SALVARSAN IN THE TREATMENT OF SYPHILIS 287 



destruction of important cell complexes, such as the blindness and 

 ataxia of tabes, the remedy will naturally be without effect. It is 

 to be noted, however, that in very early cases one may occasionally 

 see remarkable improvement even in some of those very symptoms 

 which we are accustomed to refer to the actual destruction of nerve 

 cells, so that the inference suggests itself that some of the symptoms, 

 of tabes, for example, may be due both to toxic influences and to an 

 actual destruction of nerve cells. For this reason the remedy may 

 be given- a trial in tabes and paresis at the first sheet lightning, as 

 Ehrlich puts it, while later on it is, of course, useless, and in advanced 

 paresis especially, its employment is even attended by a certain 

 amount of danger. 



As the destruction of spirochetes leads to the production of anti- 

 bodies of a protective character, as is evidenced by the beneficial 

 effect which the milk of salvarsan-treated syphilitic mothers has upon 

 the syphilitic lesions of the child, it has been suggested to extract 

 blood from treated syphilitic patients and to inject the serum into 

 the subarachnoid space of such cases of cerebrospinal syphilis 

 (paresis) in which salvarsan is of no benefit, when given by itself. 

 But as yet no data are available to warrant any conclusions regard- 

 ing such a mode of procedure. It would seem logical, but it may 

 be questioned whether the injected antibodies would reach the 

 spirochetes in sufficient quantity to do much good. 



However this may be, if we eliminate from our analysis all those 

 cases in which destructive lesions have occurred, and sum up the 

 findings in the remainder, there is overwhelming evidence to show 

 that in salvarsan, either by itself or in combination with mercury, 

 we have a treatment by which we cannot only produce a favorable 

 influence upon the clinical symptoms, but actually effect a cure, 

 in the vast majority of cases. It seems very doubtful in fact whether 

 any cases exist, in which the infection cannot be completely eradi- 

 cated either by the salvarsan alone, or in combination or alternation 

 with mercury, if the results of the treatment are controlled at fre- 

 quent intervals by the Wassermann reaction, and if the treatment 

 itself is carried out by experts. A suitable combination -of the 

 sy philologist's clinical knowledge and the peculiar training of the 

 immunologist will unquestionably yield the best results; either 

 alone is not in a position to give the patient the very best that can 

 be given. 



