APPENDIX 349 



Mcintosh and Fildes state after the intramuscular and sub- 

 cutaneous administration of salvarsan (0.3 to 1.2 gm.) in 

 primary cases all showed negative Wassermann reactions on 

 an average of five weeks ; in the secondary stage many be- 

 came negative on an average of eight weeks; in the early 

 latent form the average was ten weeks ; in the tertiary stage 

 little or no effect was observed so far as negative reactions 

 were concerned. After the combination of intramuscular 

 with intravenous injections (0.8 to 1.7 gm.), however, a 

 much more pronounced beneficial effect was observed. In 

 secondary syphilis no case failed to become negative and 

 did so with great regularity in six and a half weeks. In the 

 tertiary stage of the disease the intravenous method again 

 proved its superiority over the intramuscular and was pro- 

 ductive of a high percentage of negative reactions. The 

 dictum of Ehrlich, that in the use of salvarsan there exists an 

 agent capable of curing syphilis by a single dose — a " thera- 

 pia sterilisans magna " — is true. Our experience has shown 

 that if the diagnosis of the chancre be made sufficiently early, 

 using the dark field ultra-microscope, before the Wasser- 

 mann reaction becomes positive, the disease may be cured by 

 a single dose of salvarsan. The hope inspired by that dic- 

 tum, however, has not been fully realized, in view of the fact 

 that only a small percentage of cases, untreated with mer- 

 cury, yield a permanently negative Wassermann reaction 

 even after repeated injections of salvarsan. It is the con- 

 sensus of opinion to-day that, as a general rule, the most 

 appropriate, efficient and speedy cure of syphilis is the 

 association of salvarsan, preferably intravenously, with mer- 

 cury or mixed treatment. 



