no symptoms develop within that period of time, 

 one would hardly be justified in looking upon the cases referred to 

 above as being latent. 



The assumption that a cure had actually been established is, 

 however, further supported by the fact that in those cases which 

 could be examined in this direction a so-called provocative Wasser- 

 mann reaction could not be elicited. This reaction is based upon the 

 idea that in individuals in whom the spirochetes have been exter- 

 minated to such a degree that a positive Wassermann can no longer 

 be demonstrated but in whom a small number of organisms still 

 remain, this may yet be done, temporarily at least, if a further injec- 

 tion of the salvarsan is given, or if a few large doses of mercury are 

 administered. As a matter of fact, it can be shown that in truly 

 latent cases a positive Wassermann may indeed be obtained in this 

 manner in the course of two weeks from the time of the test treat- 

 ment, and Ehrlich very properly advises that such an examination 

 should be made before a patient is finally discharged from treatment. 



Further evidence of the remarkable efficacy of the salvarsan 

 treatment is the rapidity with which the spirochetes disappear from 

 primary sores and from secondary ulcerations. This usually takes 

 place within twenty-four hours, but sometimes even more rapidly. 

 Schreiber thus mentions a case that had been treated with neo- 

 salvarsan, in which the organisms could no longer be demonstrated 

 four hours after the injection. He nevertheless advises the excision 

 of the primary sore whenever this is possible. 



While the best results may thus be expected during the primary 

 stage of the disease, especially if several doses of salvarsan, possibly 

 followed by mercury, have been administered, no effect whatever is 

 to be hoped for in cases that are no longer suffering from their syphilis 

 proper, but from the consequent lesions. Symptomatic improve- 

 ment, to be sure, may at times be seen even then, and is no doubt 

 due to the destruction of the few foci of spirochetes that may still 

 be remaining, and the elimination of such sources of toxin produc- 

 tion. But upon the symptoms that are the outcome of the actual 



