PROGRESSIVE GENERAL PARALYSIS
Quadriplegic Dementia — One of the most serious and more frequent ailments is Progressive General Paralysis or Quadriplegic Dementia.
In the XVIII century it was not known completely that the brain intervened in all mental symptoms.
In 1822, Bayle, a French doctor, was the first to suspect, without being able to demonstrate it, that this disease was of syphilitic origin. In the same year, he published a paper under the title of “Investigations on mental diseases”. Within some paragraphs of his description he said: “In the first stage, speech and walking disorders, intellectual weakening and maniac delirium; in the second, movements of the tongue and the lips are sometimes difficult, general delirium with delirious ideas; in the third, dementia and increase of partial paralysis. The second period can be missing completely. In the third period appear apoplectic or epileptiform attacks...”.
The anatomo-pathologic lesions, according to Bayle, were of chronic meningitis. To the French school represented by Bayle we owe the description of this new disease accepted everywhere as a new pathological entity. Because of their great importance, as of the year 1850, the investigations on Quadriplegic Dementia, clinical as well as anatomo-pathologic, corresponded to the German school. Esmarch and Jessen made fundamental investigations and verified its intimate relation with syphilis. In 1891, Quincke discovered lumbar puncture (spinal tap), whose importance in the diagnosis and treatment of Quadriplegic Dementia has been of prime importance. In 1905, Schaudin discovered the pale spirochete as the provoking agent of Syphilis. And a year later Wassermann discovered the sero-reactions that, although not definitive, without a doubt brought us a step closer to the diagnosis of the disease.
In 1904, Nissl published his famous investigations on the histologic alterations of the brain in Quadriplegic Dementia. In 1906, Plaut and Lange conducted special investigations in the rachidian fluid, of much importance for the diagnosis of Quadriplegic Dementia. Noguchi was first in demonstrating the presence of Treponema in the brain of patients with Quadriplegic Dementia. Later Levaditi and Marie showed that this presence of Treponema was constant in these patients. In 1919, Wagner managed to turn aside the fatal course of the disease, but not its cure. He uses the application of electrical currents of high frequency causing artificial fever, under the name electropyrexia. Finally, we will relate the works that we undertook more than 20 years ago, in the effective, quick, and radical treatment, of all syphilis manifestations.
With these investigations, we saw its etiology clarified. The Disease of Bayle was named after him. Quadriplegic Dementia, General Progressive Paralysis, diffuse chronic Meningo-encephalitis, chronic diffuse Periencephalo- meningitis, are names that characterize this disease which produces: demential syndromes, various very precise neurological disorders, serologic changes in the cerebrospinal fluid, and cerebro-parenchymatous lesions due to the Treponema.
Years ago we thought that a small fraction of the syphilítics were evolving towards Quadriplegic Dementia, but the times have changed, and now a great majority of the syphilitic patients are heading towards that disease. Is it caused by the anguishes produced by a more difficult life? Is it caused by the continuous fright of constant wars? Is it caused by insufficient nourishment? Is it caused by the successive transmission of the Treponema through several generations? Finally, the fact is clear, there are now more General Paralytics than there were a few decades ago, in spite of the propagation of Malaria with which we pretend to fight this disease, at least in our country (Mexico). In spite of the great prophylactic measures, which are certainly effective; in spite of the exact knowledge of how, who and when the infection of this disease takes place.
It has been theorized that a special Treponema exists, which has an affinity for the nervous system. And for this reason it is called neurotropic, in contrast to the one that has an affinity for the skin and mucous which is called dermotropic. The observation of an infinity of cases has come to verify that such fact cannot be made definitive. Any form of Syphilis can cause General Progressive Paralysis.
What is demonstrated with certainty is that the individual can be ready to contract this form or localization by inheritance or predisposition during his life. Families of General Paralytics can exist because the hereditary predisposition is already there. The general rule of Pathology is that in any infection, the more sensitive and weaker organ is the one affected. Because of this, it is logical to think that the individual born of parents who have suffered some form of Neurosyphilis is most prone to contract Quadriplegic Dementia. By inheritance the individuals who have had in their ancestors some mental case —like schizophrenia, epilepsy, etc.,— congenitally bring endogenous factors which are going to be united by the same affinity for exogenous factors.
The disease can appear between 5 years after the primary lesion was contracted up to forty years later. Normally, it appears in the adult or the elderly, but this does not mean that there is no Juvenile Quadriplegic Dementia. The social characteristics of this disease are that it appears when the individual, not knowing that he is a carrier of syphilis, has created a home, has arrived to the apex of his activities, and has begun to gather the fruit of all his efforts. The same work has contributed to accelerate the Quadriplegic Dementia. Lately, he has become more active, hard working, successful in all his affairs, which according to relatives and friends has produced nervous exhaustion. And as a result of this exhaustion, he begins to lose his memory, and sleep. Many mental disorders attributed to excess work are more frequent in a man. Many dementias or schizophrenias have happened this way and they are nothing more than Paralytic Dementias. Many reactions in the cerebrospinal fluid, which are not shown in the blood, are negative and correspond to patients of Quadriplegic Dementia. Due to the existing belief by the great majority of doctors that the reactions in the cerebrospinal fluid are a matter of fact, relying on these results, therapeutic failure happens quickly, and the disease continues progressing to end in a few days, with the loss of the patient’s life. It is necessary to make the observation that no patient of General Progressive Paralysis gets cured. It has only been managed with classic medicine, avoiding a quick death, but not stopping the fatal course of this disease. With more careful observations, one realizes that we have only managed to make the acute stage pass quickly, that is to say, the period of great excitement, and soon the patient passes to the chronic stage, the state of dementia. Speaking in other terms, having obtained the social recovery of the patient, but not the cure and the return to the total capacity of all his mental activity. Surely most of these patients do not return to work, nor carry out the social function they were carrying out before the disease appeared. A certain mental incapacity exists in them that precludes their previous activities; and these mediocre results are observed when the patient has arrived at the very beginning of the disease. In all the cases in which there has been a certain progress of the disease, and the classic treatment was applied, after a few months, no improvement has ever been obtained.
Actually, laboratory investigations do help extraordinarily the early diagnosis. But the cases are many whose clinical discovery is very difficult, because serologic paralyses without clinical signs exist, as well as clinical paralyses without serologic signs. Only great experience with this type of disease can insure the exact diagnosis. At the end of this chapter we will describe clinical histories where we will be able to observe this truth with dazzling clarity.
In the great majority of cases, the beginning of Quadriplegic Dementia passes unnoticed, of course long before the incipient pathognomonic signs. Consequently, speaking of prequadriplegic symptoms, understood as such, those of the cerebro-spinal syphilitic are precisely not those that are going to indicate to us that a Quadriplegic Dementia will appear. These can appear years, and even lustrums before clarifying the diagnosis. Indeed, the psychological symptoms can precede the disease by two, three, and even more years. And these are undetermined, such as irritability, inquietude, indifference, agitation, decrease of memory, increase of cerebral fatigue, migraines, paresis, and other symptoms that are not in any way typical of the disease. Of course only the antecedents and a good clinical study can make one suspect this serious disease, and for greater inaccuracy in the diagnosis, the examination of the cerebrospinal fluid does not yield any data. Generally, one does not think about Quadriplegic Dementia, when the enumerated symptoms appear, because it is frequent to attribute this clinical picture to alcohol excesses, domestic misfortunes, bad economic situation, failing businesses, etc., without being able to tell the true meaning of these symptoms, until the case becomes more advanced and seizure or vertigo spells are taking place.
Gradually, and attributed to diverse causes, the disease is progressing in spite of the doctor and his medications. The psychological symptoms are increasing, without the appearance of neurological signs that could shed more light in the diagnosis. One thinks about neurasthenia. The patient continues complaining of polymorphous and indefinite annoyances, bad temper, lack of sleep, fatigue, irascibility, irritability, mental fog, his daily problems cost him more work to solve them. His work, in these conditions, is a real sacrifice, etc., etc. We must immediately suspect Quadriplegic Dementia when this continues progressing, and when the patient is an adult or close to old age. During this period the patient is perfectly aware of his disease, realizes the changes of his character, the loss of his mental capacity; he calls himself neurasthenic or hypochondriac because of excess of work or the preoccupation of a difficult life. This clinical picture is the most frequent, but some well taken statistics give the following data:
23% of the cases have symptoms approaching irascibility, irritability, and change of character; 17% incapacity, negligence, confusion, psychic asthenia; 10% loquacity, good humor, unconcerned, ideas of grandeur, great designs; 9% loss of memory, mental incapacity, forgetfulness, indifference; 8% anguish, melancholic thoughts, sadness, mental confusion, difficulty in reasoning; 4% effective stupefaction, indifference, reserved and quiet character; in 14% appear seizures; and only 8% are showing neurological signs that make it possible to make the clinical diagnosis. It is during the presentation of these symptoms that classic medicine has some effect. And not in all cases, because in the great majority, in spite of the use of the various classic fevers, continue to appear more and more symptoms until the patient reaches true Quadriplegic Dementia. This is the period that many doctors claim, where they can apply with some results all the antisyphilitic drugs, along with all the fevers. It is here that can be made the precocious diagnosis of the disease. It is said among psychiatrists that it is in this state of the disease, even when the treatments are applied efficiently, that very few of the patients who were observed, in Mexico as well as in the United States, have obtained the real cure.
Unconsciously, the patient is passing from the prodromal period to the period of acute disease. All the symptoms are increased. Sometimes remissions coinciding with the application of some medication are observed, as well as spontaneous exacerbation. The slow development of the anatomo-pathologic, meningo-encephalic lesions coincides with the appearance of the symptoms. In these cases, exploration demonstrates neurological signs that are fundamental to the disease. For example, tremors of facial and tongue muscles appear, lack of photomotor reflex, or at least diminished hyperflexion of the tendinous reflexes. And can at the same time, the specific reactions in the cerebro-spinal fluid can be positive.
One of the interesting phases of the diagnosis is when the patient has lost consciousness of his mental state, and that neurasthenia he was complaining about, he is no longer aware of. As of this date, he believes he is already cured of all his ills; however they are more accentuated, and more mental symptoms are appearing. The fundamental difference is that the neurasthenic fights and obeys all the therapeutic indications of his doctor; however the General Paralytic ignores all the prescriptions, pretends having been already cured with the medications prescribed, and feels perfectly sane of body and mind.
The irritability of the General Paralytic is characterized by his gradual exacerbation, and the disproportion between the cause and such resulting violent reaction, contrary to the education and the character of the personality prior to the disease. We observed that a calm individual, kind, and courteous, becomes, for insignificant reasons, abrupt, crude, and insulting with his dearest beings. The quadriplegic does not behave like the healthy man who soon regrets and asks for forgiveness, because he does not remember such facts and life continues as such. Stable amnesia continues its progress and brings back these very important forgotten and confused symptoms when this happens around age forty; adding greatly to the distraction and the common forgetfulness of people of a certain age. These errors increase in frequency, in number, and importance, without trying to correct them because of the lack of consciousness of all his acts.
There are frequent cases in which the quadriplegic has, at the beginning, a hypomanic episode mainly characterized by the exaltation of the sexual instinct, tendency to crude jokes, procacity, words too obscene, preposterous projects, ruinous businesses, the cohabitation with the first stranger or with the first harlot he meets, to the acquisition of useless objects, to perpetrate absurd thefts in places he visits, to appear in public places with out-of-fashion clothes that cause laughter, saluting strangers familiarly, engaging conversation with the first stranger who comes along and sharing his most intimate secrets with him. The paralytic, like the normal man, activates his fantasy, but only the quadriplegic expresses it, losing control, expressing himself aloud, and exaggerating like a pleasant entertainer; he is a true actor. The repeated rudeness is not more than the reflection of the illness, the loss of self-criticism, that prevents him from judging his situation correctly, and the incapacity to use the rules of politeness as guidelines. It is a kind of dream in which is lacking the control of education and social rules.
Among the neurologic syndromes of Quadriplegic Dementia, are alterations of the pupil; very early and almost always during the period of acute disease, they are the first observed. A series of ocular manifestations, some of them very frequent, that demonstrate a predilection in the attack of the disease on the apparatus of vision, and paralysis of the common oculomotor nerve. Manifested by a drooping of the upper eyelid (Ptosis); expansion of the pupil that is not contracted with stimulation; paralysis of the trochlear nerve, manifested by diplopia by the paralysis of the oblique muscles. Before the mental disorders appear, and the paralysis of the trochlear and common oculomotor nerves already exists, the doctor should always think that the etiologic cause of these evils is syphilis. We have observed some patients who were first consulting ophthalmologists for months and years. And in spite of the medications the disease continued progressing until falling into Quadriplegic Dementia for lack of diagnosis.
One of the symptoms of major importance in the eye is the atrophy of the pupil that appears quite often in some forms of Neurosyphilis, (General Paralysis, Tabo-Paralysis and Tabes).
The cardinal signs of the ocular alterations are: anisocoria and pupil deformations; extinction of the pupillary reflex with relative conservation of accommodation.
Another one of the first clinical signs in another sphere is dysarthria; its diagnosis is of such importance that for some authors it is almost a pathognomonic sign. Dysarthria or arthrolalia difficulty of the spoken word, usually appears from the beginning of the affection. But if we do not make a careful examination, it happens unnoticed and only when the disease has progressed can he who listens carefully to the patient become aware of it. Known by all the doctors, there are tests used to put in evidence this speech alteration. It is important to catch the disorder during the conversation without resorting to the classic test words, since often the intervention of some factors can cause a dysarthria that does not really exist. It is frequent since in maniacs, neuropaths, and lunatics of another origin appear alterations of emotional origin, distraction, or lack of attention. The intensity of dysarthria progresses with time, getting some patients to display an incomprehensible language. Dysarthria has psychological components; it is not only motor but is also an alteration to more than one component of the thought process or of conception.
Tremor can be considered as one of the constant symptoms of the disease, beginning in the face, particularly in the peribuccal muscles, in the tongue, and sometimes extending to upper limb muscles. It reminds one of the alcoholic’s tremor, fine, rapid, increasing when carrying out delicate movements. It is frequently confused with Parkinson’s tremor, with the beginning of Multiple Sclerosis, and with some poisonings, above all alcoholic.
We have pointed out the three main syndromes: tremors, dysarthria, and ocular disorders. They can appear separately, without the least trace of another, or with some of the others. In our practice, what we have observed more frequently have been ocular disorders without the patient’s awareness, appearing much before the mental disorders. The confusion of some doctors wanting to attribute these disturbances to ocular problems only, without any connection to syphilis, has also been frequent, which has always been fatal to the patient. For this reason we must repeat that when there are progressing ocular disorders, we must always think about Neurosyphilis and more particularly about Quadriplegic Dementia.
The simple loss of consciousness, and more particularly if it is accompanied by cyanosis, tachycardia, and stertors, lasts only a few minutes. These are accompanied by clonic convulsions. Seizures can be of two types: apoplectic or epileptiform. In both cases it is not rare to observe pareses or hemiplegias, generally transient.
The exaltation of the patellar reflexes is common to the beginning of the disease; the cutaneous reflexes usually remain normal.
The main symptom of Quadriplegic Dementia is the weakening of the intellectual faculties; weakening of the judgment, revealed by absurd conduct to which contribute the unawareness of his situation, increase of suggestibility, delirious ideas, and the absence of all concept of disease. The progressive indifference, absence of affection, absolute lack of self-criticism, complete loss of ethical and aesthetic concepts, all this together with the lack of will power, is triggered by the smallest difficulty. In summary, the General Paralytic presents certain stupid dullness of a very characteristic pattern that differentiates it from the other dementias.
In certain types of patients appear hallucinations, mainly acoustic and visual. But they are also observed with gustatory, olfactory, and sensory hallucinations that do not represent more than the conscience of the deep personality of the patient, i.e. his fears or his yearnings. The content of the hallucinations is analogous to dreams, the satisfaction of instincts, that in the General Paralytic is expressed without the control of the outer world that judges him.
In order to understand with greater clarity the symptoms presented by the General Paralytic, we must give a slight glance to the lesions that have occurred in the nervous centers.
Observed macroscopically: thickening of the meninges, their adhesion in certain points, and the Pia Mater is sometimes so adhered that in trying to separate it, a little at the time, the brain withdraws. The cerebral circumvolutions are seen squashed; this is the reason why in the slices they are observed shrunk. The cavities of the ventricles are increased, with the surface rough and uneven, due to an ependymitis process.
Seen microscopically: arteritis lesions, miliarias aneurysms, the capillaries are almost empty of blood; however the perivascular lymphatic spaces are full of leukocytes and red blood cells. These vascular lesions bring as consequence parenchymatous alterations; proliferation of neuroglia and therefore defective nutrition of the noble nervous elements, that is to say of the nerve cells (neurons), ending up with their degeneration.
The nerve cells become deformed, lose their stamina, get fragmented and atrophy, they undergo pigmentary or fatty degeneration and they tend to take an oval shape; their protoplasm takes a vitreous aspect and fills up with vacuoles. All the nerve fibers of the cortex diminish considerably. As the disease is progressing, all the lesions progress to end up in sclerosis and atrophy of the cerebral cortex. When medullar symptoms exist, there are also lesions in the posterior cord and the pyramidal tract of the medulla.
Generally the lesions are in agreement with the symptoms presented by the patient. At times it will be the alteration of the vessels that will appear first, and at other times, those of the nervous elements and their envelopes. Summarizing, the histology lesions are: hyperplasia of neuroglia, regression of cerebral parenchyma, and accidental localization of infiltrative/inflammatory character.
The course of Quadriplegic Dementia is progressive towards dementia, as its name indicates it. But the display of diverse marginal symptoms and their predominance in the clinical state allow us to distinguish several clinical forms. A precise form during the whole evolution of the disease is not observed all along the illness, nor is the symptomatology the same. We will describe the most frequent: the simple demential form, characterized by the rudeness in social and professional conduct, amnesia in daily acts, negligence in cleanliness and wardrobe, lack of self-criticism and judgment even for the simplest problems. These patients exhibit a combined stupid euphoria with affective lability, caprice, and egoism, or frequently combined with irritability when his desires are not acceded to or when his will is opposed. However he easily accepts opposite opinions to those he has held, without discussion. The euphoria is simple, accentuating more the dullness and indifference that little by little sink more into dementia. The widespread form was typically described in the classic case by Bayle: it is characterized by alternating unexpected and abrupt beginning of euphoric excitation or melancholic depression; loquacity, exaggerated activity, showed by purchases disproportionate to the means of the patient who immediately gives away the acquired objects, wastefulness and prolixity, abuses of all inclinations, with grandiose ideas. He is the true megalomaniac, feeling like the king of kings. They are owners of thousands of millions, the owners of the universe. In another sphere they are champions who with a single punch have defeated one by one all the rivals in power; or they have had hundreds of children. With the progress of the dementia, the conversation reduces its field and they only maintain some monstrous ideas, always the same ones. Since he is highly suggestive, we can amplify to his fabulous ideas in the form we want, with great conviction on the part of the patient of the veracity of everything that is said to him, not realizing the real misery in which he lives. One characterizes this type by the propensity to remissions and spontaneous relapses.
The depressive or melancholic forms of Quadriplegic Dementia have an insidious beginning of neurastenoid type, gradually transforming itself into a pure depression, whose main characteristic are delirious depressive ideas. The patient has committed the greatest sins of the world, is the gangster among the gangsters, is lost and completely ruined; his debts are immense and are up to hundreds of millions. He will bring disgrace to half of humanity. Frequently his ideas of delirium are about his own body: it is corrupt, putrefied, petrified, his head is hollow, the stomach perforated, the heart does not beat, and he has reduced his body to a few millimeters. Such ideas of enormity or micromania are simultaneously combined. Sometimes anxious depression with real suffering exists that has reached suicide or auto-aggressive attempts. The evolution of this form is very slow, and normally the prognosis is fatal.
The shaking form, mainly characterized by psychomotor agitation, obnubilation of the senses and disorientation accompanied by hallucinations, and auditory and visual illusions; with symptoms of cortical excitation, such as athetosic movements, teeth grinding, carphologies, similar to those observed during the acute delirium of high fevers. This form has a fatal prognosis, because soon the patients exhaust themselves and the heart fails, or by the repeated manifestation of quadriplegic seizures, or by the frequent appearance of intercurrent infectious affections.
Being a syphilis attack, in some patients, a general process can develop manifestations mistakable with schizophrenia, and this is too frequently with manic-depressive and paranoid phases.
For this reason, cyclical periods are observed in which are alternated depressive or hypomanic phases, with phases of remission, in the beginning without very pronounced demential symptoms. As a general rule in these patients no changes occur in the cerebrospinal fluid, or are there any neurological signs, because with anyone with these symptoms, the diagnosis could be easily done from the onset of the disease.
The presentation of catatonic symptoms in General Paralytics is attributed to the fact that the syphilitic disease that has developed in schizophrenic individuals is characterized by stupor and automatism. The form of Paralysis where there are apoplectiform or epyleptiform strokes is also the most serious, because almost always in one of those seizures, the patient is left hemiplegic, paraplegic, or with another paralysis that comes to complicate his situation. These accesses [episodes, attacks, or fits] are due to the fact that there are focal lesions in the brain; this is called Paralysis of Lissauer.
SOME HUMORAL DISORDERS IN SYPHILIS
With the old and the modern antisyphilitic treatments included here, the use of the various fevers, even the most effective, malaria, as previously mentioned, only in the first symptoms of nervous syphilis has then been obtained some mental or motor recovery. In advanced cases no improvements have ever been obtained.
Investigations of a great number of patients with various localizations of the disease have demonstrated perfectly that the cause of the resistance to the treatments, as well as the cause of the non elimination of the luetic reactions, results from the acid-basic imbalance of the plasma that, in the course of all chronic and progressive affections, like syphilis, undergoes these variations. Indeed verifying a great number of determinations of blood pH, verifications of much interest were made, mainly concerning the relations of serologic curves. From these observations were extracted the following conclusions:
1. In secondary syphilis with positive sero-reactions, an obvious acid-basic imbalance was verified quite often in almost all the examined patients, by a marked state of alkalosis.
2. In secondary syphilis treated, the pH imbalance is influenced in the same manner as the serologic. The two curves are parallel.
3. In syphilis of irreducible reactions, an acid-basic imbalance is frequently noticed. Only the application of a system that changes the blood’s physico-chemical properties, the pH included among these, is able to render the blood negative.
4. The specific oscillating sero-reactions are accompanied by an oscillating and parallel imbalance.
5. In nervous syphilis of irreducible serology, where mainly appear these imbalances in the blood physico-chemical properties, and for this reason it is where, is indicated with greater justification, this treatment returns these unbalanced properties to normal.
6. In syphilis resistant to the various treatments, it is where most of this imbalance is observed and this resistance is only modified as soon as the acid-basic balance has been changed.
A free exchange in the glucose regulation has been verified, without being constant. Hyperglycemia exists mainly in the chronic cases, that is to say in the last stages of syphilis. With hyperglycemia or hypoglycemia, all the chronic patients of any form of syphilis are extremely sensitive to the hypoglycemic action of insulin. This corroborates what many authors had already observed: disturbances in the regulation of the glucids. We have the satisfaction to confirm in more than a thousand patients these observations previous to ours.
There is also a decrease of the serum albumin coefficient. The lipids are increased, particularly the phosphatides, with tendency to the formation of unsaturated fatty acids. The perturbation of calcium is also proven, it is not only the factor of this disease but also of almost all the chronic affections, demonstrating to us the chronicity and the progression of syphilis.
There are certain humoral similarities between syphilis and cancer. It seems, by all the humoral aspects, that syphilis is biologically a precancer or at least it has certain kinship. This may explain the great frequency found in individuals who had syphilis and that after many years maintain their negative reactions of what apparently represents a perfect state of health.
In addition to other unknown mechanisms with respect to the pathogeny of humoral disorders, are the syphilitic lesions, which attack the parenchyma of all the internal secretion glands, bringing secretory dysfunction.
TREATMENT OF THE VARIOUS FORMS OF SYPHILIS
The insurmountable barrier that prevented the specific medications from reaching the nervous centers has been overcome. Experiments done on dogs, to which antisyphilític medications were introduced via Cellular Therapy, demonstrated that a few seconds after the application, the medications were already in the nervous centers, almost in the same proportion as in the blood. In the other test dogs, which simply received the antisyphilitic drugs just as they are routinely injected, the medications were never found at any time in the cerebro-spinal fluid nor in the nervous mass.
The membrane enveloping all cells limits the means by which they live — and that is where normally all the metabolic exchanges take place. It is deeply modified, as described in chapter V, almost disintegrated, because one of its main components is dissolved. For this reason it allows the free exit of all the elements contained in it. And later the curative medications of each disease, introduced intravenously, penetrate very easily within its own protoplasm. Another one of the phenomena researched for many years has been realized: to render permeable the cells of the organism. Without this permeabilization, in no way can medications penetrate within the protoplasm of these cells. This is the main disadvantage encountered by all medications with the routine classic medicine. The cells cannot benefit from them, because the medications are not penetrating the protoplasm, following the blood flow and later, the channel of elimination will expel them without having reached the object for which they were introduced within the organism. This general problem of medicine has been, for many years, the main stumbling block encountered by medications in producing their curative effect.
The definitive proofs that the medications reached the nervous centers are chemical. They consisted of immediately killing animals after injecting them, extracting the brain and the medulla, washing them perfectly, looking within the nervous tissues for the applied medications, and applying the proper chemical reactions to detect the presence of these medications. This was how Professor Juan Manuel Noriega found arsenic inside the nervous tissues. After the animals were killed, the cerebrospinal fluids were extracted from the various dogs to which the Therapy was applied. And in all of them the arsenic was found in almost the same proportions as in the blood stream. By itself, this test was enough to accept Cellular Therapy as the only effective therapy. But we also immediately gave other tests: mental, neurological, and serologic tests. For this, it is clearest to refer to clinical histories.
METHOD OF APPLICATION OF CELLULAR THERAPY
From 1930 to 1938, we used a different application technique than we use now. This consisted of waiting for the Therapeutic Moment to prick the vein; then 4 cc of blood were extracted that served to measure the glucose and pH. Immediately were inserted two syringes, the first containing Neosalvarsan 0.45 to 0.30 in 30% glucose serum until completing 20cc, and the second containing 20cc of calcium and iodide salts in 30% glucose serum. Finally, solutions containing cyanide of Hg 0.01 and bismuth (soluble salts) were injected intramuscularly in 5% glucose solution.
When the injection of the 40cc contained in the first two syringes was finished, the patient had recovered. This was demonstrated by using a dry syringe to draw 4cc of blood, to make the same measurements — glucose and pH — that always corresponded to the clinical state of recovery with higher than the normal levels of glycemia and pH.
At the present time  we have modified the technique somewhat. When the patient lets us know, or when the beginning of hypoglycemia is observed, the solutions or medications going intramuscularly are immediately applied. After 10 or 20 minutes the Therapeutic Moment is reached, and then we intravenously inject the chosen substances.
If there is no contraindication with respect to arsenic, it must be injected intravenously as in the old technique. But if there are contraindications, or if the doctor does not believe it advisable to prescribe this medication, then 200,000 Units to 500,000 Units of crystallized sodium or potassium Penicillin are introduced intravenously using as vehicle 20cc of 50% glucose solution. The second syringe gets vitamin B complex with calcium and iodide salts as represented in the formulas on the corresponding pages.
It is very important to consider when arsenic is administered, and when the symptoms of hypoglycemia begin. Before applying intramuscular medications, we must give by mouth 250mg of nicotinic acid [niacin] in very little water. The object is to have coinciding — as already explained — the Therapeutic Moment with the deep vasodilatation produced by the nicotinic acid. In fact, after between 10 to 20 minutes the flush color in the face is observed and the patient declares that he feels warm and itching on the whole body, more sensible in the face. This is called the Therapeutic Moment, which we are going to use to inject in the vein the medications chosen for this way of administration.
Another modification is that neither nicotinamide nor nicotinic acid is injected in the complex when arsenic is injected. This vitamin has been eliminated because all the arsenical medication that is going intravenously produces or can produce congestion of the brain and of the glottis, which is extremely serious. So serious that it can be deadly if cardiazol-ephedrine or simply ephedrine is not immediately applied, and the way of introduction will depend on the rapidity and gravity of these phenomena. We once had to apply 5 ampoules of cardiazol-ephedrine intravenously at the same moment, and all the ampoules together, in order to save the patient from certain death by nitritoid crisis.
If the second solution of vitamins, calcium, and iodine salts also contains nicotinamide, having the arsenic already inside the vein, the nitritoid crisis — which is always dangerous — can take place by injecting it. For this reason the content of the second intravenous syringe must not include nicotinamide.
There are patients prone to undergo nitritoid crises, and it is not rare to observe that even injecting the arsenic muscularly, similar scenes to those crises appear. In these cases the arsenic must be eliminated by all means. We are counting on the powerful and inoffensive penicillin. This antibiotic is administered in all the doses by all the means and we have never observed an accident at the moment of its application.
Normally it is applied intramuscularly, in the same syringe containing penicillin 1,000,000 Units to 1,500,000 Units.
When a second change of the properties appears, this is to say when hypoglycemia appears for the second time, administer by mouth iodides with nicotinic acid and calcined magnesia so as to produce light diarrhea.
In all cases, during the rest of the day the patient ingests all sorts of sweetened drinks, cold or warm.
Muscular pains, headaches, and fever usually appear after 6 hours; these symptoms have always disappeared by evacuating the intestine with enemas or some laxative taken by mouth.
On the following day, all activities can be resumed. Sometimes during a day or two the patient has a sensation of asthenia, which slowly disappears.
When the day arrives to repeat the same session, we make the necessary corrections according to two classes of symptoms: those caused by the treatment, and those of the disease.
If there was intense sweat, comatose or semi-comatose state, tremors, or beginning of convulsions, with any of these symptoms, and more so with the latter, the dose of insulin must be lowered by 5 to 10 Units. Normally these doses are sufficient to reduce the appearance of excessive signs. If, in spite of having reduced the dose, some of these symptoms appear during the second time, continue to lower the dose by the same number of Units. The opposite can happen, where few hypoglycemic symptoms appear, and that in addition these are not very obvious; then do the opposite: increase the dose according to the time it took them to appear, and their intensity.
A normal increase is 5 to 10 Units, but of course it can also be increased by 20 Units; the experience in this therapy indicates in each case the appropriate dose.
There can be patients who, after 60 minutes have elapsed, do not have any symptoms. In these patients you can give them again the same initial dose as if the treatment was just being initiated. When this happens the doctor must be well prepared with other remedial solutions. However, there are cases in which in a very short time all the symptoms of hypoglycemia are occurring quickly, intensely, and simultaneously.
One of the recommendations that never varies is that the intravenous preparations must be injected very slowly, and continually observing the pulse, as well as the face of the patient. As the preparations enter, the pulse will return to the rhythm it had prior to the application of this remedial procedure.
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