The investigations that have led us to employ specific vaccines and antisera in the treatment of general paralysis and tabes dorsalis have been the subject of several previous papers, the last of which formed the basis of a discussion at a meeting of this Association on May 16th. It is necessary, however, to state here in a few words the more immediate reasons which seemed to us some eighteen months ago to justify the undertaking of these experimental observations of therapeutic aim. Prior to their initiation we had definitely ascertained that a threading diphtheroid bacillus, isolated from the brain and the bronchus of a rapidly progressing case of general paralysis, was capable of producing a subacute disease in rats, in which the symptoms were distinctly comparable to those of general paralysis, that on postmortem examination of the animals the brain showed the characteristic changes of general paralysis, and that there was also the characteristic invasion by the thread form of the bacillus. It was thus evident that among the various species of diphtheroid organisms that can be isolated from a general paralytic there is at least one capable of producing the disease general paralysis. We had also ascertained numerous facts which harmonised with this view. We had obtained cultures of a diphtheroid bacillus from the brain of the general paralytic in ten out of twenty-four cases; and whilst attempts to cultivate the organism from the blood and cerebrospinal fluid of the living patient had, as in the experience of most other observers, been in most instances entirely negative, we had succeeded in obtaining pure growths from the blood in four cases and from the cerebro-spinal fluid in two. We had also ascertained that diphtheroid bacilli, in a more or less advanced state of disintegration, are frequently recognisable in these fluids, even when a culture cannot be obtained, and that such altered bacilli are almost constantly present in the walls of the inflamed vessels of the brain in cases dying in a congestive attack. We had also evidence of the occurrence of a diphtheroid cystitis in all of several cases of tabes dorsalis examined, and of the existence of a high intracorpuscular bacteriolytic index to certain diphtheroid bacilli on the part of such patients and of general paralytics, which we interpret as denoting that they were defending themselves against the attack of an organism of this kind.
An Address on the Early Recognition of General Paralysis of the Insane, and the Relations between this Disease, Tabes Dorsalis, and Disseminated Sclerosis
