Baalim and Ashtaroth
Paradise Lost, Book I, line 422.
VII. SUMMARY AND KEY
No more important human problem now exists than syphilis. Syphilis of the nervous system or, briefly, neurosyphilis is a highly important fraction of the total problem. The few outstanding dates and items which we present on the following page give but a faint idea of the amount of observation and thinking which the medical aspects of neurosyphilis alone have required. The present work deals with but a small fraction of the results of this work, nor can we more than glance at the scientific history of syphilis and neurosyphilis—a history that would form an epoch in itself.
It is only in the most recent years that syphilology and the narrower science of neurosyphilology have threatened to become separate disciplines boasting full time specialized workers. Up to recent years the contributions to the theory of syphilis have been largely by-products of work in larger sciences and arts. Thus, the cellular pathology of syphilis as worked out by Virchow and the more special vascular features as worked out by Heubner were incidental in the progress of pathological anatomy and histology. The bold procedure of Quincke in proposing lumbar puncture also had its more general ground in the extension of clinical medicine,—an interpretation likewise true of the French achievements in the cyto-diagnosis and chemical diagnosis of the lumbar puncture fluids. The careful histological definitions of the Nissl-Alzheimer group were incidental to the application of approved and classical pathological methods to neurological and psychiatric material.
Again, the work of Schaudinn, as well as that of Metchnikoff and Roux, was ingenious work with the methods of parasitology and experimental pathology. The great work of Schaudinn in establishing the constancy of the spirocheta pallida in syphilis may be said to have started syphilology as something approaching a special discipline. The ideas of one of the greatest of immunologists, Bordet, were almost immediately applied to the serum diagnosis of syphilis by Wassermann and the further application of this method to the problems of neurosyphilis was almost immediate, with the spirocheta pallida as an object of attack. The commanding intelligence of Ehrlich could at once seek application of long incubated ideas of chemotherapy with the startling outcome, salvarsan.
| DATES, NEUROSYPHILIS | ||
| VIRCHOW | PATHOLOGY | 1858 |
| HEUBNER | ENDARTERITIS | 1874 |
| QUINCKE | LUMBAR PUNCTURE | 1891 |
| RAVAUT, SICARD, NAGEOTTI, WIDAL | CYTODIAGNOSIS, C.S.F. | 1901 |
| WIDAL, SICARD, RAVAUT | ALBUMIN, C.S.F. | 1903 |
| METCHNIKOFF AND ROUX | TRANSMISSION TO APES | 1903 |
| ALZHEIMER | HISTOPATHOLOGY, BRAIN SYPHILIS | 1904 |
| SCHAUDINN AND HOFFMANN | SPIROCHETA PALLIDA | 1905 |
| WASSERMANN, NEISSER AND BRUCK | SERUM DIAGNOSIS | 1906 |
| PLAUT | WASSERMANN REACTION, C.S.F. | 1908 |
| EHRLICH | SALVARSAN | 1909 |
| SWIFT AND ELLIS | SALVARSANIZED SERUM | 1912 |
| NOGUCHI AND MOORE | SPIROCHETES, BRAIN TISSUE, PARESIS | 1913 |
| LANGE | GOLD SOL TEST | 1913 |
| Chart 28 | ||
The history of syphilis and neurosyphilis was now to be thickly sown with ideas and results growing from the achievements of Schaudinn and Ehrlich. The positive reactions in the blood and spinal fluid in the most striking of mental diseases, general paresis, led to the impression that general paresis itself might at last be proved to be what Mœbius had suspected, namely, 100% syphilitic. We know how difficult is the technical proof of spirochetosis in the brains of general paretics both post mortem and ante mortem, but no one doubts the certainty of the syphilitic hypothesis concerning the origin of general paresis.
The data of the gold sol reaction ultimately obtained from the ideas of Thomas Graham concerning colloids, as developed by Szigmondi and effectively applied by Lange, have broadened and solidified the whole plane of attack.
The ingenious suggestions of Swift and Ellis (salvarsanized serum) and the notable work of Noguchi and Moore (spirochetosis in paretic brains) indicate to us as Americans what the establishment of scientific institutes may do to permit the rapid application of new ideas to branches of inquiry that are opened out. Scientific institutes do not manufacture a Virchow, a Metchnikoff, a Schaudinn, a Bordet or an Ehrlich but they directly permit such men to work and indirectly stimulate the development of more.