The treatment for neurosyphilis according to the viewpoint of the authors is treatment for syphilis. It is necessary in order to cure a case of neurosyphilis to cure the syphilis in the patient. Accordingly, the methods of treatment best adapted for the cure of syphilis are indicated in the treatment of neurosyphilis. As experience shows that it is often more difficult to cure the neurosyphilitic cases, treatment will have to be pushed with greater intensity than in some non-nervous system syphilis. In general, then, the methods that have been applied by the syphilologist will be used in the treatment of cases of neurosyphilis. In addition, methods attempting to bring the drug into local contact with the central nervous system have been devised. The methods of treatment have been in part indicated in Chart 27.

The method chiefly used in treatment of the cases of this book is what we have called intensive systematic intravenous treatment. The treatment consists of intravenous injections of salvarsan (or a substitute for salvarsan, as arsenobenzol and diarsenol) given in a dose of about 0.6 gram and repeated twice a week over a period of a number of months. In addition, injections of mercury salicylate averaging 0.065 gram once a week are given and potassium iodid by mouth. As indicated, the important point is to keep up treatment for a long period of time. This method has produced practically no untoward results, certainly no more untoward results than are to be expected with salvarsan in smaller quantities and it has seemed to us that the therapeutic results have been as satisfactory as in any other form of treatment.

Specialized forms of treatment intended to place the drug in contact with the central nervous system may be described under the headings of spinal intradural treatment and cerebral subdural and intraventricular treatment.

Three main therapeutic agents have been largely used. These are (1) salvarsanized serum according to the method of Swift-Ellis (in vivo). The serum according to this method is prepared as follows: An intravenous injection of salvarsan is given to a patient and blood withdrawn at the end of one-half hour. This is allowed to clot. The serum is removed and after inactivation at 56° C. for one-half hour it is ready for use. The average dose is 15 to 30 cc. of serum. As a matter of fact, it is not necessary to use the blood serum from the same patient to whom the intraspinous injection is to be given. (2) The salvarsanized serum according to the method of Ogilvie (in vitro). Blood serum is prepared from any patient and to it is added salvarsan in such a strength that the amount to be injected, 10 to 30 cc. of serum, will contain 0.0001 to 0.001 gm. (3) Mercurialized serum according to the method of Byrnes. Mercury bichloride is added to blood serum in such proportion that the amount of serum to be injected will contain from 0.00065 gram to 0.0026 gram.

The method of intraspinous injection is to perform lumbar puncture, withdraw an amount of fluid approximately equivalent to the amount to be injected; then allow the serum to be injected to run in by gravity.

For the cerebral, subdural and intraventricular injections, the same sera may be used as for the intraspinous. Five or six times as much salvarsan may be given, but a smaller amount of serum may be advisable, that is, 10 to 15 cc. To perform injections a trephine opening is made in the calvarium about the size of a dime. The location of choice for the opening is slightly back of the longitudinal prominence just to the right of the median line, to avoid the frontal sinus. For subdural injections a curved needle is thrust between the dura and the brain and the serum allowed to flow in slowly by gravity. For the intraventricular injections a blunted spinal puncture needle is thrust through the brain substance into the 3rd ventricle. When the 3rd ventricle is reached the clear cerebral fluid will flow out; then after withdrawing a sufficient amount, the serum may be introduced by gravity. The trephining may be done under local anesthesia but as a rule it is better to induce general anesthesia. The subsequent injections can be made without recourse to any anesthesia whatsoever, as they are practically painless.

All procedures both in the injections and in the preparation of sera are naturally to be performed under aseptic conditions.