(4). All positive cerebrospinal fluid reactions at the end of a year are indicative that further treatment is necessary.(5) The number of serological relapses was low: 2 in the malaria group and 3 in the malaria-plus-tryparsamide series.(6) In no case tested after 2 consecutive negative results did the cerebrospinal fluid reactions revert to positive.(7) In latent and asymptomatic neurosyphilis it is not necessary to supplement malaria therapy with chemotherapy. The results of malaria therapy in the treatment of neurosyphilis are assessable from two aspects, clinical and serological. From the point of view of the patient, of his relatives and of the community, the former is obviously the more useful and for a long time it was, and sometimes it still is, the only thing considered. This outlook was inevitable until some sort of working hypothesis could be produced to explain the action of malaria.It is now more or less generally accepted that malaria is a spirochaeticidal agent and that its success in neurosyphilis is due to its action in bringing about the death of the spirochaetes. In order to assess the success or failure of the treatment we need some indicator of the presence of the living organism. This has been found in the cerebrospinal fluid. A positive reaction of the cerebrospinal fluid indicates the presence of living spirochaetes, a negative one of dead organisms. We have here a simple and straightforward means of telling how successful the treatment has been.
In support of the theory of a toxic genesis of mental diseases arising from chronic infection, some authors have attributed a special rôle to the B. coli. As long ago as 1904 Johnsohn and Goodall (1) examined the agglutination of a series of psychotics to the B. coli. They found this reaction completely or weakly positive in 50% of their cases of insanity (mostly with a serum dilution of 1: 100), while only 15.5% of their control cases showed a positive reaction. These results were not confirmed by Puca (2). Later on Goodall, together with Barton White (3), also examined the stool flora of psychotics, and found no qualitative difference as to the coliform group between psychotics and normal persons. On the other hand, Stewart (4), in more recent experiments, claims to have found such differences; thus he emphasizes the much higher frequency of the B. para-coli and B. coli mutabile in mental patients, especially in recent cases, and the parallelism between their presence and the intensity of the symptoms. Further, he found a difference in the phenol formation in broth cultures obtained from stools-of psychotics and normal persons, the former producing on the average 0.02 to 0.03%, and the latter only 0.008 to 0.03% of phenol. This stronger production of phenol is attributed by Stewart to the high frequency of B. Morgan and other phenol-producing bacteria in psychotics. He discusses the possibility that aromatic bodies produced by these bacteria in the acid milieu of the large intestine may represent the toxic agent in mental diseases.
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