SALVARSAN AND ITS USE IN TREATMENT OF SYPHILIS 273 



occur during that period of the disease when there is a maximal 

 distribution of spirochetes, viz., during the early secondary stage, 

 notably in connection with the first exanthem, while during the later 

 stages when actual nerve lesions exist they are not observed. He 

 regards their occurrence as evidence of a nearly complete sterili- 

 zation of the body, and very aptly compares the neurorelapse to 

 the extensive development of individual bacterial colonies on agar 

 plates, when but few organisms are present, as contrasted with their 

 tiny size when the number is large. He accordingly advises that 

 such cases be reinjected with the salvarsan, and there are already a 

 number of reports to show that such treatment is indeed frequently 

 followed by a most favorable result, while it is well known that a 

 nerve that has actually been damaged by arsenic itself (atoxyl 

 for example) is hopelessly doomed if a second injection is given. 



Results. While there is evidence to show that the therapia magna 

 sterilisans, i. e., the complete destruction of all the parasites during 

 a single course of treatment, is no mere dream but an actual possi- 

 bility, this point is not reached so readily in syphilis of the human 

 being, at least, as in the spirillosis of chickens, in relapsing fever, 

 and in frambesia, where a single injection is usually sufficient. That 

 a cure can be effected, however, in a relatively short time is beyond 

 all question. 



Here as elsewhere in the treatment of disease the best results will 

 be obtained if this is instituted early. Gennerich thus reports, that 

 of 58 cases of primary disease that had been treated with calomel, 

 followed by salvarsan, not a single one developed secondaries, nor 

 did the Wassermann reaction become positive again, and that of 

 these, 20 had already been followed for from nine to sixteen months 

 at the time of writing. Tanzer, who used the salvarsan by itself, 

 similarly reports that of 21 cases which could be followed for from 

 three to thirteen months, none had a relapse, while the Wassermann 

 reaction remained negative. Arning states the same of 67 cases 

 which had been treated with salvarsan and mercury, etc. The ques- 

 tion, of course, might rightfully be asked, whether these people could 

 actually be regarded as cured, and whether the disease had not merely 

 become latent. Opposed to such a conclusion is the fact that some 

 cases of syphilis which had been treated with salvarsan, and in whom 

 no further symptoms developed, later came back with a new infection, 

 i. e., with a new chancre, which would prove that the patient must 

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