The Third Great Plague Part 2

+Late Syphilis of the Nervous System--Locomotor Ataxia.+--The ways in which late syphilis can attack the nervous system form the real terrors of the disease to most people. Locomotor ataxia and general paralysis of the insane (or softening of the brain) are the best known to the laity, _though only two of many ways in which syphilis can attack the nervous system_. Though their relation to the disease was long suspected, the final touch of proof came only as recently as 1913, when Noguchi and Moore, of the Rockefeller Inst.i.tute, found the germs of the disease in the spinal cords of patients who had died of locomotor ataxia, and in the brains of those who had died of paresis. The way in which the damage is done can scarcely be explained in ordinary terms, but, as in all late syphilis, a certain amount of the damage once done is beyond repair.

Locomotor ataxia begins to affect the lower part of the spinal cord first, so that the earliest symptoms often come from the legs and from the bladder and r.e.c.t.u.m, whose nerves are injured. Other parts higher up may be affected, and changes resulting in total blindness and deafness not infrequently occur. Through the nervous system, various organs, especially the stomach, may be seriously affected, and excruciating attacks of pain with unmanageable attacks of vomiting (gastric crises) are apt to follow. This does not, of course, mean that all pain in the stomach with vomiting means locomotor ataxia. All sorts of obscure symptoms may develop in this disease, but the signs in the eyes and elsewhere are such that a decision as to what is the matter can usually be made without considering how the patient feels, and by evidence which is beyond his control.

+Late Syphilis of the Nervous System--General Paralysis.+--General paralysis, or paresis, is a progressive mental degeneration, with relapses and periods of improvement which reduce the patient by successive stages to a jibbering idiocy ending invariably in death. Such patients may, in the course of their decline, have delusions which lead them to acts of violence. The only place for a paretic is in an asylum, since the changes in judgment, will-power, and moral control which occur early in the disease are such that, before the patient gets unmanageable, he may have pretty effectually wrecked his business and the happiness of his family and a.s.sociates. When the condition is recognized, the family must at least be forewarned, so that they can take action when it seems necessary. Both locomotor ataxia and paresis may develop in the same person, producing a combined form known as taboparesis.

The importance of locomotor ataxia and paresis in persons who carry heavy responsibilities is very great. In railroad men, for example, the harm that can be done in the early stages of paresis is as great as or even greater than the harm that an epileptic can do. A surgeon with beginning taboparesis may commit the gravest errors of judgment before his condition is discovered. Men of high ability, on whom great responsibilities are placed, may bring down with them, in their collapse, great industrial and financial structures dependent on the integrity of their judgment. The extent of such damage to the welfare of society by syphilis is unknown, though here and there some investigation scratches the surface of it. It will remain for the future to show us more clearly the cost of syphilis in this direction.

+Syphilis and Mental Disease.+--Williams,[7] before the American Public Health a.s.sociation, has recently carefully summarized the role of syphilis in the production of insanity, and the cost of the disease to the State from the standpoint of mental disease alone. He estimates that 10 per cent of the patients who enter the Ma.s.sachusetts State hospitals for the insane are suffering from syphilitic insanity. Fifteen per cent of those at the Boston Psychopathic Hospital have syphilis. In New York State hospitals, 12.7 per cent of those admitted have syphilitic mental diseases. In Ohio, 12 per cent were admitted to hospitals for the same reason. An economic study undertaken by Williams of 100 men who died at the Boston State Hospital of syphilitic mental disease, the cases being taken at random, showed that the shortening of life in the individual cases ranged from eight to thirty-eight years, and the total life loss was 2259 years. Of ten of these men the earning capacity was definitely known, and through their premature death there was an estimated financial loss of $212,248. It cost the State of Ma.s.sachusetts $39,312 to care for the 100 men until their death.

Seventy-eight were married and left dependent wives at the time of their commission to the hospital. In addition to the 100 men who became public charges, 109 children were thrown upon society without the protection of a wage-earner. Williams estimates, on the basis of published admission figures to Ma.s.sachusetts hospitals, that there are now in active life, in that state alone, 1500 persons who will, within the next five years, be taken to state hospitals with syphilitic insanity.

[7] Williams, F. E.: "Preaching Health," Amer. Jour. Pub. Health, 1917, vi, 1273.

+Frequency of Locomotor Ataxia and General Paralysis.+--The percentage of all syphilitic patients who develop either locomotor ataxia or paresis varies in different estimates from 1 to 6 per cent of the total number who acquire syphilis. The susceptibility to any syphilitic disease of the nervous system is hastened by the use of alcohol and by overwork or dissipation, so that the prevalence of them depends on the cla.s.s of patients considered. It is evident, though, that only a relatively small proportion of the total number of syphilitics are doomed to either of these fates. Taking the population as a whole, the percentage of syphilitics who develop this form of late involvement probably does not greatly exceed 1 per cent.

+Treatment and Prevention of Late Syphilis of the Nervous System.+--Locomotor ataxia and paresis, even more than other syphilitic diseases of the nervous system, are extremely hard to affect by medicines circulating in the blood, and for that reason do not respond to treatment with the ease that syphilis does in many other parts of the body. Early locomotor ataxia can often be benefited or kept from getting any worse by the proper treatment. For paresis, in our present state of knowledge, nothing can be done once the disease pa.s.ses its earliest stages. In both these diseases only too often the physician is called upon to lock the stable door after the horse is stolen. The problem of what to do for the victims of these two conditions is the same as the problem in other serious complications of syphilis--keep the disease from ever reaching such a stage by recognizing every case early, and treating it thoroughly from the very beginning.

SUMMARY

Summing up briefly the main points to bear in mind about the course of syphilis--there is a time, at the very beginning of the disease, even after the first sore appears, when the condition is still at or near the place where it entered the body. At this time it can be permanently cured by quick recognition and thorough treatment. There are no fixed characteristics of the early stages of the disease, and it often escapes attention entirely or is regarded as a trifle. The symptoms that follow the spread of the disease over the body may be severe or mild, but they seldom endanger life, and again often escape notice, leaving the victim for some years a danger to other people from relapses about which he may know nothing whatever. Serious syphilis is the late syphilis which overtakes those whose earlier symptoms pa.s.sed unrecognized or were insufficiently treated. Late syphilis of the skin and bones, disfiguring and horrible to look at, is less dangerous than the hidden syphilis of the blood-vessels, the nerves, and the internal organs, which, under cover of a whole skin and apparent health, maims and destroys its victims. Locomotor ataxia and softening of the brain, early apoplexy, blindness and deafness, paralysis, chronic fatal kidney and liver disease, heart failure, hardening of the blood-vessels early in life, with sudden or lingering death from any of these causes, are among the ways in which syphilis destroys innocent and guilty alike. And yet, for all its destructive power, it is one of the easiest of diseases to hold in check, and if intelligently treated at almost any but the last stages, can, in the great majority of cases, be kept from endangering life.

Chapter VI

The Blood Test for Syphilis

It seems desirable at this point, while we are trying to fix in mind the great value of recognizing syphilis in a person in order to treat it and thus prevent dangerous complications, to say something about the blood test for syphilis, the second great advance in our means of recognizing doubtful or hidden forms of the disease. The first, it will be recalled, is the identification of the germ in the secretions from the early sores.

+Antibodies in the Blood in Disease.+--It is part of the new understanding we have of many diseases that we are able to recognize them by finding in the blood of the sick person substances which the body makes to neutralize or destroy the poisons made by the invading germs, even when we cannot find the germs themselves. These substances are called antibodies, and the search for antibodies in different diseases has been an enthusiastic one. If we can by any scheme teach the body to make antibodies for a germ, we can teach it to cure for itself the disease caused by that germ. So, for example, by injecting dead germs as a vaccine in typhoid fever and certain other diseases, we are able to teach the body to form protective substances which will kill any of the living germs of that particular kind which gain entrance to the body. Conversely, if the body is invaded by a particular kind of germ, and we are in doubt as to just which one it is, we can identify it by finding in the blood of the sick person the antibody which we know by certain tests will kill or injure a certain germ. This sort of medical detective work was first applied to syphilis successfully by Wa.s.sermann, Neisser, and Bruck in 1904, and for that reason the test for these antibodies in the blood in syphilis is called the Wa.s.sermann reaction.

To be sure, it is now known that in syphilis it is not a true antibody for the poisons of the Spirochaeta pallida for which we are testing, but rather a physical-chemical change in the serum of patients with syphilis, which can be produced by other things besides this one disease. But this fact has not impaired the practical value of the test, since the other conditions which give it are not likely to be confused with syphilis in this part of the world. The fact that no true antibody is formed simply makes it unlikely that we shall ever have a vaccine for syphilis.

+Difficulties of the Test.+--The Wa.s.sermann blood test for syphilis is one of the most complex tests in medicine. The theory of it is beyond the average man's comprehension. A large number of factors enter into the production of a correct result, and the attaining of that result involves a high degree of technical skill and a large experience. It is no affair for the amateur. The test should be made by a specialist of recognized standing, and this term does not include many of the commercial laboratories which spring up like mushrooms in these days of laboratory methods.

+The Recognition of Syphilis by the Blood Test.+--When the Wa.s.sermann test shows the presence of syphilis, we speak of it as "positive."

Granted that the test is properly done, a strong positive reaction means syphilis, unless it is covered by the limited list of exceptions. After the first few weeks of the disease, and through the early secondary period, the blood test is positive in practically all cases. Its reliability is, therefore, greatest at this time. Before the infection has spread beyond the first sore, however, the Wa.s.sermann test is negative, and this fact makes it of little value in recognizing early primary lesions. In about 20 to 30 per cent of syphilitic individuals the test returns to negative after the active secondary stage is pa.s.sed.

This does not necessarily mean that the person is recovering. It is even possible to have the roof fall out of the mouth from gummatous changes and the Wa.s.sermann test yet be negative. It is equally possible, though unusual, for a negative Wa.s.sermann test to be coincident with contagious sores in the mouth or on the genitals. So it is apparent that as an infallible test for syphilis it is not an unqualified success. But infallibility is a rare thing in medicine, and must be replaced in most cases by skilful interpretation of a test based on a knowledge of the sources of error. We understand pretty clearly now that the Wa.s.sermann test is only one of the signs of syphilis and that it has quite well-understood limitations. It has revealed an immense amount of hidden syphilis, and in its proper field has had a value past all counting. Experience has shown, however, that it should be checked up by a medical examination to give it its greatest value. Just as all syphilis does not show a positive blood test, so a single negative test is not sufficient to establish the absence of syphilis without a medical examination. In a syphilitic, least of all, is a single negative Wa.s.sermann test proof that his syphilis has left him. In spite of these rather important exceptions, the Wa.s.sermann test, skilfully done and well interpreted, is one of the most valuable of modern medical discoveries.

+The Blood Test in the Treatment and Cure of Syphilis.+--In addition to its value in recognizing the disease, the Wa.s.sermann test has a second field of usefulness in determining when a person is cured of syphilis, and is an excellent guide to the effect of treatment. Good treatment early in a case of syphilis usually makes the Wa.s.sermann test negative in a comparatively short time, and even a little treatment will do it in some cases. But will it stay negative if treatment is then stopped? In the high percentage of cases it will not. It will become positive again after a variable interval, showing that the disease has been suppressed but not destroyed. For that reason, if we wish to be sure of cure, we must continue treatment until the blood test has become negative and stays negative. This usually means repeated tests, over a period of several years, in connection with such a course of treatment as will be described later. During a large part of this time the blood test will be the only means of finding out how the disease is being affected by the treatment. To all outward appearance the patient will be well. He may even have been negative in repeated tests, and yet we know by experience that if treatment is stopped too soon, he will become positive again. There is no set rule for the number of negative tests necessary to indicate a cure. The whole thing is a matter of judgment on the part of an experienced physician, and to that judgment the patient should commit himself unhesitatingly. If a patient could once have displayed before him in visible form the immense amount of knowledge, experience, and labor which has gone into the devising and goes into the performing of this test, he would be more content to leave the decision of such questions to his physician than he sometimes is, and would be more alive to its reality and importance. The average man thinks it a rather shadowy and indefinite affair on which to insist that he shall keep on doctoring, especially after the test has been negative once or twice.

Just as a negative test may occur while syphilis is still actively present and doing damage in the body, so a positive Wa.s.sermann test may persist long after all outward and even inward signs of the disease have disappeared. These fixed positives are still a puzzle to physicians. But many patients with fixed positives, if well treated regardless of their blood test, do not seem to develop the late accidents of the disease. If their nervous systems, on careful examination, are found not to be affected, they are reasonably safe as far as our present knowledge goes. People with fixed positives should accept the judgment of their physicians and follow their recommendations for treatment without worrying themselves gray over complications which may never develop.

+Practical Points About the Test.+--Certain practical details about this test are of interest to every one. Blood for it is usually drawn from a small vein in the arm. The discomfort is insignificant--no more than that of a sharp pin-p.r.i.c.k. Blood is drawn in the same way for other kinds of blood tests, so that a needle-p.r.i.c.k in the arm is not necessarily for a Wa.s.sermann test. There is no cutting and no scar remains. The amount of blood drawn is small and does not weaken one in the least. The test is done on the serum or fluid part of the blood, after the corpuscles are removed. It can also be done on the clear fluid taken from around the spinal cord, and this is necessary in certain syphilitic nervous diseases. There is nothing about the test that need make anybody hesitate in taking it, and it is safe to say that, when properly done, the information that it gives is more than worth the trouble, especially to those who have at any time been exposed, even remotely, to the risk of infection. But the test must be well done, by a large hospital or through a competent physician or specialist, and the results interpreted to the patient by the physician and not by the laboratory that does the test, or in the light of the patient's own half-knowledge of the matter.

Chapter VII

The Treatment of Syphilis

GENERAL CONSIDERATIONS

+Scientific Methods of Treating Disease.+--In trying to treat diseases caused by germs, the physician finds himself confronted by several different problems. Certain of these diseases run their course and the patient gets well or dies, pretty much regardless of anything that can be done for him. In certain others, because of our knowledge of the way in which the body makes its fight against the germ, we are able either to prepare it against attack, as in the case of protective vaccination, or we are able to help it to come to its own defense after the disease has developed. This can be done either by supplying it with ant.i.toxin from an outside source, or helping it to make its own ant.i.toxin by giving it dead germs to practise on. In the third group, the smallest of the three, we are fortunate enough to know of some substance which will kill the germ in the body without killing the patient. For such diseases we are said to have a "specific" method of treatment. Syphilis is one of these diseases. It is not to be understood that there is a sharp line of division between these three groups, since in every disease we try as far as possible to use all the methods we can bring to bear. In pneumonia we have to let the body largely make its own fight, and simply help it to clear out the poisons formed by the germ, and keep the heart going until the crisis is past. In diphtheria, nowadays, we help the body out promptly by supplying it with ant.i.toxin from an outside source, before it has time to make any for itself. We do the same thing for lockjaw if we are early enough. We practise the body on dead typhoid germs by vaccination until it is able to fight the living ones and destroy them before they get a foothold. The diseases for which we have specific methods of treatment are few in number, and each has a.s.sociated with it the name of a particular drug. Quinin kills the germ of malaria, sodium salicylate cures inflammatory rheumatism, and mercury cures syphilis. To mercury in the case of syphilis must now be added salvarsan or a.r.s.en.o.benzol ("606"), the substance devised by Ehrlich in 1910, which will be considered in the next chapter.

The action of a specific is, of course, not infallible, but the failures are exceptional, so that one feels in attacking one of these diseases with its specific remedy as a man called upon to resist a savage beast would feel if he were armed with a powerful rifle instead of a stick.

The situation in syphilis, for which there is a specific, as compared with tuberculosis, for which there is no specific, is incomparably in favor of the former. If we had as powerful weapons against tuberculosis as we have against syphilis, the disease would now be a rarity instead of the disastrous plague it is. Comparing the situation in two diseases for which we have specifics, such as syphilis and malaria, malaria has lost most of its seriousness as a problem in any part of the world, while syphilis is rampant everywhere. Malaria has, of course, been extinguished not only through the efficiency of quinin, but also through preventive measures directed at mosquitos, which are the carriers of the disease from person to person. But allowing for this, if it becomes possible to apply mercury and salvarsan as thoroughly to the prevention and treatment of syphilis as quinin can be applied to malaria, syphilis will soon be a rarity over the larger part of the civilized world. To bring the specific remedies for syphilis and the patient together const.i.tutes, then, one of the greatest problems which confronts us in the control of the disease at the present day.

MERCURY

+Mercury in the Treatment of Syphilis.+--Mercury is, of course, familiar to every one, and there is nothing peculiar about the mercury used in the treatment of syphilis. The fluid metallic mercury itself may be used in the form of salves, in which the mercury is mixed with fatty substances and rubbed into the skin. Mercury can be vaporized and the vapor inhaled, and probably the efficiency of mercury when rubbed into the skin depends to no small extent on the inhalation of the vapor which is driven off by the warmth of the body. Mercury in the form of chemical salts or compounds with other substances can be given as pills or as liquid medicine. Similarly, the metal itself or some of its compounds can be injected in oil with a hypodermic needle into the muscles, and the drug absorbed in this way.

+Misconceptions Concerning Mercury.+--The use of mercury in syphilis is nearly as old, in Europe at least, as the disease itself. The drug was in common use in the fifteenth century for other conditions, and was promptly tried in the new and terrible disease as it spread over Europe, with remarkable results. But doses in the old days were anything but homeopathic, and overdoses of mercury did so much damage that for a time the drug fell into undeserved disfavor. Many of the superst.i.tions and popular notions about mercury originated at this period in its history.

It was supposed to make the bones "rot" and the teeth fall out, an idea which one patient in every ten still entertains and offers as an objection when told he must take mercury. Insufficiently treated syphilis is, of course, what makes the bones "rot," and not the mercury used in treating the disease. Mercury apparently has no effect on the bones whatever. The influence of the drug on the teeth is more direct and refers to the symptoms caused by overdoses. No physician who knows his business ever gives mercury at the present time to the point where the teeth are in any danger of falling out.

+The Action of Mercury.+--The action of mercury on syphilis is not entirely clear. The probabilities are that the drug, carried to all parts of the body by the blood, helps to build up the body's resistance and stimulates it to produce substances which kill the germs. In addition, of course, it kills the germs by its own poisonous qualities.

Its action is somewhat slow, and it is even possible for syphilitic sores containing the germs to appear, especially in the mouth and throat and about the genitals, while the person is taking mercury. Just as quinin must be used in malaria for some time after all signs of chill and fever have disappeared, to kill off all germs lurking in out-of-the-way corners of the body, or especially resistant to the drug, so it is necessary to continue the use of mercury long after it has disposed of all the obvious signs of the disease, like the eruption, headaches, and other symptoms, in order to prevent a relapse. No matter in what form it is used, the action of mercury on syphilis is one of the marvels of medicine. It can clear up the most terrific eruption with scarcely a scar, and transform a bed-ridden patient into a seemingly healthy man or woman, able to work, in the course of a few weeks or months. Symptoms often vanish before it like snow in a thaw. This naturally makes a decided impression, and often an unfavorable one, on the patient. It is only too easy to think that a disease which vanishes under the magic influence of a few pills is a trifle, and that outwardly cured means the same thing as inwardly cured. Mercury therefore carries its disadvantages with its advantages, and by its marvelous but transient effect only too often gives the patient a false idea of his progress toward cure.

+Methods of Administering Mercury.+--As has been said, mercury is given princ.i.p.ally in three ways at the present time. It can be given by the mouth, in the form of pills and liquids, and in this form is not infrequently incorporated into patent medicine blood purifiers. Mercury in pills and liquid medicine has the advantage for the patient of being an easy and inconspicuous way of taking the drug, and for that reason patients usually take it willingly or even insist on it if they know no better. Even small doses taken in this way will hide the evidences of syphilis so completely that only a blood test will show that it exists.

If it were true that large doses taken by mouth could always be relied on to cure the disease, there would be little need for other ways of giving it. But there is a considerable proportion of persons with syphilis treated with pills who do not get rid of the disease even though the dose is as large as the stomach can stand. Such patients often have all the serious late complications which befall untreated patients. It seems almost impossible to give enough mercury by mouth to effect a cure. Thus pill treatment has come to be a second-best method, and suitable only in those instances in which we simply expect to control the outward signs rather than effect a cure.

The mercury rub or inunction, under ideal conditions, all things considered, is the best method of administering mercury to a patient with the hope of securing a permanent result. In this form of treatment the mercury made up with a salve is rubbed into the skin. The effectiveness of the mercurial rub is reduced considerably by its obvious disadvantages. It requires time to do the rubbing, and the ointment used seems uncleanly because of its color and because it is necessary to leave what is not rubbed in on the skin so that it discolors the underwear. The mercurial rub is at its best when it is given by some one else, since few patients have the needed combination of conscientiousness, energy, and determination to carry through a long course. The advantages of the method properly carried out cannot be overestimated. It is entirely possible in a given case of syphilis to accomplish by a sufficient number of inunctions everything that mercury can accomplish, and with the least possible damage to the body.

Treatment by mouth cannot compare with inunctions and cannot be made to replace them, when the only objection to the rubs is the patient's unwillingness to be bothered by them. The patient who is determined, therefore, to do the best thing by himself will take rubs conscientiously as long as his physician wishes him to do so, even though it means, as it usually does, not a dozen or two, but several hundreds of them, extending over a period of two or three years, and given at the rate of four to six rubs a week.

The giving of mercury by injections is a very powerful method of using the drug for the cure of syphilis. It reduces the inconvenience of effective treatment to a minimum and has all the other advantages of secrecy and convenience. It keeps the patient, moreover, in close touch with his physician and under careful observation. Injections by some methods are given daily, by others once or twice a week. The main disadvantage is the discomfort which follows each injection for a few hours. For any one who has one of the serious complications of syphilis, injections may be a life and death necessity. Mercurial injections are a difficult form of treatment and should be given only by experts and physicians who are thoroughly familiar with their use.

Like every important drug in medicine, mercury is a poison if it is abused. Its earliest effect is on the mouth and teeth, and for that reason the physician, in treating syphilis by vigorous methods, has his patients give special attention to the care of their mouths and teeth and of their digestions as well. Mercury also affects the kidneys and the blood, if not properly given, and for that reason the person who is taking it must be under the care and observation of a physician from time to time. Only the ignorant undertake to treat themselves for syphilis, though how many of these there are can be inferred from the amount of patent medicine and quack treatment there is in these fields.

Properly given, mercury has no harmful effects, and there is no ground whatever for the notion some people have, that mercury will do them more harm than a syphilitic infection. Improperly used, either as too much or too little, it is capable of doing great harm, not only directly, but indirectly, by making it impossible later for the patient to take enough to cure the disease. The extent to which some overconfident persons fail in their efforts to treat and cure themselves explains the necessity for such a warning.

+Effect of Mercurial Treatment on the Blood Test.+--The effect of mercury on the Wa.s.sermann blood test for syphilis should also be generally understood. In many cases it is possible, especially early in the disease, by a few rubs of mercurial ointment, or a few injections of mercury, or even in some cases by the use of pills or liquid medicine, to make a positive blood test for syphilis negative. But this negative test is only temporary. Within a short time, usually after treatment is stopped, the test becomes positive again, showing that the mercury has not yet cured, but simply checked, the disease, and that it may at any time break out again or do internal damage. It must be understood that a negative blood test just after a patient has been taking mercury _has no meaning_, so far as guaranteeing a cure is concerned. It is only the blood test that is repeatedly negative after the effect of mercury wears off, which shows the disease is cured. Yet many a syphilitic may and does think himself cured, and may marry in good faith, or be allowed a health certificate, only to become positive again. He may then develop new sores without his knowledge even, and perhaps infect his wife, or may himself in later years develop some of the serious consequences of the disease.

Whenever one talks to a person who knows something about the advances in knowledge in the past few years about the treatment of syphilis, and goes into detail about mercury, the odds are two to one that he will be interrupted by the question, "But what about '606'?" Before talking about salvarsan, or "606," it is well to say here that this new drug, wonderful though it is, has in no sense done away with the necessity for the use of mercury in the treatment of syphilis. Mercury has as high a reputation and is as indispensable in the cure of syphilis today as it was four centuries ago. It has as yet no subst.i.tutes. We appreciate every day, more and more, how thoroughly it can be depended on to do the work we ask of it.[8]

[8] A drug known as the iodid of potash (or soda) is widely used in the treatment of syphilis, and especially of the late forms of the disease, such as gummas and gummatous sores. It has a peculiar effect on gummatous tissue, causing it to melt away, so to speak, and greatly hastening the healing process. So remarkable is this effect that it gives the impression that iodids are really curing the syphilis itself. It has been shown, however, that iodids have no effect on the germs of syphilis, and therefore on the cause of the disease, although they can promote the healing of the sores in the late stages. For this reason iodids must always be used in connection with mercury or salvarsan if the disease itself is to be influenced. It is occasionally difficult to get patients to understand this after they have once taken "drops," as the medicine is often called. Otherwise the use of iodids in syphilis is of medical rather than general interest.

Chapter VIII

The Treatment of Syphilis (Continued)

SALVARSAN

+The Discovery of Salvarsan ("606").+--Salvarsan, or "606," is a chemical compound used in the modern treatment of syphilis. It was announced to the world by Paul Ehrlich, its brilliant discoverer, in December, 1910. Ehrlich and his j.a.panese co-worker, Hata, had some years before been impressed with the remarkable effect certain dyes had on the parasites infesting certain animals and which resemble the germs that cause the African sleeping sickness in man. When one of these dyes was dissolved and injected into the blood of the sick animal, the dye promptly picked out and killed all the parasites, but did not kill the animal. Dyes are very complex chemical substances and certain of them seem to have an affinity for germs. It occurred to Ehrlich that if a substance could be devised which was poisonous for the germ and not for the patient it might be possible to prepare a specific for a given disease, acting as quinin does in malaria. By combining a poison with a dye it might be made to pick out the germs and leave the body unharmed.