General Preventive Measures

In

192o Sazerac and Levaditi showed that tartro-bismuthate of potassium and sodium is more powerful than mercury in de stroying the spirochaetes of syphilis, and a large number of bismuth preparations have been placed on the market since it was found that it is the metal rather than the compound which matters in the therapeutic action. Generally it can be said that bismuth injections effect more towards the cure of syphilis than do mer curial and that preparations of bismuth can be used which cause less discomfort than do any mercurial.

Bismuth is useless for the cure of syphilis if given by the mouth and its injection into veins is practised very little on account of its greater toxicity when administered by this route. Bismuth is gen erally considered to be an adjuvant rather than a substitute for arsenobenzol treatment. It is retained in the tissues for long after a series of injections has been given, and it thus prolongs the anti syphilitic effect after all the arsenobenzol has been excreted.

The powerful effect of the arsenobenzol and bismuth com pounds on the germ of syphilis has led to a number of experiments to determine whether or not they prevent the development of syphilis after inoculation.

There is strong evidence to the effect that a few arsenobenzol injections given after contamination with syphilitic virus does protect against the disease. Kolle has produced experimental evi dence tending to show that the injection of bismuth carbonate protects against infection resulting from inoculation with syphilitic virus so long as the compound remains in the muscles. Rabbits treated thus proved resistant to inoculation with syphilitic mate rial for as long as 109 days after injection of the bismuth.

The disadvantage of injections as a method of preventing syph ilis after venereal risk led Levaditi to try an arsenical compound called stovarsol or acetyl-oxyamino-phenyl arsenic acid, which is administered by the mouth. There is good evidence that the ingestion of stovarsol in suitable doses prevents infection, but considerably more work on the subject will be necessary before stovarsol can safely be given to the public as a prophylactic against syphilis.

General Paralysis of the Insane.

A great advance has been made in the treatment of a form of syphilis which is acknowledged to be the most incurable of all, namely general paralysis of the insane. This disease is one which has almost always ended fatally, defying the most intensive treatment by anti-syphilitic remedies. Its course is marked by remissions of varying length, during which the patient may appear to have recovered. It has been known for a century or more that an intercurrent infection ac companied by fever often results in a long remission, and this knowledge has led Wagner von Jauregg and his colleagues in Vienna since 1887 to inoculate patients with a variety of sub stances designed to make their temperatures rise. The best of all the agents has proved to be the parasite of benign tertian malaria and since its introduction in 1919 the method has been tested all over the world. The results have been very encouraging. The inoculation is by injection of malarial blood or by the bites of infected mosquitoes, and eight to twelve attacks of fever are allowed before quinine is given.