Intraspinal Treatment in Neurosyphilis

Abstract

More than six years have elapsed since Dr. Oliver S. Ormsby and the writer instituted intraspinal therapy in our cases of neurosyphilis. Sufficient time, therefore, has passed to justify a survey of the clinical and serologic results obtained by this form of treatment.LITERATURE ON THE SUBJECT Many criticisms, notably those of Sachs 1 and of Dercum,2 have been directed against intraspinal therapy on the ground that no clinical results can be obtained by the introduction of arsphenamized serum into the spinal canal, because it can be demonstrated experimentally that substances injected subdurally cannot penetrate the cortex of the brain, and that changes in the spinal tissue are beyond the reach of remedies in solution in the spinal fluid. Sachs firmly believes that sufficiently intensive intravenous medication will accomplish all that intraspinal therapy will accomplish. That arsenic appears in appreciable quantities in the fluid after intravenous injections of arsphenamin has been demonstrated by a number of workers, but the early work of Weed 3 and of Frazier 4 seemed to prove that dyes injected intrave¬ nously penetrated only the pial meshes, whereas dyes injected intraspinally penetrated not only the pial surfaces of the brain, but also the cortex.Recently, attempts by Tzanck, Gilpin and Early, and by Barbat, have been made to increase the permeability of the choroid plexus for arsphenamin by spinal drainage after intravenous injection. Barbat5 found that whereas only 31 per cent, of the cases punctured in twenty minutes after intravenous injection gave positive tests for arsenic,