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Article
June 1914

THE INTRAMENINGEAL TREATMENT OF TABES AND CEREBROSPINAL SYPHILIS

Author Affiliations

BALTIMORE

From the Medical Clinic of the City Hospital at Bay View.

Arch Intern Med (Chic). 1914;XIII(6):970-977. doi:10.1001/archinte.1914.00070120132011
Abstract

The treatment of syphilis of the central nervous system has always been unsatisfactory. The cerebrospinal system is a closed one, and the diffusion of drugs from the circulating blood into the cerebrospinal fluid is slow and incomplete. For this reason organisms which have invaded the nervous tissue or meninges remain more or less protected from the drugs which may be present in the vascular system. For a number of years the desirability of the direct application of antisyphilitic drugs has been recognized. Horsley1 went so far as to advocate the "heroic" treatment of opening into the subdural space and washing out with mercuric chlorid (1:1,000) solution, but this procedure proved too irritating. With the advent of salvarsan and neosalvarsan, hope was entertained that this therapeutic agent could be injected intraspinally ; but investigation showed that it also damaged the tissues. Wechselmann2 found that small amounts (1 mg.) when

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