CHAPTER XIV 

 TREATMENT OF GENERAL PARALYSIS, TABES, ETC. 



While the etiological significance of the Spirocheta pallida in its 

 relation to tabes and general paralysis has been firmly established, 

 the therapy of these diseases has never been very satisfactory, 

 despite the development of our more intensive methods of mercurial 

 treatment and the intravenous and intraspinal application of 

 salvarsan. The damage once done the central nervous system is ir- 

 reparable and the problem of therapy resolves itself largely in pre- 

 venting progress of the disease rather than with the thought of re- 

 covery. Even this modest result is seldom achieved. Remissions 

 are of course known to occur spontaneously during the course of the 

 disease and this fact is more often than not apt to bias the observer 

 working with some new preparation and he ascribes therapeutic ef- 

 fects to the procedure which are not actually due to the remedy. 



GENERAL PARALYSIS 



There seems little doubt of the clinical observation that has been 

 made by numerous observers and for many years that intercurrent 

 infections (malaria, typhoid, suppurative processes, etc.) are not 

 uncommonly followed by an arrest of the disease process and even 

 apparent improvement in the general condition of the patient suffer- 

 ing from progressive paralysis (v. Halban, Marro and Ruata, etc.). 



Very early efforts to make use of this knowledge were reported. 

 Jacobi in 1854 reported on the use of artificial abscesses in the treat- 

 ment of general paralysis and Meyer in 1877 again took up the 

 method. 



Some rather illuminating statistics have been compiled by Mat- 

 tauschek and Pilcz in this connection. They found that in 4,134 cases 

 of syphilis 4.7% developed general paralysis. In a group of 157 

 of the luetic cases there was a history of an intercurrent infection such 

 as erysipelas, pneumonia, etc.; not a single case of general paralysis 

 developed among these. While by no means free from criticism, 

 they nevertheless confirm to some extent the clinical observations 

 just alluded to. 



It was on this basis that v. Jauregg began the use of tuberculin in 

 the treatment of general paralysis; tuberculin being selected as a 

 pyrogenic agent because of its availability and the certainty of the 

 febrile reaction, v. Jauregg had first tried a pyocyaneus vaccine in 



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