THE INTRASPINAL INJECTION OF SALVARSANIZED SERUM IN PARESIS
Journal of the American Medical Association
This is a preliminary report of the treatment of general paralysis of the insane with salvarsanized serum. The method used is that described by Swift and Ellis1 and first used by them in cases of tabes. It is an attempt to influence the disease by introducing serum from a salvarsanized patient into the cerebrospinal fluid. The ordinary dose of salvarsan is injected intravenously, and one hour later a quantity of blood withdrawn (about 40 c.c.) sufficient to produce 12 c.c. of serum. The serum
... serum. The serum is heated for half an hour at 56 C. (132.8 F.) and diluted to 30 c.c. with normal salt solution. This mixture is then injected by gravity into the spinal canal after the withdrawal of an equal amount of fluid. The patients are then kept in bed for at least twenty-four hours. It is not proposed to discuss the rationale of the method, but only to give a brief outline. The work of Camp2 shows that salvarsan injected intravenously does not result in the presence of arsenic in the cerebrospinal fluid. The cborioid plexus in the ventricles has a selec¬ tive activity, not allowing a filtration into the ventricles of all substances in the blood-serum. Hence it is neces¬ sary to use local therapy in reaching the spirochetes in the cortex. Salvarsan injected into the spinal canal causes too much irritation, but salvarsanized serum is well tolerated. It has been shown (Swift and Ellis) that the salvarsanized serum is destructive to spiro¬ chetes. Evidence of this has been obtained by cultural methods and from clinical data in the treatment of a syphilitic infant with serum from a salvarsanized patient. The maximum effect of the serum is reached one hour after the salvarsan injection, and is increased by heating at 56 C. The cases dealt with in this paper are the first of a series being treated, and enough time has now elapsed to warrant a preliminary report. An attempt has been made to select early cases, but unfortunately they are usually of considerable duration before commitment to a state hospital. The earliest case of the series was of five months' and the most advanced of three years' duration. They were all in the second stage of the dis¬ ease, none having reached the paralytic stage. It is worthy of note that none of these cases had a remission before treatment. The injections were given at intervals of two weeks until each patient had received three treatments. In Case 2 four injections were given. A cerebrospinal fluid examination was made and Wassermann reactions deter¬ mined before the beginning of treatment, and at the time of injection blood and fluid were taken for sub¬ sequent examination. For example, at the time of the second injection the Wassermann report would be on the serum collected one hour after the second dose of salvarsan, and the Wassermann report on the fluid would be two weeks after the first intraspinal injection of serum and about five hours after the second dose of salvarsan.