Therapy in Neurosyphilis, With Particular Reference to Intraspinal Therapy

The pressing need of more effective therapy in neurosyphilis has stimulated syphilographers and neurologists to elaborate methods expressly adapted to combat the disease.These methods may be roughly divided into: (1) intensive antisyphilitic medication, includ- ing arsphenamin given intravenously, mercury and the iodids ; (2) drainage of the spinal fluid, following a previous intravenous injection of arsphenamin; (3) the intraspinal methods of Swift and Ellis, Ogilvie and Byrnes.Each of these methods has produced good clinical results in the hands of competent observers, but each has certain inherent defects.Sachs 1 and his co-workers feel strongly that intrave- nous treatments will clear up such cases as are amenable to medication.Dercum 2 has obtained favorable results from complete drainage of the spinal fluid.Swift,3 Ogilvie, Byrnes and Fordyce report good results following intraspinal procedures.Other than an inclination to advise intraspinal medication in difficult cases, there has been little tendency in the literature on the subject to indicate the type of therapy most likely to benefit a particular case.That such individualizing, if it could be accomplished, would be of marked benefit is quite obvious.The intensive methods are the simpler, they require no specialized technic and therefore can be used more generally by the profession.They are less distressing and time-consuming to the patient.Drainage is next in point of simplicity and presents no drawback, except lumbar puncture headaches and the inconvenience of the pune-