STUDY OF FIFTY CASES OF SYPHILIS TREATED 
WITH SALVARSAN, WITH SPECIAL REFERENCE 
TO THE CLINICAL RESULT AND THE 
WASSERMANN REACTION 
By ABR. L. WOLBARST, M. D., 
New York 
/ 
Reprinted from the 
New York Medical Journal 
Incorporating- the Philadelphia Medical Journal and the Medical News 
September 16 and Jj, /p/7. Copyright, 1911, by 
A. R. Elliott Publishing Company. Reprinted from the New York■ Medical Journal for September 16 and 23. iijii 
A STUDY OF FIFTY CASES OF SYPHILIS TREATED WITH SALVARSAN, 
WITH SPECIAL REFERENCE TO THE CLINICAL RESULT 
AND THE WASSERMANN REACTION 
By A hr. L. Wolbarst, M. D., 
New York. 
Through the courtesy of Geheimrat Professor 
Paul Khrlich, the first injection of salvarsan was 
given by the writer, October 10. 1910. Since then 
the author has treated about 150 syphilitic patients 
with this remedy and carefully studied the results. A 
few patients have disappeared, some have taken mer- 
cury or iodides since salvarsan treatment, and some 
have been treated within a period of time too brief to 
be of much value in a paper of this kind. Such cases 
have therefore not been included in the present re- 
port. The cases herein reported have all been un- 
der observation, either by the writer or by the at- 
tending physician, for periods varying from four 
to ten months. This time is considered sufficient 
to warrant our drawing a fair conclusion as to the 
results obtained. The data herewith submitted 
were summarized up to August 15, 1911, nearly 
ten month" since the first injection was given. 
With hut a few exceptions, all of these patients 
receited hut one injection of salvarsan. The intra- 
muscular method of Alt (alkaline solution) was 
used in all except five cases, in which the intra- 
venous method was employed. Careful attention 
was given to every detail, particularly, however, in 
reference to the clinical results and the effect on 
the Wassermann reaction. Wherever it was pos- 
sible the blood was examined before the injection, 
and as often as practicable after. It will be ob- 
served that in quite a number of cases, though the 
patients were under observation clinically, the re- 
action was not determined because the patients re- 
fused to give their consent to the test. 
In every case, without exception, a careful ex- 
amination was made of the heart and kidneys, and 
in most cases the eyes were also carefully exam- 
ined. Accurate reports were kept of the patients 
while in the hospital. The urine was examined 
every four hours, with special reference to the oc- 
currence and elimination of arsenic and the pres- 
ence of albumin. It may be said here that arsenic 
was found in nearly every case within from eight to 
fourteen hours, and that elimination ceased at the 
end of from eight to ten days. In a few cases a slight 
tendency to urinary suppression was noted, which 
quickly gave way to the administration of diuretics. 
In not a single instance did albumin make its ap- 
pearance in the urine after the injection; in fact, 
in most of the cases, the preexisting albuminuria 
disappeared soon after the treatment. All patients 
were kept in bed at least four or five days, and 
many of them remained in the hospital about ten 
days. Treatment was not administered in any case 
that did not show a distinct, palpable lesion trace- 
able to syphilis. 
1. By effects: There were no alarming by effects 
or secondary phenomena of any importance in this 
series of cases, except in one case (Case xxvii). 
This patient exhibited an unusually severe reaction 
to the remedy, characterized bv the development of 
a high temperature (105.40 F.), an extensive scar- 
latinal eruption, and marked urinary suppression. 
All of these symptoms responded readily to the ad- 
ministration of diuretics. Chills, vomiting, diar- 
rhoea, collapse, and similar phenomena that have 
been described by other writers were conspicuous 
by their absence. In not a single instance was a 
normal eye affected by the drug, and in only one 
case (xlii), the existing optic atrophy was ap- 
parently stimulated in its progress and total blind- 
ness ensued. It is not fair to ascribe this outcome 
to the salvarsan alone, in view of the rapidity of 
the atrophic process before the injection. Tn one 
case (xlvi), peroneal paralysis and sciatic neu- 
ritis, with degeneration, followed the second injec- 
tion. In not a single case did necrosis or abscess 
develop; the average reaction temperature did not 
exceed 101.50 F.; the Jarisch-Herxheimer appeared 
in about five per cent, of the cases. Pain was a 
frequent sequel to the injection, but in no case was 
it severe enough to cause alarm. In one case 
(xxiv), it persisted several months, in the form of 
a stiffness in the gluteal region, which made it dif- 
ficult for the patient to tie the strings of his shoes. 
In most cases the pain disappeared within ten days 
to two weeks, and some of the patients exhibited 
110 pain whatever after the second or third day. 
2. Doses. With a view of determining what ef- 
fect, if any, the dose has upon the clinical result 
these data are presented: 
t6 patients received 0.6 gramme. 
29 patients received 0.5 gramme. 
4 patients received 0.45 gramme. 
1 child received 0.25 gramme. 
Of the 27 patients in whom a clinical “cure' was ob- 
served, 
10 patients received 0.6 gramme, 
17 patients received 0.5 gramme. 
an average dose of 0.54 gramme 
Of the 10 patients who improved, without clinical re- 
currence. 
1 patient received 0.6 gramme. 
6 patients received 0.5 gramme, 
2 patients received 0.45 gramme. 
t patient (child) received 0.25 gramme. 
an average (excluding the child’s) of 0.5 
gramme. 
Of the 10 patients who improved, with clinical recur- 
rence later. 
3 patients received 0.6 gramme, 
5 patients received 0.5 gramme. 
2 patients received 0.45 gramme. 
an average cf 0 5 gramme. 4 
IVotbarst: Salvarsan. 
Of the 3 patients who showed no benefit from the treat- 
ment, 
2 patients received 0.6 gramme, 
i patient received 0.5 gramme, 
an average dose of 0.56 gramme. 
It is thus to be noted that there was no apprecia- 
ble difference in clinical result between the patients 
who received the standard dose, 0.6 gramme, and 
those who received less. The result was about the 
same in all cases, irrespective of the slight difference 
in dose. 
3. The period of observation: 
Cases under observation 10 months, 1 case 
Cases under observation 9 months, 6 cases 
Cases under observation 8 months, 8 cases 
Cases under observation 7 months, 8 cases 
Cases under observation 6 months, 9 cases 
Cases under observation 5 months, 10 cases 
Cases under observation 4 months, 7 cases 
Cases under observation 3 months, r case 
An average period of observation of 6.4 months. 
In addition to these fifty cases, we may consider 
three cases which presented somewhat unusual fea- 
tures, but which were not observed for any length 
of time. These will be mentioned in detail at the 
end of this paper. 
4. The stage of the disease: These cases have 
been divided for classification purposes into five 
stages or classes, viz.: primary, secondary, tertiary, 
inherited, and parasyphilitic. Thus : 
Primary syphilis 6 cases 
Secondary syphilis, 14 cases 
Tertiary syphilis 14 cases 
Parasyphilis, 14 cases 
Inherited syphilis, 2 cases 
Total, 50 cases 
The primary cases were under observation as follows: 
9 months, 2 cases 
8 months '1 case 
7 months, 1 case 
6 months, 1 case 
5 months , .. . 1 case 
An average of 7.4 months. 
The secondary cases were under observation as follows: 
10 months, 1 case 
9 months, . .. * 1 case 
8 months 3 cases 
7 months 2 cases 
6 months 1 case 
5 months, 4 cases 
4 months, 2 cases 
An average of 7 months. 
The tertiary cases were under observation as follows: 
9 months 1 case 
8 months, 1 case 
7 months 3 cases 
6 months 2 cases 
5 months 2 cases 
4 months 4 cases 
3 months r case 
An average of 7.6 months. 
The parasyphilitic cases were under observation as fol- 
lows : 
9 months 2 cases 
8 months 2 cases 
7 months 2 cases 
6 months 4 cases 
5 months 3 cases 
4 months A case 
An average of 6.5 months. 
The inherited cases were under observation as follows: 
8 months T case 
6 months. . ... ; 1 case 
An average of 7 months. 
The parasyphilitic cases were all cases involving 
the brain and spinal cord, without the presence of 
distinctly typical syphilitic lesions. The hereditary 
cases were both in children, in whom there was a 
distinct history of syphilis in one or both parents, 
and in one instance the syphilitic ancestry could be 
traced back three generations. 
5. The clinical results obtained: 
Patients who have been apparently “cured” clinically, 
27 (54 per cent.). 
Patients who have improved materially, without recur- 
rence, 10 (20 per cent.). 
Patients who have improved, but clinical recurrence de- 
veloped, 10 (20 per cent.). 
Patients who have not been influenced by the treatment, 
3 (6 per cent.). 
From these data it will be seen that seventy-four 
per cent, of the patients treated were either “cured" 
clinically or greatly improved, without a recurrence 
lasting over a period averaging about seven months. 
By clinical “cure,” we mean that condition in which 
the clinical manifestations of the disease have dis- 
appeared and the patients feel perfectly well. This 
clinical “cure” does not take into account the Was- 
sermann reaction, inasmuch as I believe that it is 
possible to be “cured” of syphilis, in the clinical 
sense, and still present a positive seroreaction. It 
is also recognized in this classification that an ab- 
solute “cure” for syphilis is still something to be 
wished for; nevertheless, it is safe to consider such 
patients “cured” clinically, for present purposes, 
when they have gone for long periods without show- 
ing any recurrence of their former or new lesions. 
That these patients have been under observation a 
sufficient length of time to justify our conclusion 
may be seen from these data: 
Of the 27 cases considered “cured” clinically, 1 case has 
been under observation to months, 3 cases have been un- 
der observation 9 months, 6 cases have been under obser- 
vation 8 months, 5 cases have been under observation 7 
months, 4 cases have been under observation 6 months, 5 
cases have been under observation 5 months, 3 cases have 
been under observation 4 months. An average of 7 
months. 
Of the 10 cases “improved” without recurrence, 2 cases 
have been under observation 8 months, 2 cases have been 
under observation 7 months, 1 case has been under obser- 
vation 6 months, 1 case has been under observation 5 
months, 3 cases have been under observation 4 months, 1 
case- has been under observation 3 months. An average 
of 5.6 months. 
Of the 10 cases “improved” and followed by recurrence, 
3 cases have been under observation 9 months, 2 cases 
have been under observation 6 months, 4 cases have been 
under observation 5 months, 1 case has been under obser- 
vation 4 months. An average of 6.3 months. 
6. The stage of the disease and the clinical result: 
PrI- 
Sec- 
Ter- 
Para- 
svphi-Heredi- 
Result. 
mary. 
ondary. tiary. 
iitic. tary. Total. 
“Cured” 
5 
II 
6 
5 27 
Improved 
6 
3 I IO 
Improved with 
recurrence.I 
3 
2 
4 io 
No change . .. 
2 I 3 
Tntals . . . 
6 
14 
14 
14 2 50 
This table indicates that of six primary cases five 
patients were “cured” and one suffered a recurrence 
(Case xxxviii) eight months after the injection; of II olburst: Salvarsan. 
5 
the fourteen secondary cases eleven patients may be 
considered “cured” and three suffered recurrence; 
among the tertiary cases twelve patients were either 
“cured” or improved, without recurrence, and but 
two suffered recurrence; and among the fourteen 
parasyphilitic cases eight patients were either 
“cured” or improved without recurrence, four suf- 
fered recurrence, and in two no change was noted. 
I believe this to be a remarkable evidence of the 
potency of the remedy, in view of the comparatively 
small doses (but one injection) and the long period 
under which these cases have been observed. 
7. Period of time after injection when recurrence 
took place: 
In 1 case recurrence occurred 8 months after injection. 
Ir. I case recurrence occurred 7 months after injection. 
In 1 case recurrence occurred 4 months after injection. 
In 3 cases recurrence occurred 3 months after injection. 
In 1 case recurrence occurred 2 months after injection. 
In 3 cases recurrence occurred 1 month after injection. 
An average period of 3.3 months. 
Here again we note that one injection has been 
capable of preventing the development of syphilitic 
lesions for periods varying from three to ten 
months. The recurrent cases will be mentioned in 
detail later. It is a fair inference that all or the 
greater part of these recurrences might have been 
prevented if a second injection had been given a 
month after the first, thereby obtaining a sterilisatio 
tnogno instead of a sterilisatio fractionata. 
8. As to the Wassermann reaction: 
In 36 cases the reaction was positive before treatment: 
Of these. 12 remained positive, or became so after becom- 
ing negative (33 per cent.) ; 11 became negative and re- 
mained so, for the entire period of observation (30 per 
cent.); 12 were not examined for the reaction; 1 became 
negative after the second injection. 
In 2 cases the reaction was negative before treatment: 
Of these, 1 remained negative after the injection, and 1 
become positive after the injection. 
In 12 cases the reaction was not determined before the 
injection: Of these, 6 were negative after the injection. 2 
were positive, 4 were not examined for the reaction. 
In other words, in thirty-six positive cases the 
positive reaction remained unaffected in thirty-three 
per cent., and changed to negative Hn thirty per 
cent. These reactions were observed for various 
periods, as follows: 
1 case remained negative 9 months after the injection. 
1 case remained negative 8 months after the injection. 
1 case remained negative 6 months after the injection. 
3 cases remained negative 5 months after the injection. 
2 cases remained negative 4 months after the injection. 
3 cases remained negative 1 month after the injection. 
An average of 4.5 months. 
Of the 12 cases that remained positive after the treat- 
ment, 2 cases remained positive 8 months after the injec- 
tion, 1 case remained positive 7 months after the injection. 
cases remained positive 5 months after the injection, 2 
cases remained positive 4 months after the injection, 1 
case remained positive 3 months after the injection, 3 cases 
remained positive 2 months after the injection, 1 case re- 
mained positive I month after the injection. An average 
of 4 3 months. 
It is thus seen that in twenty-three cases with a 
positive reaction, eleven cases became negative and 
remained so for periods averaging 4.5 months, while 
twelve cases cither remained positive or became so 
after having become negative after periods aver- 
aging 4.3 months. This again, I believe, to be a 
very commendable evidence of the potency of one 
intramuscular injection of salvarsan. Surely no 
other preparation of arsenic or of mercury can 
equal these results after one treatment. 
9. The relation between the clinical results and the 
reaction: 
In the 27 cases considered “clinically cured,” the reac- 
tion became negative in 11 cases (41 per cent.) ; the re- 
action remained positive in 8 cases (30 per cent.) the 
reaction was not observed in the remainder. 
In the 10 cases in which improvement was noted, with- 
out clinical recurrence, the reaction became negative in 4 
cases (40 per cent.) ; the reaction remained positive in 2 
cases (20 per cent.) ; the reaction was not observed in the 
remainder. 
In the 10 cases in which improvement was followed by 
a clinical recurrence, the reaction became negative in 3 
cases (30 per cent.) ; the reaction remained positive in 5 
cases (50 per cent.) ; the reaction was not observed in the 
remainder. 
In the 3 cases in which no clinical change was noted, 
the reaction remained unchanged. 
These figures indicate that in thirty-seven cases 
in which a “clinical cure” or a decided improvement 
without clinical recurrence was seen, the reaction 
changed from positive to negative in fifteen cases 
(forty-one per cent.), and remained positive or be- 
came so after having changed to negative in ten 
cases (twenty-seven per cent.) ; whereas in those 
cases in which improvement was followed by a clini- 
cal recurrence, the reaction changed to negative in 
but thirty per cent, of the cases and remained posi- 
tive in fifty per cent., thus showing that there is a 
definite relationship between the clinical improve- 
ment and the change in reaction. We may assume 
from these data that salvarsan has the effect of 
changing the seroreaction from positive to negative 
in direct proportion to the clinical improvement, or, 
in other words, that the change in reaction goes 
hand in hand with the change in the clinical condi- 
tion. 
10. The relation betzueen the reaction and the 
stage of the disease: 
In the 6 primary cases, the reaction became negative in 
2 cases (33 per cent.) ; the reaction remained positive in 
3 cases (50 per cent.) ; the reaction was not observed in 
the remainder. 
In the 14 secondary cases, the reaction became negative 
in 7 cases (50 per cent.) ; the reaction remained positive 
in 5 cases (36 per cent.)1 the reaction was not observed 
in the remainder. 
In the 14 tertiary cases, the reaction became negative in 
2 cases (15 per cent.); the reaction remained positive in 
3 cases (22 per cent ) ; the reaction was not observed in 
the remainder. 
In the 14 parasyphilitic cases, the reaction became nega- 
tive in 7 cases (50 per cent.) ; the reaction remained posi- 
tive in 5 cases (40 per cent.) ; the reaction was not ob- 
served in the remainder. 
Tn the 2 hereditary cases, the reaction was not observed 
after the injection. 
If these data signify anything, they make it ap- 
pear that there is no definite relation between the 
stage of the disease and the seroreaction as far as 
the treatment with salvarsan is concerned. The 
best results, however, seem to have been obtained 
in the secondary and parasyphilitic stages, in which 
fifty per cent, of the cases changed from positive to 
negative. 
lOne case became negative only after a second injection was 
given. 
2One case became negative onl> after, a second injection was 
given. 6 
IVolbarst: Salvarsan. 
11. Table showing the seroreaction before and 
after treatment: 
(a) Cases considered clinically cured. 
, Reaction >, Period after 
Case No. before. after. injection. 
j 4. — 5 months 
i J = ; ■ 
,1::::::::::::::::::::::: : = 
” + f « 
12 + — 6 
13 + + 5 
16 + + 3 
17 + + 8 
18 + + 5 
19 + + 4 „ 
27 — + 9 
7 0 ~ 3 <( 
8 0 - 3 „ 
(&) improved without recurrence. 
28 + — 1 “ 
29 + ~ ? .. 
33 + 1 
36 + + 2 
31 o — 3 
(c) Cases improved, with recurrence. 
41 + — 4 
38 + + 8 
39 + + 7 
40 + + 2 ; 
42 + + 2 
43 + + 4 ; 
45 o — 1 
Note: +, positive; —, negative; o, reaction not observed. 
12. The character of the recurrences: 
Recurrence took place in 1 primary case. 
Recurrence took place in 3 secondary cases. 
Recurrence took place in 2 tertiary cases. 
Recurrence took place in 4 parasyphilitic cases. 
The character of the recurrence varied in the individual 
cases. 
1. Case XXXVIII. Primary. Eight months after 
the injection, a few small mucous patches appeared on the 
lips. This was associated with a positive seroreaction. 
2. Case XXXIX. Secondary. Seven months after 
the injection, two minute ulcerations appeared on the ton- 
sils, associated with a slight papular eruption on the fore- 
arm. Seroreaction, slightly positive. 
3. Case XLI. Secondary. Four months after the in- 
jection. the voice became hoarse and husky. There were 
no visible lesions of any kind. Noguchi reaction, negative. 
4. Case XLV. Secondary. One month after the in- 
jection, patient began to see dark spots before the eyes, 
which was diagnosticated as svphilitic neuritis. Wasser- 
mann and Noguchi reactions, both negative. 
5. Case XL. Tertiary. Two months after the injec- 
tion, the patient noticed a return of the redness of the 
nose and thickening of the skin, to a slight degree. Was- 
sermann reaction, slightly positive. 
6. Case XLVII. Tertiary. One month after the in- 
jection, the obnoxious ozoena accompanying the destruc- 
tion of the nasal tissues returned, after having disappeared. 
7. Case XLII. Tabes. Three months after injection, 
the pains and ataxia returned with renewed vigor, and 
optic atrophy became markedly worse. 
8. Case XLIII. Paresis. Three months after injection, 
the improvement, which was very marked, suddenly gave 
way to a return of all his paretic symptoms. This change 
was coincident with a slight cerebral haemorrhage. 
9. Case XLIV. Syphilitic Gastritis. The symptoms 
returned three months after the injection. Wassermann 
and Noguchi reactions were both positive. 
10. Case XLVI. Tabes. For a month the pains and 
vomiting had ceased, but at that time a gastric crisis set 
in, accompanied by all the previous symptoms. 
13. Therapeutic effect of salvarsan: 
There can be no denying the wonderful effect of 
salvarsan on syphilitic conditions. Undoubtedly 
experience is teaching us that a single injection of 
salvarsan has the potency of a thorough course of 
mercury and iodides. That one injection will cure 
syphilis, it would be folly to expect in the light of 
our experience, but I feel safe in saying that we may 
hope to cure syphilis, clinically and serologically, 
after we have learned all that this marvellous rem- 
edy is capable of doing. We are still uncertain in 
regard to the best method of administration, the 
proper dose, the number of times it should be given, 
and the interval of time between injections. Time 
alone can determine these important facts for us. 
Time will also tell us whether it is best to give sal- 
varsan alone or combined with mercury, for we have 
not yet reached that point where we may with safety 
relegate this old time specific to the rear. Appar- 
ently the best results are to be obtained by a judi- 
cious use of both remedies combined, but the exact 
method of procedure must be left to future experi- 
ence to decide. 
In the meantime, we are justified in adopting 
certain routine methods in cases in which the treat- 
ment is deemed suitable. The intravenous injection 
is by far the most agreeable from the patient’s stand- 
point, and is probably the most effective mode of 
administration. It should be carefully given and 
repeated once or twice at intervals of two or three 
weeks. For the sake of further security, though I 
have not found it necessary, it is well to precede and 
follow these injections with a course of mercurial 
inunctions or injections. Next to the intravenous 
method, the intramuscular injection of an iodipin 
emulsion is the most desirable, but it is still to be 
proved that it is as effective as the intravenous or 
the alkaline intramuscular method. It has the sin- 
gle advantage, if that is one, that the treatment may 
be given by the physician in his office, and the pa- 
tient may then go home. I am not at all certain 
that it is wise or even safe to do this. 
A brief clinical review of the fifty cases constitut- 
ing this study will be of interest: 
(a) Cases in Which a Clinical “Cure" Follozvedt the 
Injection of Salvarsan: 
Case I. Primary Syphilis: S. H., male, aged twenty- 
three vears. Referred bv Dr. L. T. Ashcraft, of Philadel- 
phia. Infected one month. Wassermann reaction,+. No- 
vember 29. 1910, received 0.6 gramme. No pain whatever, 
but it became very severe the next day. Maximum tem- 
perature 102.4° F.. on the second day. Left the hospital 
in twelve davs. Wassermann reaction, December 28th. 
—; March 22d, —; May 3d, —, patient clinically well. 
On August 3d, Dr. Ashcraft stated that the man had not 
presented any clinical symptoms since the last report. 
Period of observation, eight months. 
Case II. Secondary Syphilis: G. A., male, aged twenty- 
four years. Macular eruption on body, duration ten days; 
chancre still visible, though disappearing; duration six 
weeks. No Wassermann reaction taken. Injected, Janu- 
ary 4, 1911. at People’s Hospital, 0.6 gramme. Slight pain, 
which soon disappeared. January 24th, site of chancre 
marked by a pinkish discoloration of the skin; eruption 
gone. Patient reappeared for examination, May T9. 1911. 
Felt well in every respect. Wassermann reaction, — 
August 8. T9TT. patient perfectly well. Wassermann and 
Noguchi reactions, both negative. Period of observation, 
seven months. 
Case ITT. Primary Syphilis: I. L., male, aged twenty- H'olbarst: Salvarsan. 
7 
■five years. Reierred by Dr. T. Parodi. Chancre on up- 
per lip. Duration, six weeks; no secondary lesions. Was- 
strmann reaction, two tests, 4 I Noguchi reaction, two 
tests, 4-- Injected. February 14, 1911, at St. Mark’s Hos- 
pital, 0.6 gramme; moderate pain. Within ten days the 
lesion had entirely disappeared, and the mucous membrane 
of the lip seemed normal. . March 27, 1911, Wassermann 
and Noguchi reactions, —. May 12th, patient stated that 
he felt perfectly well. There have been no secondaries. 
July 21, 1911. he reported by telephone that he felt per- 
fectly well. On August 8, 1911, he reported the same. 
Period of observation, six months. 
left the hospital ten days later, almost entirely recovered. 
The ulcer had disappeared altogether (Fig. 4) and the 
eruption on the face had become much less prominent and 
faded in color. Likewise the mucous patches in the throat 
had disappeared. 
Since then there has been no recurrence whatever, and 
the patient considers himself perfectly well. The Wasser- 
mann reaction was not taken before the injection, owing 
to his being salivated at the time, but since the injection 
it has been taken four times as follows: December 20, 
1910, negative; February 1, 1911, negative; March 7, 1911, 
negative; May 10, 1911, negative. The patient has gained 
twenty-five pounds in weight. When last seen, August 1, 
1911, his face showed no traces whatever of the former 
syphilide. Period of observation, eight months. 
Case VI1. Secondary Syphilis: L. S., male, aged thirty 
years. Referred by Dr. I. C. Rubin, with this history: 
For three months, patient has had mucous patches cover- 
ing entire palate, uvula and pharynx; a pustular syphilide 
covering the face and body. These lesions had faded 
away to some extent, under mixed treatment and inunc- 
tions, but the macular syphilide and adenitis still persisted. 
He did not stand mercury injections well. 
February 14, 1911, at People’s Hospital, he received 0.6 
gramme. No pain at first, but severe pain later lasting 
several weeks. At the end of a week’s stay in the hospi- 
tal, he left, feeling much better—practically well, in fact. 
He has been under observation since then, and has had no 
recurrence. Wassermann-Noguchi reactions, May 18, 1911. 
negative. July 3r, 1911, patient clinically well. Period 
of observation, five months. 
Case VIII. Secondary Syphilis: G. S., male, aged thir- 
ty-two years. Mucous patches in mouth, duration four 
months. Has been treated with inunctions, without ben- 
efit. March 7, 1911, at St. Mark’s Hospital, received 0.5 
gramme salvarsan. April 9, 1911, felt perfectly well, no 
recurrence; Wassermann-Nogtichi reaction, —; May 28, 
1911, also —. Had gained seven pounds in weight. July 
10th, clinically well. Period of observation, four months. 
Case IX. Cerebral Syphilis (reported in the Interstate 
Medical Journal, January, 1911): A. A., male, aged 
twenty-nine years. Referred by Dr. Charles A. Spivacke, 
with this history: Family history negative as to syphilis. 
Primary infection in 1905. Was treated for about six 
months with mercurial injections. No history of sore 
throat, alopecia, or pains in head. A year later the right 
elbow became painful and swelled a great deal. The pain 
was dull in character and so severe at night as to keep him 
awake. This condition improved under treatment. 
Fig. 1.—Illustrating Case TV 
chancre of urinary meatus, be- 
fore treatment 
Case IV. Primary and Secondary Syphilis: S. H., male, 
aged twenty-three years. Chancre of urinary meatus. 
Typical hard, intiltrated. Duration, three and one half 
months; has had no constitutional treatment. Chancre 
surrounds entire meatus and extends backward into the 
urethra for half an inch (Fig. t). Roseola present, hut 
faded. Wassermann and Noguchi reactions, +. Injected, 
March 15, 1911, at St. Mark’s Hospital, 0.6 gramme, intra- 
venously (one of the few cases in this series in which the 
intravenous method was employed). May 10, 1911, reaction, 
negative; June rst, patient reported for examination. The 
meatus was perfectly normal; patient had gained eighteen 
pound. Photograph taken forty-two days after injection 
shows a normal meatus (Fig. 2). July 20, 1911, patient 
reported feeling absolutely well Period of observation, 
four months. 
Case V. Secondary Syphilis: G. F., male, aged twenty- 
seven years; mucous patches involving the mouth and 
pharynx; duration four months. Unaffected by injections 
of salicylate of mercury and inunctions. Wassermann- 
Xogucht reaction, -f. November 22, 1910. at People’s Hos- 
pital, 0.5 gramme. Slight pain. Patient left the hospital ten 
days later, in excellent condition. Returned for observa- 
tion. May 12. 1911. Condition normal, without any re- 
currence of the patches. Had gained four pounds in 
weight, and felt perfectly well. Wassermann-Noguchi. 
negative. August 2. ion. condition the same. Wasser- 
mann-Noguchi reaction. —. Period of observation, eight 
months. 
Case VI. Secondary Syphilis:, L. B., male, aged thirty- 
eight years. Referred by Dr R. Livingston. When first 
seen, the patient had a large, deep ulcer on the right lower 
lip. mucous patches in the mouth and pharynx, and a papu- 
lar synhilidc on the left side of the face and neck (Fig. 
y). These lesions had appeared eight months previously, 
with the disapnearance of the primarv chancre on the 
penis. The patient had been treated with mercurv in all 
of its forms, and was salivated several times in the hone 
of obtaining a recession of the lesions, but without avail. 
\nnarently. this was a case with a decided constitutional 
antipathy to mercurv. for the more treatment he received, 
die worse his condition became. 
On November ly. 1910. at St Mark's Hospital, the pa- 
tient was injected with 0.5 gramme, hyperideal. Moderate 
pain, traces of which remained for several months. He 
Fig. 3.—Illustrating Case VI. 
Large deep luetic ulcer on lower 
lip, before treatment. 
Eighteen months ago patient suffered an attack of right 
hemiplegia while under the influence of alcohol. The 
right arm, leg, and right side of face were affected. In 
bed several weeks. Also suffered slight illusions at the 
time. He improved under a course of iodides, hut felt 
very depressed and lost all ambition for work or play. 
The right elbow remained swollen and tender. Had been 
under treatment for some time at the Vanderbilt clinic. 
I saw him first October 26. tqio. He was dull and apa- 
thetic. unable to do his work (bartender), losing one posi- 
tion after another. His face had a constant smiling, 
childish appearance Had no illusions, but realized that 8 
IVolbarst: Salvarsan. 
he was not well and wanted to do something that might 
enable him to go back to work to support his mother. 
Physical examination as to viscera, heart and arteries, 
and urine, normal. The right elbow joint measured eleven 
inches in circumference, the left ten and a quarter inches. 
Eyes normal, except for a slight cloudy deposit on the 
anterior surface of lens of left eye, in upper right quad- 
rant. Wassermann reaction -j- -j-. 
November 3, 1910, at People’s Hospital, received 0.5 
gramme. Slight pain, which passed off next day. Tem- 
perature reaction quite active, never higher than 102° F., 
on the third day. Pulse varied from 70 to 94. Was out of 
bed most of the time. Improved markedly after the 
fourth day. His mind brightened up perceptibly, he took 
a greater interest in things about him, and expressed a 
strong desire to go home and back to work. He felt 
strong and able to do anything. No infiltration or tender- 
ness at the site of injection. 
November 8th, at my request, he wrote me a letter de- 
scribing his condition. It was full of hope and optimism; 
in fact, it gave every evidence of being written by a man 
who had awakened out of a stupor and saw the light of 
day. 
November 15th. Sent home. Much improved. His 
arm did not pain any more and there was but a slight dif- 
ference in the measurement of the elbows. His mind was 
active and bright, and his mother felt that he was brighter 
than he had ever been. 
Arsenic was found in the urine eight days after the in- 
jection, albumin negative throughout. 
December 1st. Condition highly satisfactory in all re- 
spects. Wassermann reaction -f- + +• Eyes normal. 
December 31st, + + -f-; April 17, 1911, negative; May 
15th, negative. He felt perfectly well, though he tired 
easily. 
August r, 1911, felt well. Wassermann-Noguchi reac- 
tions, —. Period of observation, nine months. 
Case X. Repeated Abortions of Suspected Syphilitic 
Origin: Mrs. M. B., aged thirty years. Referred by Dr. 
S. W. Bandler. Patient had been married twelve years, 
and was the mother of one child, seven years old. Since 
the birth of this child she had had three miscarriages— 
two at six months and one at three months. Gynaeco- 
logical examination, negative. Wassermann reaction, 
strongly positive. 
December 31, 1910, at Beth Israel Hospital, she received 
0.5 gramme hyperideal. Moderate pain, which soon be- 
came very severe. Marked Herxheimer reaction. Pa- 
tient reappeared for examination May 4, 1911, feeling 
perfectly well; Wassermann-Noguchi reactions, —. No- 
ticed that her sexual feeling had changed considerably. 
Before the treatment, she was frigid and lacked sexual 
desire; since the injection, she had acquired a strong sex- 
ual feeling. Period of observation, four months. 
Case XI. Syphilitic Periostitis: J. W. E., male, aged 
thirty-seven years. Complained of severe racking pains 
in the forearms and legs, sufficient to keep him awake at 
night. Had lost much flesh, and weighed 117 pounds. Pre- 
vious history somewhat indefinite as to primary lesion. 
He first noticed a sore throat which persisted in spite of 
local treatment. Under internal treatment, however, it 
disappeared. Since then was well until about a year ago, 
when the pains in the arms and legs came on. Since then 
he has lost twenty-five pounds. December 1, 1910, Was- 
sermann reaction, —|—(—|-; January 5, 1911, + ++. 
January 15. 1911, at St. Mark’s Hospital, received 0.5 
gramme salvarsan. Moderate pain, which persisted for a 
week. The pains in the bones soon left him, and up to 
the present writing (August 15thj they did not since 
return. Wassermann reaction, March 17th, negative; 
June 2d, negative. Julv 25th, clinically well. Period of 
observation, six months. 
Case XII. Disseminated Cerebrospinal Syphilis, with 
Symptoms Suggestive of Tabes, and with Hysteroid Symp- 
toms: Mrs. L. E„ aged thirty-six years. Referred by 
Dr. C. F. J. Laase, with the following history: 
The patient was treated, fifteen years ago, for syphilis 
involving the throat. Primary lesion discovered on the 
genitals. Four years ago, she returned with the com- 
plaint of having severe rheumatic pains, which appeared 
all oyer the body at different times. These pains were 
associated with severe spasms or contractions of the mus- 
cles of her legs, arms, and neck. During these spells she 
could not stand or walk, and when they affected the neck, 
her head was held stiff, sometimes turned to one side; 
easily becomes “hysterical” when excited. Now (Decem- 
ber, 1910) her complaint was exactly the same, but in ad- 
dition she had headaches, and she got spasms of the tem- 
poral muscles so that she could not close her mouth vol- 
untarily, but must use her hand to do so. 
All of these years, she had been going from one phy- 
sician to another without relief, but she always failed to 
mention the specific infection fifteen years ago, until she 
returned to Dr. Laase for relief. 
Dr. Laase gave her ten injections of salicylate of mer- 
cury, but she did not tolerate them well, though her 
symptoms were somewhat relieved by them. When the 
injections were suspended, the pains and spasms returned 
with renewed frequency and severity. Her eyes have 
been examined many times, and always found normal. 
Wassermann reaction (German Hospital) -f--j- 
November 26, 1910, examination by Dr. B. Onuf, sug- 
gested the diagnosis mentioned above. Salvarsan was 
advised, rather as an experiment than with any expecta- 
tion of success. 
December 7, 1910, at St. Mark’s Hospital, I injected 0.5 
gramme. Slight pain at first, which gradually increased, 
and remained fairly moderate for several days. 
January 7, 1911, Dr. Laase reported: “She feels better 
than she has for some time, although she still experiences 
some of her former pains; but they are not severe enough 
to keep her in bed.” 
January 27th, Dr. Laase stated that “she reports decided 
relief from her pains. While at times she experiences 
some pains, they are bearable, being nothing in com- 
parison with her previous suffering. The Wassermann 
reaction, on January 16th, was negative.” 
March 29th, Dr. Laase gave the patient an intravenous 
injection and on May 8th, he stated: “I saw her yester- 
day, and it seems that according to her report and her 
husband’s observation, she has improved to the extent of 
ninety per cent., in that she seldom gets the pains com- 
plained of and then only for the brief space of a few 
hours.” 
June 1st, Wassermann and Noguchi reaction, both —. 
July 30th, clinically well. Period of observation, eight 
months. 
Case XITI. Primary Syphilis: S. B., male, aged thirty 
years. Referred by Dr. Henry Schumer. Duration of 
initial lesion two weeks; no secondaries. General ade- 
nopathy. Initial infection consisted of two distinct typical 
indurated chancres situated at the pubic crest. Wasser- 
mann reaction, -f-. December 20, 1910, at People’s Hos- 
pital, 0.5 gramme. Considerable pain, which passed off 
the next day. Within two weeks the lesions disappeared, 
and the patient had been perfectly well since. There had 
been no secondaries at any time. Patient had been travel- 
ing, and returned to town on May 29, 1911. No clinical 
recurrence of any kind. Wassermann-Noguchi reactions, 
“I—I—I—K 
Because of this positive seroreaction, I gave him an in- 
travenous injection of 0.6 gramme June 3d, at St. Mark’s 
Hospital, and another July 22d. Period of observation, 
seven months. 
Case XIV. Secondary Syphilis: F. V. E., physician, 
aged twenty-five years. Macular and papular ro- 
seola, three weeks’ duration. Primary lesion barely visi- 
ble. January 6, 1911, at People’s Hospital, injected 0.6 
gramme, Alt method. No pain. The patient left the hos- 
pital about a week later feeling splendid. Roseola entirely 
gone. March 14, 1911, Wassermann-Noguchi recations, —; 
patient has gained ten pounds; Mav 1st, clinically well, 
Wassermann-Noguchi reactions, —. As a result of this test, 
he was given an intravenous injection on May 15th. Au- 
gust 2, iqti, he wrote, saying that he never felt so well 
nor looked as well as at present. Period of observation, 
seven months. 
Case XV. Secondary Syphilis: M. B. R„ male, aged 
twenty-six years. Papular roseola, duration two weeks. 
Primary lesion still visible. Few mucous patches on ton- 
sils and in mouth. On January 19, tqit, at St. Mark’s 
Hospital, was given 06 gramme. Slight pain, which soon 
passed off. The erosions in the mouth disanpeared within 
twenty-four hours, and the eruntion passed off within a 
week. He left the hosnital and went West on business. 
He was referred for further observation to Dr. M. A. Wolbarst: Salvarsan. 
9 
Fechheimer, of Detroit, who reported on May 16th as 
follows: “Patient shows no external manifestations of 
the disease. The Wassermann test was positive.” On 
July 27th, reported feeling perfectly well. Here we have 
Treatment; Mercury suecinamide, grain >5, three 
times weekly, by hypodermic injection; 15 injections; no 
result. Salivated first two weeks in August. Last two 
weeks in August, protoiodide of mercury, grain by 
mouth; salivated again. Inunctions since September 7th. 
>5 (30 grains), 8 (40 grains) ; also potassium iodide. No 
effect. October 16th, Wassermann reaction +-|--+-+• 
October 17th, at the People’s Hospital, received 0.5 
Fic. 5.—Illustrating Case XVII. Crust covered pustules on back, 
resisting treatment for four months. 
another case of clinical “cure,” with a positive reaction. 
Period of observation, six months. 
Cask XVI. Secondary Syphilis: M. J. S„ male, phy- 
sician, aged twenty-eight years. Infected five months 
previously: three weeks after primary lesion appeared. 
Wassermann reaction was positive. Had been under bi- 
chloride injections, but did not stand them well. His 
physician advised salvarsan. On February 28, 1911, at St. 
Mark’s Hospital, was given 0.6 gramme intravenously. 
Wrote from home. April 10th, that he was feeling better 
than ever, but a Noguchi 
test made a few days pre- 
viously was positive. A 
second intravenous injec- 
tion was therefore given by 
Dr. Holliday, of Pittsburgh, 
on April 23. 1911. June 5, 
iqii, Noguchi reaction, —. 
Clinically well. July 31, 
1911, perfectly well. Pe- 
riod of observation, five 
months. 
Cask XVII. Secondary 
Syphilis Rebellious to Mer- 
cury and Iodides (reported 
in the Interstate Medical 
Journal, January, 1911). 
\V. S., male, aged twenty- 
three years. Referred by 
Dr. E. M. Hawks, with this 
history: Initial lesion on 
penis in May, 1910. Roseo- 
la appeared on body last 
week in June. Macules 
slowly changed to pustules, and were not influenced by 
treatment. Condition, October 1, iqio, pustules on back, 
ranging in size from a dime to a quarter; dried slowly, 
and became scaly (Fig. 5). Mucous patches on tongue 
since July remained and became ulcerous. Slough over 
both tonsils during August and September. Left iritis 
since September 15th. Ulceration on great toe (Fig. 6) 
since early in September Nail removed October 14th. 
He had lost much flesh and strength. 
Fic. 7.—Case XVII. Photograph taken twelve days after the 
injection of 0.5 gramme of salvarsan. Crusts and scales have dis- 
appeared and left nothing but a pinkish coloration of skin. (See 
lug- S-) 
• • 1 m 
Kidiiime. i am moueraie, rauiaung principally down me 
thighs, and controlled by hot water bag on buttocks. Re- 
action not marked. Uneventful stay in hospital; up and 
about on the second day. Temperature highest on second 
day (99.8° F.). No infiltration nor redness at site of in- 
jection. Tender on pressure. 
Examination of eyes, by Dr. M. Rosenbaum: “October 
-’4th, syphilitic iritis of left eye; slight circumcorneal in- 
jection, posterior synechiae, cloudiness of vitreous. Octo- 
ber 28th: Cloudiness of vitreous disappeared, iritis not 
present; posterior synechiae 
fading. Right eye normal; 
left eye, vision 12/70 with 
atropine. November 3d: 
Both eves normal.” 
Discharged from hospital 
October 29th. Skin lesions 
but faintly visible; pink 
spots on back. Scaling all 
disappeared. Great toe 
granulating. (Fig. 7.) 
November 18th: Eyes 
normal; skin still showed 
pink areas where the ulcers 
formerly were. Patient 
had gained nearly fourteen 
pounds. Big toe nearly 
well, with new nail rapidly 
coming out. 
December 13th: Skin 
clear : toe practically well: 
eyes normal. Wassermann 
reaction -I—(-. 
June 26, 1911 (eight 
months after the injection' 
Fig. 6.—Illustrating Case 
XVII. Luetic ulceration of tlie 
great toe with loss of nail, in 
spite of vigorous treatment with 
mercury and iodides. 
Fig. 8.—Case XVII. Photo- 
graph of toe (see Fig. 6) taken 
eight months after the injection 
of o.i; gramme of salvarsan. 
The ulcer has disappeared and & 
perfect nail has taken its place. 10 
H'olbarst: Salvarsan. 
the patient was feeling perfectly well, eyes normal, and 
the great toe had grown to its normal size and condition 
(Fig. 8). Wassermann-Noguchi reaction, -|—p. August 
8, 1911, he reported no change in his condition. Period 
of observation, ten months. 
Case XVIII. Tertiary Syphilis Involving the Nasal 
Septum and the Hard Palate: Mrs. S. B., aged thirty- 
seven years. Referred by Dr. L. S. Blumberg, of New- 
ark, N. J., with this history: Patient denied ever having 
had syphilis knowingly; first noticed trouble in the mouth 
a year ago. Three months later, she passed a small bone 
from the nose through the hard palate, which left a per- 
foration about an eighth of an inch in diameter. This had 
partially closed under antisyphilitic treatment. About 
eight months ago the nasal septum broke down, and the 
process had been going on since then. Eleven months ago 
her sixth baby was born, perfectly well, and remained 
so. For many years she suffered from pain in the gall- 
bladder region, but on operation a necrosed area was 
found, which was thought to be gummatous in character. 
The mass was undisturbed, and the wound closed up. 
Since then she has felt better. December 4, 1910, Was- 
sermann reaction, + + + +• December 12th, at People’s 
Hospital, she received 0.5 gramme. Moderate pain, which 
soon passed off. 
The patient then went to her home in Newark, and was 
not heard from until May 24, 1911, when Dr. Blumberg 
wrote as follows, concerning her: “She is now enjoying 
good health. Since the treatment she has gained thirty- 
five pounds in weight, is doing all her housework, besides 
helping her husband in his store. The perforation of the 
hard palate has decreased in size from that of a dime 
to the diameter of a small pencil, and there is no more 
foul discharge. The destruction of the nasal septum, 
while complete, has been arrested, and a plastic operation 
to correct the deformity will be done very shortly. May 
21st a Wassermann-Noguchi test proved strongly posi- 
tive.” August 9th Dr. Blumberg wrote: “She is enjoy- 
ing very good health at present. Is gaining in weight and 
looking splendid.” Here, too, we have an excellent clin- 
ical result, with a strong positive reaction. Period of 
observation, eight months. 
Case XIX. Syphilitic Periostitis: H. W., male, aged 
thirty-two years. Complained of severe pains in the ex- 
tremities, especially at night, associated with indefinite 
pains in the head at various times. Otherwise well, ex- 
cept that he is drowsy and could not apply himself to his 
work as well as he should. Had initial lesion nine years 
ago, and was treated on and off since then for about five 
years with mercury and iodides. Since stopping the treat- 
ment, his appetite had been poor, he was very nervous and 
complained of the pains mentioned before. Married five 
and a half years, wife never pregnant. November 17, 
1910, Wassermann-Noguchi tests, -j-; December 19, 1910, 
-PH—j—|-. January 5, 1911, at St. Mark’s Hospital, re- 
ceived 0.6 gramme. No pain. Called for observation 
several times, and improved continually. May 9, 1911, 
stated that he felt excellent, his nervousness gone, pains 
absent, and appetite and sleep excellent. Had gained 
weight. Nevertheless, Wassermann and Noguchi tests, 
both -j—p. Refused further treatment. June 7, 1911, clin- 
ically well. Period of observation, five months. 
Case XX. Precocious Tertiary Syphilis: L. C., male, 
aged thirty-four years. Referred by Dr. M. J. Klein, 
with the following history: The patient was infected two 
years previously. Three months later a severe exten- 
sive vesiculopapular eruption developed, covering the 
entire body and face, associated with a gummatous in- 
filtration of the epiglottis and the tonsils. The treatment 
at that time consisted of injections of cypridol, alternat- 
ing with salicylate of mercury, with increasing doses of 
sodium iodide up to three drachms three times daily; also 
local applications to the throat. The general condition 
vTas not much improved by this treatment, although the 
lesions in the throat did show some betterment. The 
eruption on the face and extremities remained, however, 
and soon localized itself on the forehead, lobe of the ears, 
and on the legs and hands. Here there was actual loss 
of tissue, which was not influenced in the least by the 
treatment. At this time he was getting an injection of 
mercurv every second day, and was taking in addition. 
*.he yellow iodide of mercury pills, grain p£, from nine to 
twelve daily. At no time did he show any symptoms of 
salivation. At various times he was given injections of 
enesol, bichloride and succinamide of mercury, and in- 
unctions, all without effect. The ulcers on the hand ami 
leg of the patient, just before receiving the injection of 
salvarsan, are well shown in the accompanying photo- 
graph's (Fig. 9). Wassermann-Noguchi reactions, -)—(-. 
October 12, 1910, at the People’s Hospital, he was given 
0.5 gramme. Had slight pain, which soon disappeared. 
At the end of ten days he left the hospital, much im- 
proved. Fig. 10, taken five days after the injection, in- 
dicates the rapidity of the action in this case. The ulcers, 
which had previously been from Ya to V* inch in depth, 
were now even with the surface and complete epidermi- 
zation followed in a few days. This patient did not re- 
appear for observation, but Dr. Klein who saw the pa- 
tient several times, reported, August 2, 1911, more than 
Fig. 9.—Illustrating Case XX. 
Luetic ulcers of hand and leg, 
resisting vigorous treatment. The 
ulcers were half an inch in 
depth. 
nine months after the injection, that he was perfectly 
cured, clinically, and had grown very stout. Period of ob- 
servation, nine months. 
Case XXI, Tertiary Syphilis with Extensive Syphil- 
ide: Mrs. D. B., aged forty-five years. Married twenty- 
seven years, and had three children, all well. Had three 
miscarriages, years ago. First noticed bad sore throat 
six years ago. Was never sick before that time. The 
angina was followed by a skin eruption (red rash), which 
lasted a week, and disappeared under interna! treatment. 
Patient took this medicine two years. For one year, was 
apparently well, hut at that time ulcers began to break 
out, first in the face, and then on the left hand and arm. 
The face ulcers healed, but those on the hand and arm 
have remained ever since (three years). Had lost forty 
pounds in weight, but regained it. Had not taken medi- 
cine in three months, and felt greatly discouraged. The 
throat had been well since the first attack; there had 
been no alopecia, or headaches. 
When first seen by me she presented enormous crust 
covered syphilides involving the left shoulder and arm. ll’olburst: Sal: arson 
and forearm and hand (Fig. n). Wassermann and No- 
guchi reactions, both Urine contained faint traces 
of albumin, no sugar. 
January 25; 1911, at St. Mark’s Hospital, she received 
0.5 gramme. Slight pain, which soon disappeared. With- 
in a few days the syphilide began to show evidences of 
improvement, and on February nth, seventeen days after 
ihe injection, the scales had disappeared, and healing was 
11 
twenty-two years. Referred by Dr. S. J. Bernfeld. His- 
tory: Primary infection uncertain, but apparently about 
four months ago. Secondaries never present. hirst no- 
ticed loss of hair about three months ago; has been under 
mixed treatment with slight benefit. Wassermann reac- 
tion (Dr. George F. Dixon), positive. 
December 12, 1910, at the People’s Hospital, he received 
0.6 gramme hyperideal. No pain at any time. Sat up out 
of bed next day. Photograph taken immediately before 
the injection showed the typical alopecia. The patient left 
the hospital and soon disappeared On July 25, 1911, Dr. 
Bernfeld heard from him from Europe, to the effect that 
he was feeling well and that his hair had returned to its 
normal condition. Period of observation, seven months. 
Case XXIV. Tertiary Syphilis Involving the Tongue: 
K. J., male, aged fifty-five years. For twelve years he 
had been suffering from leucoplakia of the tongue and 
syphilides in the mouth and on the face and neck. Pri- 
mary infection obscure. Had been taking iodides and 
mixed treatment, with temporary benefit. H?d lost much 
weight and now weighs but 122 pounds. Ha l numerous 
small mucous patches in the mouth and throat, and a 
copper colored svphilide scattered over the face and neck. 
The tongue was grooved and covered with white patches. 
Fic. 1 i.—Illustrating Case XXI. This photograph shows but one 
of many large crust covered -yphilides. covering shoulder and arm, 
before treatment. 
well under way (Fig. 12). This woman refused to pre- 
sent herself for further observation, in spite of every 
effort to have her do so, but on June 2.3, 1911, her hus- 
band stated that she was absolutely well. Period of ob- 
servation, five months. 
Case XXII Syphilitic Osteomyelitis: G. W., male, 
aged forty years. In the service of Dr. L. J. Ladinski, at 
Gouverneur Hospital. For twenty years, this man had 
suffered from an osteomyelitis of the forearm, which had 
resisted operative treatment of all kinds. When I saw 
him, on the invitation of Dr. Ladinski, he had two or 
three sinuses extending into the bones of the forearm, 
which had been operated on without benefit. The Was- 
sermann reaction being strongly positive, it was decided 
to give him an injection of .salvarsan. 
December tQth, at Gouverneur Hospital, I injected 0.5 
gramme hyperideal. He had moderate pain, which soon 
passed off Temperature reaction, moderate. Within 
nine days he gained five pounds in weight, and the 
wounds showed signs of closing up. 
This patient left the hospital well, and did not reap- 
pear for observation untH May 29, 1911. On that day, 
five months after the injection, the sinuses in the arm were 
closed entirely and the man considered himself entirely 
"ell. fie had gained much weight and felt fine. He re- 
fused to have a Wassermann test made. July 21, 1911. 
he reported, perfectly well. Period of observation, seven 
months. 
Cask XXTTT. Syphilitic Alopecia: H. F. F... male, aged 
Fic. 12.—Illustrating Case XXI. Photograph taken seventeen 
days after the injection of 0.5 gramme of salvarsan. The crusts 
have entirely disanptared, leaving a smooth surface. These syphi- 
lides have since disappeared altogether. 
Wassertnann reaction, weakly positive (he had been tak- 
ing iodide up to a few weeks ago). 
November 27, igro. at the People’s Hospital, he re- 
ceived 0.5 gramme. Moderate pain, which increased and 
lasted for several months, making it impossible for him to 
bend or stoop. This pain eventually passed off. 
He left the hospital, much improved. 
January 19, 1911 (two months after the injection) he 
wrote: “I feel perfectly well, so much so that I com- 
mence to think of the future. I have still some pain in 12 
IVolbarst: Sah'arsan. 
my loins (caused by the injection), but am now able to 
put on my shoes without assistance, but of the dread 
disease there is no trace left. Altogether I am of the 
lopapular eruption all over the body, duration two weeks. 
Primary lesion still visible. 
November 7, 1910, at the People's Hospital, received 0.5 
gramme. No pain. Patient left the hospital in six days, 
feeling well. The eruption- had nearly entirely disap- 
peared. 
March 12, 1911 (four months after the injection), he 
reappeared for observation, feeling well except for occa- 
sional pains in the forearm. Refused to have blood test 
made. There had been no secondary phenomena. Period 
of observation, four months. 
Case XXVI. Malignant Secondary Syphilis Resisting 
Mercury and Iodides (reported in the Interstate Med- 
ical Journal, January, 1911) : J. L., male, aged twenty- 
eight years. Referred by Dr. J. B. Prager. Initial in- 
fection eighteen months ago, on the penis. Began as a 
pustule, which grew large and hard and eventually broke 
down, resisting treatment for seven months. Inguinal 
glands swollen and tender. Six weeks later, the roseola 
appeared and disappeared only after several months of 
treatment. For the past three months the patient com- 
plained of a sore throat, growing worse all the time, so that 
it interfered with his speech and rendered swallowing dif- 
ficult and painful. Had also had pains in the joints. 
Examination of the eyes, heart, lungs, and kidneys 
negative. Wassermann reaction + -j- + +■ 
Examination of the throat revealed a large greenish 
white, ulcerating area covering the uvula, tonsils, post- 
pharyngeal space, and part of roof of the mouth (Fig. 
13). The mouth could be opened only with difficulty. 
November 3, 1910. Injected 0.5 gramme hyperideal. 
No pain at time of injection, but a few hours later pain 
of moderate severity over the site of injection which lasted 
two days. Throat was cleansed with saline solution. 
November 5th, improvement noted. Green ulceration 
turning paler and assuming a brownish color. Throat 
felt better, swallowing and speech easier. 
November 10th. improvement continuous. Full diet. 
Out of bed and felt better in every way. Ulcerated area 
assuming normal color. No infiltration nor redness at 
site of injection. 
November 15th, left the hospital feeling perfectly well, 
though the throat still showed some signs of the recent 
ulceration. 
Noyember 20th, throat normal. 
November 25th. throat normal, and patient back to 
work. Gained seven pounds. Did not return for further 
observation. 
April 15, 1911 (five months after the injection). Dr. 
Prager saw the patient, and stated that he was feeling 
perfectly well and that he had gained at least thirty pounds 
in weight. This information was corroborated by my own 
observation on July 23d. He felt perfectly well; blood 
Fig. 13.—Illustrating Case XXVI. Uvula, tonsils, and palate 
covered with a greenish white, membranous ulceration, which had 
resisted treatment for nearly two years. Within seventeen days 
after the injection of 0.5 gramme of salvarsan the mouth and throat 
were absolutely normal. 
impression that I am perfectly cured.” Did not re- 
appear for another blood test. 
May 26, 1911, he reported feeling well in every way. 
Period of observation, six months. 
Case XXV. Secondary Syphilis: P. A., male, aged 
twenty-eight years. Referred by Dr. M. J. Klein. Macu- 
Fig. 14.—Illustrating Case XXVII. This chart shows an unusual rise of temperature to 105.40 F., eight days after the injection of 
0.5 gramme of salvarsan. This was associated with urinary suppression; both responded to diuretics. Wolbarst: Salvarsan. 
13 
examination was refused. Period of observation, eight 
months. 
Case XXVII. Primary Syphilis: Unusual Reaction to 
the Treatment (This case has been reported in the In- 
terstate Medical Journal, January, 1911). R. E., male, 
aged twenty-seven years. Referred by Dr. S. VV. Band- 
ler. Good general health. Initial lesion on shaft of penis, 
near corona, hard and typical in appearance, the size of 
a quarter. Duration two weeks. No secondaries. In- 
guinal glands indurated, not tender. Other glands nega- 
tive. 
November 4th: Examination for spirochaetae, positive. 
Wassermann reaction, negative. Excision was suggested, 
but not permitted. To avoid any possible doubt as to the 
character of the lesion (in the absence of secondaries) 
patient was also examined by Dr. Ludwig Weiss, who 
confirmed the diagnosis. Examination of eyes, visceral 
organs, and urine, negative. 
November 7, 1910, at a private sanatorium, 0.5 gramme 
hyperideal. 1’ain moderate, but in a few hours it ex- 
tended down the thighs, and remained there for several 
days. Controlled somewhat by hot applications, and grain 
% morphine at bedtime. In the afternoon the tempera- 
ture rose suddenly to 102° F. Pulse 76. A study of the 
temperature curve (Fig. 14) shows an unusually active 
response to the drug. 
1st day. 99.5° to 102.0°; pulse 64 to 76. 
2d day, 97.00 to 101.80; pulse 68 to 80. 
3d day, ioo.i0 to 102.6°; pulse 68 to 100. 
4th day, 100.6° to 102.0°; pulse 98 to 100. 
5th day, 102.0° to 101.0°; pulse 96 to 92. 
6th day, 101.2° to 103.0° ; pulse 92 to 96. 
7th day, 103.0° to 104.5° I pulse 90 to 102. 
8th day, 104.5° to 105.4° I pulse 90 to 102. 
9th day, 105.4° to 103.8°; pulse 100 to 95. 
10th day, 103.8° to 103.2°; pulse 95 to 90. 
nth day, 103.2° to 100.8°; pulse 90 to 85. 
12 th day, ioo.8° to 99.0°; pulse 85 to 72. 
13th day, 99.0° to 98.2°; pulse 72 to 70. 
14th day, Normal. Normal. 
Interesting features of this case that are unusual were 
the very high temperature, partial suppression of urine, 
and coincident appearance of a generalized scarlatinal 
rash. The amount of urine passed on each day after the 
injection was as follows: 
1st day, amount not counted. 
2d day, 23 ounces. 
3d day, 19 ounces. 
4th day, 19 ounces. 
5th day, 13 ounces. 
6th day, 10 ounces. 
7th day, 10 ounces. Rash on buttocks (diuretic given). 
8th day, 44 ounces. Rash on entire body, scarlatinal 
9th day, 134 ounces. 
10th day, 153 ounces 
nth day, 74 ounces. Rash disappearing. 
12th day, 73 ounces. Diuretic stopped. 
13th day. 43 ounces. 
14th day, 15 ounces. 
The rash appeared coincidentlv with the high tempera- 
ture and urinary suppression; it first appeared on the 
buttocks (site of injection) and soon spread to the rest 
of the body (Fig. 15), including the face; the urinary 
condition was relieved by a strong diuretic and hot packs, 
with plenty of water internally. During all this time the 
patient did not feel unwell in the least, except for the 
pains in the legs, and in the arms. These were somewhat 
relieved by alcoholic rubs. There seemed to be a neuritis, 
possibly of arsenical character. The patient was rather 
dull and slept a good deal. Otherwise felt well. The 
tongue was coated with a yellowish white, thick, slimy 
fur. However, there can be no doubt that the entire 
complex of symptoms was due to faulty elimination of the 
drug, or supersensitiveness (idiosyncrasy) to the drug, 
or both. 
November nth. . Spirochjetae negative. Chancre soft 
and fast disappearing; glands negative. No infiltration 
or redness at the site of injection. 
November 15th. discharged from hospital. Primary 
lesion gone, except a slight pinkish discoloration of the 
skin and slight thickening. 
November 30th. Wassermann reaction +-j-+. Skin 
clear, glands negative, patient has gained about ten 
pounds. Eyes normal. 
December 4th, Wassermann reaction 4-+; skin clear, 
patient normal and felt well. 
July 25th. 1911, the patient reported feeling perfectly 
well; there have been no secondaries or other manifesta- 
tions of the disease. He has gained much weight. Was- 
sermann-Xoguchi, slightly positive ( + ). August 7th, con- 
dition the same. Period of observation, nine months. 
(b) Cases in which Marked Improvement Followed 
the Injection without Recurrence. 
Case XXVIII. Advanced. Tabes Dorsalis: M. E., 
male, aged thirty years. Previous history as to primary 
and secondary syphilis, obscure. Present illness, duration 
one and one half years. Principal symptom, tabetic gait, 
which was very marked; also typical shooting pains in the 
legs. Walked with two canes; could not stand unaided. 
No involvement of the optic nerve. Wassermann reaction, 
strongly positive. 
Fig. 15.—Illustrating Case XXVII. Photograph shows an unusual 
scarlatinal eruption covering entire body, on the seventh day after 
the injection of 0.5 gramme of salvarsan. This also disappeared 
on the administration of diuretics. 
November 3, 1910, at the People’s Hospital, received 0.5 
gramme. No pain, at any time thereafter. Left the hos- 
pital twelve days later, apparently walking better. De- 
cember 2, 1910, Wassermann reaction, 4’I gait much im- 
proved. February 27, 1911, walked unaided with one cane; 
looked and felt better; no pains; had gained in weight; 
tabetic gait not so marked. Wassermann and Noguchi, 
reactions, —. May 2, 1911, he reported feeling much better. 
Refused blood test. Period of observation, six months. 
Case XXIX. Tabes Dorsalis: C. G. M„ male, aged 
thirty-six years. Referred by Dr. S. Ravich, of New 
Bedford, Mass. Primary syphilitic infection somewhat 
in doubt, but secondary lesions in the throat and about 
the anus appeared twelve years ago Was treated on and 
off for three years, and had been well, except at intervals, 
when the sore throat reappeared; it was controlled by 
mixed treatment. First noticed pains and numbness in 
the legs about two years ago. Did not “feel sure” in 
his gait. Sight normal: about a year ago had inconti- 
nence of the bladder and rectum, hut this was controlled 14 
Wolbarst: Salvarsan. 
by the treatment. Romberg symptom, loss of patellar 
reflex, and Argyll Robertson pupil. Wassermann and No- 
guchi reaction, weakly positive. 
November 22, 1910, at tbe People's Hospital, received 
0.5 gramme. Slight pain. Left the hospital twelve days 
later, in good condition. 
December 27th (one month after the injection) Dr. 
Ravich wrote: “Patient says he feels stronger and hap- 
pier than before. Has gained ten pounds in weight. The 
shooting pains are not as marked as before, but still pres- 
ent. Vision unaltered. He always felt a little weakness 
in his legs, which is somewhat less marked than before. 
It is in the sensory symptoms that the patient feels the 
greatest improvement. He felt a sensation of numbness 
in the tips of his fingers and toes. This sensation has now 
diminished to a marked degree. The dormant sensation 
in the thighs has also improved greatly. He feels great 
improvement in the condition of the bladder. Micturition 
is of normal frequency (he used to suffer from too fre- 
quent micturition) and is accompanied by very little 
straining.” Eyes normal, and Wassermann reaction 
weakly positive. (Massachusetts General Hospital). 
March 25th (four months after the injection) patient 
reported his condition as being “the same as last report.” 
April 18, 1911, Dr. Ravich wrote: “His general condition 
is as good, if not better, than at the time of the last ex- 
amination. The patient states he has completely regained 
the power of erection. Wassermann reaction, negative.” 
August 7, 1911, Dr. Ravich again kindly wrote: “The 
patient says he has better control of the flow of urine 
than before. Formerly there was a condition bordering 
on incontinence. He used to lose a drop or two involun- 
tarily once in a while. All this is corrected now. On the 
other hand, he says that the act of micturition implies 
more straining now than before. . . His state of health 
in all other respects is the same as before.” Period of 
observation, eight months. 
Case XXX. Tertiary Syphilis Involving the Inguinal 
Glands: C. A., male, aged forty-five years. Referred by 
Dr. L. T. Ashcraft, of Philadelphia, with the following 
history: There was no history of syphilis; five years ago, 
Dr. Ashcraft did a penile amputation and excised the 
•chain of inguinal glands of the right side, the lesion being 
highly suggestive of carcinoma. This chain was very 
much broken down. Wassermann reaction, positive. 
November 29. 1910, patient received 0.5 gramme. No 
pain. On that day the measurements of the thighs were 
as follows: Affected side, around the hip, 24.5 inches; 
around the ankle, 11.5 inches. On the normal side, hip, 
20.5 inches, ankle, 9.5 inches. 
December 7th, the patient appeared better. There was a 
slight decrease in the swelling of the affected side. 
December 15th, Dr. Ashcraft wrote: “The thigh has 
■decreased circumferentially. His condition is fairly good. 
Tiie wound has not changed much. He seems to be de- 
veloping pyelitis.” 
December 29, 1910, Wassermann reaction,. negative. 
January 3, 1911: “The wound shows decided evidences 
of improvement, but of course, as it was very deep, it is 
> far from being healed. The thigh measurements have de- 
creased from the original 24 inches in the thigh, and 18 
in the calf, to 21 in the thigh and in the calf.” 
May 3, 1911, the patient died of pneumonia. “He was. 
however, better from the injection.” Period of observa- 
tion, five months. 
Case XXXI. Tertiary Syphilis with Perforation of the 
Hard Palate: K. M., male, aged twenty-two years. In- 
fected two years ago, and had received intermittent treat- 
ment. Presented a perforation of the hard palate, poster- 
iorly, about half an inch in diameter. Speech markedly 
interfered with. 
December 30, 1910, at the People’s Hospital, he received 
0.5 gramme. Moderate pain, which soon passed off. He 
left the hospital at the end of a week. 
January 30, 1911, perforation is about the same, but 
speech was somewhat clearer, and patient had gained five 
pounds. Wasserman reaction, February 6, 1911, strongly 
positive. March 15th. Wassermann-Noguchi reactions, 
negative. Perforation had diminished in size perceptibly, 
and measured about one-eighth inch in diameter; speech 
much improved, and patient had gained eight pounds. 
Tuly 30, 1911. his condition was the same as at last report. 
Period of observation, seven months. 
Case XXXII. Syphilitic Periadenitis: M. H., male, 
aged thirty years. Referred by Dr. H. P. Schlansky. 
History:—Primary infection three years ago, followed by 
usual secondaries. Received about thirty-five injections 
of mercury, and was apparently doing well, until two 
months ago, when the glands on the right side of the neck 
began to swell rapidly.. The growth had continued in spite 
of mercury and iodides. A specimen of the tumor ex- 
amined at Mount Sinai Hospital, proved the growth to be 
gummatous. November 3, 1910, Wassermann reaction, 
positive. 
On November 13th, Wassermann-Noguchi reaction, 
strongly positive. On the 15th, at the People’s Hospital, 
he was given 0.45 gramme, hyperideal. Owing to the pres- 
ence of sugar and albumin in the urine, and a coexisting 
fatty heart, it was not deemed safe to give him a larger 
dose. He stood the injection usually well, having very 
slight pain, and moderate reaction. November 30th, Was- 
sermann-Noguchi reaction, -I—|—|—J-. During the next two 
weeks, the growth diminished perceptibly in size, and be- 
came much softer, and the individual glands composing the 
mass could be made out. At that time, the mass began to 
cause pain for the first time, and his family refused permis- 
sion for a second injection. He then went to Mount Sinai 
Hospital, where the mass was removed by Dr. A. A. Berg. 
After operation, the syphilitic induration extended to all 
the cellular planes of the neck. He returned to the hos- 
pital, where he was given mercury and iodides, and a 
second injection of salvarsan. The pathologist again re- 
ported the glands to be syphilitic in character. A great 
improvement in the induration was noticed thereafter, but 
one day, about two months after the operation (three 
months after the first injection of salvarsan), he sat up 
suddenly in bed, while still in the hospital, and fell back 
dead. No autopsy was granted. Cause of death was stated 
to be syphilitic myocarditis. Period of observation, three 
months. 
In this case it will be observed that a distinct im- 
provement followed the first injection, but unfor- 
tunately it did not last long. Possibly a larger dose, 
or a second injection soon after the first, might have 
saved him. 
Case XXXIII. Cerebrospinal Syphilis: L. S., male, 
aged thirty-two years. In the service of Dr. D. Robin- 
sohn, at Beth Israel Hospital. History: Primary infec- 
tion twelve years ago, and received some treatment; 
amount indefinite. Had been well since then, up to present 
illness. His wife had had three abortions and two healthy 
children. Four months ago, his wife noticed that he 
was becoming weaker physically, speech becoming jerky 
and incoherent, and a coarse tremor involving all the 
limbs. No pain anywhere. Ate and slept well, mentality 
clear. He kept on gradually growing weaker, his speech 
more indistinct, and was able to walk but a short dis- 
tance without tiring. Perfect sphincter control; eyes nor- 
mal. On admission, he gave these neurological signs: 
Spastic gait; Romberg; general spasticity; marked inten- 
tion tremor; incoherent speech; Argyll Robertson pupil; 
dull mentality; eyegrounds normal (Dr. Born). Wasser- 
mann reaction, positive. 
When I first saw him, on the invitation of Dr. Robin- 
sohn, he was unable to talk, except to mutter unintelli- 
gently; he was confined to bed, but was not able to sit up, 
owing to the violent general muscular tremor. He walked 
into the operating room with the greatest difficulty. When 
told to hold out his hands, they swayed violently and were 
beyond control. 
October 20, 1910, he received 0.45 gramme hyperideal. 
Practically no pain. October 24th, sat up in bed unasisted, 
and held out his hands for the first time with but a slight 
tremor. His speech seemed to be a little more distinct, and 
his mentality seemed less dull. 
October 28th, tremor of hands and tongue less marked; 
much better. 
November 10th, Wassermann reaction, slightly positive. 
November 18th, left the hospital, much improved. 
May 2, 1911, Dr. Robinsohn reported that the patient’s 
condition was about the same as when he left the hospital. 
May 25, 1911, I saw the patient. He was bv no means 
well, but his condition was far better than it was before the 
treatment. Refused a Wassermann test. Period of obser- 
vation, seven months. IVolbarst: Salvarsan. 
15 
Case XXXIV. Tertiary Ulcer of Leg Resistant to Mer- 
cury and Iodides: B. J., male, aged twenty-eight years. 
Primary infection seven years ago. Since then had had in- 
termittent treatment. Six months ago, had ten injections 
of mercury; last treatment one month ago. Ulcer on 
right leg, duration seven months. It was almost half an 
inch in depth, and three quarters of an inch in diameter. 
Refused Wassermann test. 
January 23, 1911, at the People’s Hospital, received 0.6 
gramme. No pain, but became dizzy and suffered slight 
shock. Felt well the next day. The ulcer gradually filled 
up, and on February 22, 1911 (one month after the in- 
jection) the entire cavity had disappeared, and its surface 
was flush with the adjoining skin. Strangely enough, epi- 
dermization did not take place for several months, in spite 
of additional stimulating treatment. June 6, 1911, how- 
ever, the patient wrote that complete healing had taken 
place after taking mercury. Period of observation, four 
months. 
Case XXXV. Tertiary Syphilis with Perforation of 
Hard Palate: C. G. A., male, aged thirty-seven years. Pri- 
mary lesion six year ago, followed by obstinate secondary 
lesions, which had left scars behind. Had been treated 
with pills all the time. Had a perforation of the hard 
palate as large as a twenty-five cent piece: also persistent 
ulcers on tonsils and pharyngeal wall. A faint pustular 
eruption on the back was also visible. Patient did not 
know how long the perforation has existed. Wassermann 
and Noguchi tests, H—f—)-. 
November 23, 1910, at the People's Hospital, was given 
0.5 gramme. Moderate pain, which persisted for some 
days. Patient left the hospital at the end of two weeks 
and was not heard from again until March 25, 1911, when 
his friend wrote saying, “Mr. A is feeling fine. To-night 
he told me that he has not felt so good for years.” Period 
of observation, four months. 
Case XXXVI. Tertiary Syphilis with Considerable 
Destruction of Soft Palate: M. A., male, aged sixteen 
years. Referred bv Dr. D. L. Morrison. History: Moth- 
er stated that the boy was born healthy, but began to show 
throat symptoms at the age of nine—seven years ago. 
Never had had any skin lesions. Mother and father both 
denied any history of syphilis; there were two other chil- 
dren in the family, both well. The boy had been taking 
“drops” for a long time, with little or no benefit. The 
entire uvula and both fauces had been destroyed. The 
boy’s speech was hard to understand; he was undersized, 
and had just completed his school course. Wassermann 
reaction, —|—I—f-. 
March 17, 1911, at the People’s Hospital, received 0.5 
gramme. No pain. the hospital a week later, much 
improved. April 7, 1911, Dr. Morrison wrote that “the 
improvement in this boy’s case is decided and very ap- 
parent.” Since then there had been a decided narrowing 
of the posterior arch left by the destruction of the soft 
tissues: the boy’s speech improved markedly, and his gen- 
eral condition was also improved. He had been put on 
mixed treatment. May 5, general improvement main- 
tained. Wassermann-Noguchi tests, mildly positive. July 
20, 1911, condition same as before. Period of observation, 
four months. 
Case XXXVII. Cerebral Syphilis: S. D., girl, aged 
seven years. Referred by Dr. John H. Storer. History: 
Father had syphilis one year before marriage, was treated 
and considered himself cured. The patient, when five 
months old, fractured a femur, by rolling off a divan: this 
united in good condition. At the age of two years, a 
gumma on the under lip developed, as large as a walnut. 
This yielded to mercury and iodide of potassium. Soon 
thereafter, she began to have attacks, characterized by 
rigidity, almost loss of consciousness for a moment or 
two; these attacks usually came on on waking in the 
morning. These spells continued up to the present 
time, about once or twice a month, other times not quite 
so often. She had them as often as two or three 
times in one week. The four upper incisors of the second 
set of teeth had never appeared. She was somewhat pe- 
culiar, very bright, excitable, and it was very hard to make 
her obey. At times, she seemed to lack mental development, 
although she had a good memory for some things. At 
all times there was present a spirit of unrest and a lack of 
poise. The attacks seemed to be epileptiform in character, 
although not severe enough to be called epileptic. Their 
character was not very different or severer than they were 
years ago. They did not resoond in the least to brom- 
ides. Wassermann and Noguchi reactions, -|—|—|—f-. 
It was decided to try the new remedy, and, December 
14, 1910, at St. Mark’s Hospital, she received 0.25 gramme 
intramuscularly. This was thought to be the largest dose 
for her age that would be safe. The child had practically 
no pain, and but a slight reaction. She could easily have 
taken the full dose, apparently. She left the hospital and 
was not seen again since. A letter received from the 
mother a month after the injection, stated that she noticed 
a marked improvement in the child’s general condition, 
although she was by no means well She had not had a 
“spell” for some weeks, and her general condition was 
highly encouraging. 
May 4, 1911, (five months after the injection) tht- 
mother wrote: “She is still very nervous, but the ‘spells' 
are less frequent and not as hard. One of her front teeth 
has grown in. She sleeps well, and looks well, but as for 
making her mind, it is almost impossible. In fact we se" 
no change in her since last writing you.” 
August 7th, the mother wrote again: “She is improving 
very much, grows stronger and better every day.” 
In view of the distinct improvement in the child’s con- 
dition soon after the treatment, some of which has stilt 
remained, a second treatment has been advised, but not 
yet acted upon. Wassermann reaction has been requested, 
but also refused. Period of observation, eight months. 
Cases in which Marked Improvement was Followed* 
by Clinical Recurrence: 
Case XXXVIII. Primary and Secondary Syphilis: F. 
W. L., male, aged twenty-five years. Primary infection of 
three weeks’ duration; secondaries just appearing. Typi- 
cal Hunterian chancre on penis, adjacent to corona. Was- 
sermann reaction, positive. November 15, l£io, at the 
People’s Hospital, received 0.43 gramme, hyperideal. Mod- 
erate pain, lasting a day or two. Secondary roseola dis- 
appeared promptly, but chancre remained hardly affected, 
as it became softer and smaller very slowly. At the end’ 
of ten days, it was excised, and subjected to microscopic 
examination, with negative result. It did not appear dif- 
ferent from the untreated chancre. All lesions then dis- 
appeared and the patient left town for a business trip. 
February 7. 1911, (three months after injection), he re- 
ported clinically well; Wassermann-Noguchi reactions, neg- 
ative. April 29th, negative. July 7, 1911, however (eight 
months after injection), he returned for observation, with 
a few small mucous patches on the lower lip. which had 
appeared a few days previously. Wassermann-Noguchi 
reactions, -)—|—h July 12th. he was given a second in- 
jection. fie received 0.6 gramme, intravenously. The 
patches disappeared within forty-eight hours. This injec- 
tion was followed by a third injection (also intravenous) 
on July 31st. On that date the Wassermann-Noguchi re- 
actions were negative. He was last seen, August. 12, 1911, 
feeling perfectly well. Period of observation, nine months. 
In this case it will be seen that the patient was clinically 
well for eight months after a single injection. 
Case XXXIX. Secondary Syphilis: S. J., male, aged' 
twenty-three years. Patches in mouth and throat for past 
seven months, resistant to mercurial injections and inter- 
nal treatment. Primary infection one year ago. Was- 
sermann reaction, -|—|~f—|— 
October 24, 1910, at the People’s Hospital, received 0.5 
gramme, hvperideal. Moderate pain, lasting a few hours. 
Went heme at the end of five days, without a trace of the 
patches, feeling perfectly well. The patient then disap- 
peared from observation, but reappeared on May 10. 1911. 
(seven months after the injection), complaining of a sore- 
ness of the throat for the preceding few days. Examina- 
tion showed the presence of two minute ulcerations orr 
the tonsils; slight papular eruption on the left forearm. 
Wassermann and Noguchi +. Refused a sec- 
ond injection. 
Here we have another case of slight recurrence, seven 
months after the injection. July 25, 1911. under slight 
doses of mixed treatment, the ulcerations have passed" 
away. Period of observation, nine months. 
Case XL. Tertiary Syphilis with Gummata: E. C. H., 
male, aged twenty-nine years. Primary lesion, nine years 
ago, on upper lip. Treated intermittently for one and one 
half year, with good result. Two weeks ago, noticed a 
thickening and redness of the tip of the nose, and simul- 
taneously a purplish thickening and ulceration of the skin, 16 
IVolbarst: Salvarsan. 
of one of the thighs. The latter broke down in several 
places. Wassermann and Noguchi reactions, strongly posi- 
tive. 
December 12, 1910, at the People’s Hospital, received 0.6 
gramme, No pain. Within a few days, the 
redness of the nose disappeared, and the gumma on the 
thigh showed marked evidence of improvement; and with- 
in a week it had entirely healed. The patient reported 
from time to time by telephone, that he was well. On 
February 7, 1911, he noticed a slight reddening of the 
nose, and went to a colleague, who found a slight positive 
Wassermann reaction. The nose improved rapidly under 
iodide and injections of gray oil. April 1, 1911, his physi- 
cian reported him clinically well. Period of observation, 
four months. 
Case XLI. Secondary Syphilis Resisting Mercury: H. 
C. C., male, aged fifty-two years. Referred by Dr. Homer 
Gibney, with this history: Primary infection three months 
ago. Several weeks ago, ulceration of the throat devel- 
oped, which persisted and grew more severe, in spite 
of continual internal treatment, with mercury adminis- 
tered by his physician. His pharynx and mouth were cov- 
ered with large and small mucous patches. Voice was 
hoarse and husky. Wassermann reaction, (-. 
March 21, 1911, at St. Mark’s Hospital, received 0.6 
gramme, intravenously. No reaction. Left the hospital 
following day, with every ulceration entirely gone. The 
recovery in this case was unusually quick and thorough. 
He remained perfectly well, until late in July, when the 
voice became hoarse again. Noguchi reaction, negative. 
July 31st, he received another injection, intravenously, and 
since then he had felt no return of the hoarseness. Period 
of observation, four months. 
Case XLII. Tabes Dorsalis: Optic Atrophy: Gastric 
Crises: Marked Ataxia: (Reported in the Interstate Med- 
ical Journal, January, 1911). J. M., male, aged thirty-six 
hours after injection, pain appeared in the legs and around 
the chest. These did not differ in any way from his ac- 
customed pains. Vomiting also set in on the second day, 
and continued for three days, after which period it ceased. 
Likewise the pains. The pain and vomiting did not differ 
in any way from his accustomed crises. 
October 28th, out of bed, in ward. Walked without a 
cane. Thought his gait was less ataxic. With his eyes closed 
sways much less than previously. Pain absent. Eyesight 
not as good as before. Examination by Dr. Rosenbaum: 
“Atrophy somewhat advanced. Vision diminished. O. D. 
Fingers at five feet; O. S. Fingers at three feet. Previous 
to injection, O. D. Fingers at seven feet; O. S. Fingers 
at five feet.” No infiltration or redness at the site of in- 
jection. 
The temperature chart shows an unusual curve (Fig. 
16). It will be seen that the patient reacted slightly on 
the day of the injection, by a lowering of the temperature 
to 98°, and on the third day there was a still further de- 
cline to 970 F. This decline was soon changed to a slight 
elevation, never exceeding 99.50. It will be seen that the 
pulse did not share in the great lowering of the tempera- 
ture. Arsenic was found in the urine eight days after the 
injection. 
November 2, 1910, he left the hospital feeling very well, 
except for his sight. He walked easily without a cane, 
though he showed a distinct ataxic gait. Gain in weight, 
four pounds. 
November 16th, came to office for observation. Walked 
without a cane. Felt much better. 
December 3d. Communication from his physician, Dr. 
Savlin, stated: “Despite progressiveness of optic atrophy, 
gait and general condition show improvement. Patient 
is inherently hysteroneurasthenic,—yet, after careful ob- 
servation, I can say that his condition has improved mark- 
edly, except his vision.” 
December 13th. Communication from Dr. Saylin, as 
follows: “Wassermann reaction. December 10th, taken by 
Dr. A. A. Thibaudeau; is positive, but less strongly so 
than formerly. As regards the physical aspects of the case, 
1 can but reiterate that there is a positive improvement. 
His gait is rather that of a blind man than that of a tabetic. 
Romberg’s symptom, which was marked three months ago, is 
but slightly so now. He has gained in weight and com- 
plains less of weakness in his lower extremities and of 
the ‘carpet’ sensation. Vesical atony which was charac- 
teristic in his case, also shows improvement. However, 
he states positively that his sight became worse and be- 
came markedly so shortly after the administration of 606. 
Tests prove him right, and this raises a question as to fu- 
ture procedure.” 
It would appear from these data that with the excep- 
tion of the effect on the optic atrophy, the treatment was 
highly beneficial. Unfortunately, a later report shattered 
whatever hope there was of a permanent improvement 
in this case. May 4, 1911, Dr. Saylin reported: 
“I saw him at his home, day before yesterday. Briefly, 
T may state that he is as bad and his eyes surely worse 
than he ever was. He is totally bjind. His gait is bad, 
his lightning pains are very severe. Vesical atony is 
again pronounced and sexual potency is impaired.” 
Here we have a case with distinct relief from the tabetic 
symptoms lasting several months, and a recurrence, with 
a loss of whatever improvement took place after the in- 
jection. It is also quite evident that the eyesight of the 
patient became much worse immediately after the admin- 
istration of the salvarsan. Nevertheless in all fairness 
to the remedy may we not ask whether the blindness 
might not have come on even without the injection? How 
are we to know how much the injection had to do with 
the rapid progressiveness of the optic atrophy? Period 
of observation, six months. 
Case XLIII. Paresis: F. S. S., male, aged forty-eight 
\ears. Referred by Dr. Daniel T. Millspaugh, of Pater- 
son, N. J. This unusual case has been described in de- 
tail in the Nezv York Medical Journal, July 1, iqii, to 
which the reader is referred for fuller particulars. Briefly, 
this was a typical case of paresis, with a distinct syphilitic 
history and a strong Wassermann reaction. October 27, 
1910, he received 0.5 gramme, hvperideal. No pain. 
The patient made remarkable progress soon after the in- 
jection, which lasted for several months. At that time, 
he was seized with a mild apoplectic stroke, which soon 
passed off, but brought with it a change in his condition. 
Fig. i6.—Illustrating Case XLII. This chart shows an unusual 
reaction, in that the temperature became subnormal on the third 
•day after the injection of 0.5 gramme salvarsan. 
years. Denied venereal history of any kind. First symptom of 
illness appeared six years ago, in the form of gastric pains, 
accompanied by occasional attacks of vomiting. Was 
treated for gastric disease until six months ago, when the 
diagnosis of tabes dorsalis was made by Dr. George J. 
Savlin, of Buffalo, N. Y. These symptoms were then 
present: Absence of knee jerk, marked ataxic gait, Rom- 
berg symptom, Argyll Robertson pupil, gastric crises with 
vomiting, shooting and lightning pains in legs. Optic 
atrophy, loss of flesh and strength. Wassermann reaction 
strongly positive. Urine negative as to sugar and albu- 
min. Was put under treatment consisting of injections 
of salicylate of mercury and arsenic. Strychnine internally 
for the optic atrophy. 
October 21, 1910, marked ataxia, necessitating use of 
two canes and other support. Stumbled in the dark. All 
diagnostic symptoms of tabes marked and unmistakable. 
Eyes examined by Dr. E. Gruening: “O. D. 3/100; O. S. 
3/200. Both normal fields concentrically limited. Abso- 
lute color blindness. Optic atrophy.” 
Examination of viscera, heart, lungs, and kidneys, nor- 
mal. Pulse 96, not very strong. Wassermann reaction, 
4—I—I—K 
At the earnest solicitation of the patient, and his as- 
suming all liability as to the outcome, he was admitted 
to the People’s Hospital. 
October 24, 1910, 0.5 gramme. No nain whatever at the 
site of injection, during his entire stay in hospital. Six IVolbarst: Salvarsan. 
17 
which became worse from day to day He finally died 
after another seizure, five months after the injection. 
Period of observation, five months. 
Case XLIV. Syphilitic Gastritis: D. S., male, aged 
Case XLVI. I abcs Dorsalis with Ptosis of Eyelid: 
C.P., male, aged twenty-eight years. Primary infection 
eight years ago. Treated eight months, and felt well until 
July, 1909. Present trouble began at that time, with ab- 
dominal pains and gastric crises, followed by shooting 
pains and numbness in feet and legs; this was soon fol- 
lowed by paralysis of the left eyelid and partial optic atro- 
phy, with eversion of the corresponding eye (Fig. 17). 
Since then he had been treated continually with mercury 
and iodides in large doses, up to the point of toleration. 
Did not respond well to the treatment. August, 1910, at 
the City Hospital, was treated with mercurial injections 
for five weeks, without benefit. 
When I first saw him (October, 1910), he was in very 
poor shape, having diminished in weight from 165 to 103 
pounds in the last six months. Pains were very severe 
and almost constant, requiring morphine several times 
daily. Bladder and rectum not under control at times; 
straining at urination constant. Romberg, Argyll Robert- 
son pupil, and ioss of knee jerk present. Wassermann re- 
action, negative. 
October 24. 1910, at St. Mark’s Hospital, he received 0.45 
gramme, intramuscularly. No pain. Two days later, the 
ptosis of the left eye had entirely disappeared, and he 
was able to move his eyelid and the eye, in any direction 
at will (Fig. 18). He had no pain in the abdomen for the 
first time in a long while. The sight in the left eye was 
much improved, and he was easily able to count the fingers 
at a distance of fifteen feet; this he was unable to do 
previously. A neurological examination made by Dr. M. 
Neustaedter, October 29th (five days after the injection), 
was as follows: “Very slight ptosis in the left eye. Par- 
alysis of the inferior and internal recti of this eye. 
Marked analgesia, no anaesthesia, deep muscular sense in- 
tact on left side of body, but affected in right lower ex- 
tremity. Ataxia in lower extremities and right upper 
extremity. Marked hypotonia in lower extremities. Diag- 
nosis : Tabes, with gummatous infiltration of the abdu- 
cens and oculomotor.” 
Three weeks after the injection, however, a gastric crisis 
set in, with severe pain and the usual vomiting. Morphine 
Fig. 17.— Illustrating Case XLVI. Complete ptosis of left eye 
for two years, resisting mercury and iodides. 
forty years. Referred by Dr. L. Lesser. Primary infec- 
tion eight years ago; at that time he received inunctions 
for several months. Then was well up to two years ago, 
when the present symptoms appeared. He had been tak- 
ing large doses of iodides and had received about sixty or 
seventy mercurial injections. He complained of pain and 
tenderness over the stomach region and general malaise. 
He had been under the care of an eminent gastrologist, 
who diagnosticated his case as syphilitic gastritis. 
There was a distinct leukoplakia of the tongue, slight 
adenopathy; pupils normal, slight Romberg symptom, and 
weak knee reflex. Wassermann reaction, -|—|—|— 
February 9, 1911, at the People’s Hospital, he was given 
0.6 gramme. Gastric contents examined immediately pre- 
vious to the injection, made by Dr. A. Bassler, proved 
negative. May 5, >911, patient reappeared for observa- 
tion ; he felt much better, though he complained of the 
return of his former pains to a lesser degree than for- 
merly. Wassermann and Noguchi reaction. H—(-, July 2, 
1911. Patient reported feeling the same as at last report. 
Period of observation, five months. 
Case XLV. Secondary Syphilis: Iritis: S. W., male, 
aged thirty-two years. Referred by Dr. J. B. Palmer. 
Primary infection, one year ago, followed ten weeks later 
by involvement of the throat. Seven months after infec- 
tion, acute iritis set in, which resisted mercury and iodides 
for a long time. At present, iritis is under control. Was- 
sermann reaction not determined, as he was still taking mer- 
cury and iodide. 
February 9, tgii, at the People’s Hospital, he received 
0.5 gramme. Slight pain. Felt fine for one month, then 
began to see dark spots before the eyes, diagnosticated by 
Dr. Palmer as neuritis. Mercury and iodides in increasing 
doses had been without any benefit. The throat had been 
perfectly well, and he had gained several pounds. Wasser- 
mann and Noguchi tests, negative. May 9th (three month' 
after the injection), he wrote: "Excepting my eyes, 1 
never felt better in my life, have a fine appetite and have 
gained six pounds.” July 15, 1911, he reported the same 
condition Period of observation, five months. 
Fig. 18.—IllustratinK Case XLVI. Ptosis of left eye relieved com- 
pletely within five days after the injection of 0.45 gramme salvarsan. 
The relief has persisted up to date. (See also Fig. 17.) 
in ordinary doses was unable to control the pain. Until 
then morphine was not required. This continued up to 
November 21st, when it w as deemed necessary and wise to 18 
VVolbarst: Salvarsan. 
give him a second injection. On that date he received 
0.5 gramme. Contrary to the result in the lirst injection, 
he at once felt a severe pain in the right leg and thigh, 
which was of the nature of an acute neuritis. This pain 
continued for a long time. His general condition gradu- 
ally returned to its former state, and he lost the fourteen 
pounds that he had gained. His eyelid, however, retained 
its improvement. Sight in the affected eye, fairly good, 
fingers being discerned at twenty-five feet. 
January 7, 1911, Dr. Neustaedter made a second exami- 
nation and found: “Ptosis markedly improved; motor 
oculi still paralyzed, optic atrophy in left eye marked. 
Gait markedly worse, patient being extremely atactic in 
lower extremities, upper extremities being free from 
ataxia. Deep muscular sense in toes of right foot en- 
tirely gone; complete anaesthesia and analgesia in peroneal 
and tibial group of muscles of right extremity. Absence 
of faradaic response in these muscles and reaction of de- 
generation present; also qualitative diminution in response 
to galvanic current. This would show that we have here 
a nerve degeneration. The trophic disturbances, such as 
bed sores and diminution in size of the right limb muscles 
and their flabbiness, and partial atrophy, would substan- 
tiate this.” 
Reports from the patient, dated February 19th, April 
10th, and July 15th, stated that his condition was about the 
same as, if not somewhat worse, than when this last re- 
port was made. Morphine was resorted to for the pain, 
and the gastric crises came on with their previous fre- 
quency and severity. 
Here we have a case which responded beautifully for 
nearly a month, followed by recurrence. There has been 
an improvement, however, in the paralysis of the eyelid, 
due to the clearing up of a gummatous process. This im- 
provement has lasted nine months, and appears to be per- 
manent. 1 o offset this improvement, however, the second 
injection, which it was hoped would increase the improve- 
ment which followed the first, actually brought on a nerve 
degeneration of the right lower extremity. Whether this 
degeneration is due to a chemical or mechanical cause, 
cannot be determined. The Wassermann reaction in this 
case was uniformly negative, in three examinations at 
various times, before and after treatment. Period of ob- 
servation, nine months. 
Case XL\ II. Tertiary Syphilis: M. M., female, aged 
forty years. History: Primary infection uncertain as to 
date, but secondaries began to appear about three years 
ago. At that time her husband was being treated for 
syphilis, and she assumes that she was infected through 
him. She has received treatment intermittently, but never- 
theless the nasal bones became involved and have under- 
gone almost complete destruction. For the past year and 
a half there had been a most obnoxious ozeena, which has 
not yielded to mercury or iodides. Wassermann reaction, 
H—I—I—h 
December 30. 1910, at the People’s Hospital, she re- 
ceived 0.5 gramme. Slight pain, which persisted for about 
ten days. Within a week the ozeena had improved very 
greatly, so that there was barely any odor perceptible. 
Unfortunately this improvement was but shortlived, and 
the ozoena soon returned. May 7, 1911, the ozeena has re- 
turned, but her general health has improved considerably. 
On June 25, 1911, the same report was made. Period of 
observation, six months. 
(d) Cases in Which no Change Followed the In- 
jection. 
Case XLVIII. Total Optic Atrophy: G. H., male, aged 
twenty-six years. Totally blind. Duration one and one 
half year. Primary infection, 1903, followed by treatment 
for seven months. Had been well since then, as far as 
syphilitic lesions were concerned. On January 14, 1908, the 
right eye became blind during the night. There had been 
no premonitory symptoms of any kind, and the blindness 
was complete. The condition was diagnosticated as optic 
atrophy due to syphilis, but it made no response what- 
ever to mercury and large doses of iodides. Seven or 
eight months later the left eye became involved in the 
atrophic process, and within two weeks total blindness set 
in. Examination of the eyes, November 15. T910, showed 
total optic atrophy in both eyes; no perception of light. 
Wassermann reaction, -|—(-. 
November 15. iqio. at the People’s Hospital, received 
0.6 gramme. Moderate pain, which became worse and 
lasted several days. On the day after the injection the 
patient insisted that he saw Hashes of light before his eyes. 
He declared that he had never seen them before. They 
were so strong and constant that they interfered with his 
sleep. Under moderate doses of veronal, given at bedtime, 
they disappeared and he was enabled to sleep. He had 
no pain in the eyes at any time. 
December 5, 1910. Patient stated he felt good generally; 
had gained seven or eight pounds; still saw the flashes, 
and was unable to sleep on that account. Sight not af- 
fected. The flashes stopped soon after this date. 
December 19, 1910, received another injection, 0.5 
gramme. Slight pain, lasting one hour. After this in- 
jection he saw no flashes, and had not seen any since. 
Wassermann and Noguchi reactions (three days after the 
second injection), _-J—|—f--f-. February 7, 1911, Wasser- 
mann and Noguchi tests, negative; May 4, 1911. Wasser- 
mann positive. Noguchi, doubtful. 
It will be observed that in this case of double complete 
optic atrophy of syphilitic origin, the remedy was of no 
avail, as was to be expected, though the patient gained 
about eight pounds. The only effect of the treatment was 
to produce flashes before the eyes, which lasted about a 
month. The Wassermann reaction was also changed from 
positive to negative or doubtful. Period of observation, 
six months. 
Case XLIX. Cerebrospinal Syphilis: Hereditary Syph- 
ilis: Third Generation: M. E., male, aged fifteen years. 
History: The ancestry of this patient was of unusual in- 
terest. Both parents were of unusual intelligence and cul- 
ture. The father was perfectly well, as far as he could 
recall, until the time of his marriage, when a cutaneous 
lesion about the genitals developed which seemed to baf- 
fle the best dermatologists and syphilographers in this 
country and Europe. Shortly after their marriage a lesion 
of a somewhat similar character developed in the wife, 
also about the genitals. This lesion has also never been 
positively diagnosticated. Since then unmistakable evi- 
dences of syphilis have developed in both parents, which 
have responded to mercury and iodides. This child was 
born within a year or two after the marriage, and when 
a few weeks old, typical symptoms of syphilis developed. 
This diagnosis was made by an eminent dermatologist in 
this city, who declared at the time that the child would 
outgrow the disease. He advised against the use of mer- 
cury. The parents were both positive as to these features 
of the history. 
The cutaneous lesions passed away under treatment, 
and for several years the child seemedi bright and normal 
in every way. But, at about five years of age, epilepti- 
form convulsions appeared which increased in frequency 
and severity. During the past four years the boy had 
had as many as twenty-five convulsions in a single day, 
all of great severity. He fell frequently, and suffered 
more or less severe injuries. For several years past he 
had been deprived of all intelligence, and had been reduced 
to the condition of an imbecile. He could not stand or 
walk without assistance. 
In the hope that something might be done, it was de- 
cided to give him an injection of salvarsan. The Was- 
sermann reaction was strongly positive. A neurological 
examination made immediately before the injection by Dr. 
M. Neustaedter was as follows: “There is present a com- 
plete right hemiplegia of a spastic character, with exag- 
geration of reflexes; clonus and Babinski sign. The com- 
plete motor and sensory aphasia point, to an involvement 
of the left hemisphere and a descending degeneration of 
the lateral tracts of the spinal cord. On the left side, the 
patellar reflex is exaggerated, sunertonus in extensor mus- 
cles of the leg, and paresis. The expression is stupid, 
intelligence dull. Tronhic disturbances: Integument of the 
nose, swollen and with a reddish discoloration; lips and 
cheeks puffed. Sphincters ani and vesiae disturbed.—in- 
voluntary defaecation and micturition. Diagnosis: Cere- 
brospinal syphilis, with secondary degeneration in the 
motor cortical region and lateral tracts, and destruction 
of the Island of Reil.” 
January 27, 1911, at St. Mark’s Hospital, he received 0.5 
gramme. He had slight pain, which increased perceptibly 
and lasted for several months. This was seen by the fact 
that he cried out in pain whenever his leg or thigh on the 
injected side was moved or handled. Half an hour after IVolbarst: Sail arson. 
19 
the injection, however, he was alile to sit on a chair, while 
his l*-d was being cleaned. 
It .appeared to those who were observing the patient, 
including hit mother, that he showed unmistakable evi- 
dences 'oi improvement in mentality for three or four days 
after the injection. His face took on a more natural color 
ami lO'-k, the puffiness disappeared, and he seemed to take 
, in f* interest in his surroundings. But he soon returned 
to,h'' former state, and remained so. 
It is interesting to note in this connection that his father 
report ,j (July 26, 1911) that the hoy was in very bad con- 
dition t® to a few weeks ago, when a period of remission 
seemed io have set in, and he had shown evidences of im- 
\ *\ -d mentality, as for instance, in being able to play 
•Pyyjk' oys, and say a few words, “mamma” and "papa.” 
■ recognized his parents. 
till further interest, is the fact that both father and 
*1avc keen under antisyphilitic treatment since this 
born: that three healthy and normal children 
after this child; and that the father had but 
|7^3>^Jgi^'‘Overed the fact that his father (the boy’s 
’ad suffered for many years with syphilis. 
1 . have apparently tlie rare condition of 
occurring in three successive generations. Period 
of observation, six- months. 
C.\sp 1. Tabes Dorsalis: Osteomyelitis of Lower Jaw: 
F. L.. male, aged forty years. Married, and the father of 
a hea hy hild two and one half years old. Referred by 
Dr. tliaries Pollock, of Brooklyn. Primary infection, 
eleven • < ars ago; was treated for two years internally, 
liar ha . no symptoms of syphilis since, except a chronic 
ab-ces: of the left lower jaw, which had resisted surgical 
and antisyphilitic treatment. Present complaint (Novem- 
ber. <)to), pains in the spine and chest (girdle sensation), 
con ng on at intervals, for the past five years. During 
thi -c attacks he was incapacitated from his work. Exam- 
inat >n: limnberg. Argyll Robertson pupil, present, loss 
of kr re rnfcx. Examination of the eyes by Dr. Vincent 
1 arher. m Stive as to optic nerve lesions. A radiographic 
pin 1 of thjleft hand (taken by Dr Harry Isaacs) showed 
** u 4J1C mst metacarpal and the second and third proximal 
pharcm.vt *. a subperiosteal deposition of bone, suggesting a 
syphilitic ’esion.” 
November 18, 1910, he received 0.6 gramme hyperideal, 
at the People's Hospital. He had moderate pain, lasting 
several 4ays. He left the hospital at the end of a wreek 
feeling Somewhat better as far as his pains were con- 
cerned. and the discharge from the sinus in the jaw 
seemed to b<* less than formerly. He then disappeared 
from \icu. 'it returned for observation, June 27, 1911. 
On exatninatii n it was found that his tabes had remained 
stationary, uninfluenced by the treatment, but the wound 
iti the iatv had improved somewhat. It was quite likely that 
a second injection might have been of great advantage. 
This he refused. Period of observation, seven months. 
In addition to these fifty cases there are three 
cases of interest which, for obvious reasons, have 
not been included in this report. 
Casi 1 Suspected Primary Chancre of the Cervix: 
Mrs. B. C- aged twenty-five years. Referred by courtesy 
>f Dr. Dougal B’sscli. at his service at the Woman’s Hos- 
•ital IB-1 Married four years, one child aged twen- 
■ ffcjiiilui, opposed miscarriage, July, 1910, of one 
' lonth. O i 1 xarfination, August, 1910. this condition was 
.resent: A coniylete procidentia, erosion of entire cervix, 
cervix \ery hard. After six weeks in bed and tamponing, 
a healthy mucois surface covered the cervix. At that 
urn; she complained of leucorrhoea, backache, bearing 
do" •• and dragging pain on left side, and rheumatic (?) 
in head, especially severe at night; enlargement of 
Vr 1 glands, o,a both sides. Wassermann reaction (Dr. 
•\a it), positive Husband admitted having contracted 
tvf idis four morths before the patient presented herself 
Bbt'eatment. 
B 1 iber 10. TQtr, at the Woman’s Hospital, she received 
gramme. Fo- several weeks she complained of pain 
K.jf iffness in tlu buttock, but this soon passed off. She 
Sne hospital Otober 28th: the cervix had resumed its 
/ .al softness. »nd she felt quite well. She has since 
Psjpeared from view. 
S.<£ II. 7 abes Dorsalis: Death Twelve Days After the 
f • ion: A. B., male, aged thirty-eight years; patient of 
Dr. D. S. Millspaugh, of Paterson, N. J. This case has 
already been fully reported in the New York Medical 
Journal, July i, 1911. Briefly, the man was injected, Oc- 
tober 28, 1910, and on the following day he went into a 
stuporous condition, suggestive of uraemia, from which he 
did not emerge. He died twelve days later, with symp- 
toms that pointed to uramiia as the cause of death. Au- 
topsy was refused. 
Case III. Inherited Syphilis: M. T., infant, two 
months old. Referred by courtesy of Dr. Charles G. 
Kerley, at the New York Nursery and Child’s Hospital. 
History: Nothing known of family history; mother 
seemed to be in fair condition. When born the infant 
weighed seven pounds, three ounces, temperature 99° F., 
condition poor. Ophthalmia neonatorum; organs normal, 
lut abdomen distended; papular eruption on whole body; 
skin dry; hands and feet exfoliated. Under bichloride of 
mercury, internally, the child did rather poorly. October 
31, 1910, on the invitation of Dr. Kerley, 1 gave the pa- 
tient an intramuscular injection of 0.033 gramme. The 
doSe was a rather small one, but it was the dose that 1 
had seen Wechselmann use in his pioneer work in Berlin 
and which gave splendid results. The infant stood the 
treatment well and within a few days most of the papules 
on the face and body had faded perceptibly. There was 
a slight temperature reaction, which lasted but a few days, 
but the infant showed no ill effect from the treatment. 
There was a slight gain in weight which lasted for some 
time, but soon receded. November 24, 1910, I repeated the 
injection, with a dose much larger than the first, namely, 
0.15 gramme. Apparently, there was some slight benefit, 
but the child was soon put on mercury again. December 
8, 1910, the child died. Cause of death not given. 
CONCLUSIONS. 
As a result of a study of these data vve may con- 
clude : 
1. Of fifty cases, studied clinically for periods 
varying from three to ten months (an average of 
6.4 months), after a single injection, twenty-seven 
(54 per cent.) may be considered clinically 
“cured”; ten (twenty per cent.) improved material- 
ly, and have not yet suffered recurrence; ten 
(twenty per cent.) improved, but developed clinical 
recurrence later; three (six per cent.) showed no 
change as a result of the treatment. 
2. When clinical recurrence took place it oc- 
curred most frequently in the first three months 
after treatment. Evidently one injection was not 
sufficient to produce the desired result. One case 
recurred after seven months, and one after eight 
months. Repetitions of the treatment should be 
given within one month, to insure the best results. 
3. The Wassermann reaction remained positive 
in thirty-three per cent, of the cases, and became 
negative and remained so in thirty per cent, of the 
cases for periods averaging four to five months. 
4. I11 the cases considered “cured,” the reaction 
became negative in forty-one per cent., and re- 
mained positive in thirty per cent.; in the cases 
which improved without recurrence, forty per cent, 
became negative and twenty per cent, remained 
positive; of the cases improved, with recurrence, 
thirty per cent, became negative and fifty per cent, 
remained positive. This showed that the Wasser- 
mann reaction is more likely to change from posi- 
tive to negative in cases which also respond clini- 
cally to the influence of the remedy than in cases 
which do not show this favorable result. 
5. The positive reaction is apt to remain unin- 
fluenced in cases in which clinical recurrence takes 
place. 
6. In the primary cases the reaction became neg- 
ative in thirty-three per cent., and remained posi- 20 
Wolbarst: Salvarsan. 
tive in fifty per cent, of the cases; in the secondary 
cases the reaction became negative in fifty per cent., 
and remained positive in thirty-six per cent, of the 
cases; in the tertiary cases the reaction became 
negative in fifteen per cent, and remained positive 
in twenty-two; in the parasyphilitic cases the re- 
action became negative in fifty per cent, and re- 
mained positive in forty per cent, of the cases. 
7. The therapeutic effect of a single injection of 
salvarsan is equivalent in potency to a course of 
mercury and iodides, in a large proportion of cases. 
This is particularly true in primary cases and in 
cases which have not responded previously to vig- 
orous treatment with mercury and iodides. We 
have in this new remedy the most powerful and 
trustworthy medium for the conquest of syphilis 
that has ever been known. It will not entirely sup- 
plant mercury and iodides, but it will undoubtedly 
take its place as the foremost remedy at our com- 
mand. We are still in ignorance of the best method 
of using salvarsan; we do not know the maximum 
curative dose, nor do we yet know the best method, 
nor how often it should be repeated. All of this 
information will come to us within a reasonable 
time, and we shall then be better able to ' of 
its permanent value. Of one thing we 
certain, namely, that salvarsan has come to 
and that it will certainly play the principal rG, . 1 
the conquest of syphilis. 
I desire here to tender my thanks to Gehdmrat 
Professor Ehrlich for the generous supply o\ 
remedy which he placed in my hands last Oct 
which made possible the treatment of the * 
herein reported; also to the members of the 
of the People’s and St. Mark’s Hospitals, for- 
courteous cooperation in the observation and 
of these cases, and to Dr. M. Neustaedter ? ' 
M. Rosenbaum, for their neurological 
moscopic examinations, respectively 
113 East Nineteenth Street,