Neurorecurrences Following Treatment With Arsphenamin

Abstract

The factors which predispose a patient to neurosyphilis have been much discussed, but they are still obscure. In general three factors may be said to determine involvement of the central nervous system : variations in reaction of infected persons to Spirochaeta pallida, the strain of the infecting organism, and the amount and character of antisyphilitic treatment. Antisyphilitic treatment, properly employed, may prevent or suppress the development of clinical neurosyphilis; on the other hand, such treatment may, under certain conditions, favor its development or hasten its clinical onset. The occurrence of precocious clinical neurosyphilis following one or several doses of arsphenamin soon sobered early enthusiasm in the drug. It is unnecessary to dwell on the controversy concerning the origin of these so-called neurorecurrences or neurorecidives; they are now considered syphilitic in nature. From the opening of the Syphilis Clinic of the Johns Hopkins Hospital in 1914 to Sept. 1, 1921, 7,065 patients with syphilis have been treated. Of these 1,400, or 20 per cent., have had cases of primary or early secondary syphilis. Among this group neurorecurrences have developed in twenty-three patients, an incidence of 1.64 per cent. It is obvious that that figure is only approximate and actually too low, as many patients with early syphilis who attend the clinic until rendered asymptomatic by a few doses of arsphenamin and are accordingly ideal subjects for the development of neurorecurrences, subsequently seek treatment elsewhere. Sixteen additional neurorecurrences have been

REVIEW: Neurosyphilis: A Historical Perspective and Review

“…Merritt et al identified only 80 cases from three general hospitals over a 15‐year period starting in 1920, and only 37 cases (1.4%) among 2263 patients seen at Boston City Hospital [29, p. 28]. The majority of cases of acute syphilitic meningitis reportedly occurred after the inadequate treatment of early syphilis [30,31]. Indeed, Moore suggested that its incidence increased 10‐fold in that setting [25, p. 419].…”