SALVARSAN IN THE TREATMENT OF SYPHILIS 259 



The assumption that a cure had actually been established is, how- 

 ever, further supported by the fact that in those cases which could 

 be examined in this direction a so-called provocative Wassermann 

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

 that in individuals in whom the spirochetes have been exterminated 

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

 demonstrated but in whom a small number of organisms still remains, 

 this may yet be done, temporarily at least, if a further injection of 

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

 stered. 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 treatment, 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, where 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 production. 

 But upon the symptoms that are the outcome of the actual destruc- 

 tion 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, in very early cases that 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 may be due both to toxic influences and to an actual destruc- 

 tion of nerve cells. For this reason the remedy may be given a trial 



