SALVARSAN TREATMENT OF SYPHILIS 245 



1. The toxicity of salvarsan for the human being either normal or 

 infected is very slight, provided that the solution be properly prepared 

 and injected intravenously. The therapeutic doses are non-poisonous. 



Isolated examples of idiosyncrasy against salvarsan may be met with, but this is 

 possible with any of the more powerful drugs. Such idiosyncrasy is always more 

 liable after repeated administration (hypersusceptibility). 



In animals it has been found that a coexisting bacterial infection may greatly raise 

 the poisonous action of salvarsan. One should therefore guard against injecting a 

 syphilitic who is in addition suffering from an acute infection as an influenza. 



2. Salvarsan acts as a curative agent in all varieties of spirochete inva- 

 sion. The most favorable reports have been obtained in Febris recurrens 

 (Iversen, Bitter and Dreyer) and Frambcesia tropica (Koch and Flu). 

 These diseases may be completely cured by a single injection of a suffi- 

 ciently large dose. This realizes Ehrlich's ideal: "Therapia magna 

 Sterilisans." 



Its use in syphilis is also of undoubted value; it is one of the 

 Syphilis, most efficient antisyphilitic agents, and as a rule, influences 



favorably the different manifestations of the various stages 

 of lues. Its action is all the more marked in those individuals in 

 whom mercurials seem to be ineffective (lues maligna) or in those having an 

 idiosyncrasy to mercury. One should remember, however, that the radical 

 cure of syphilis and the disappearance of all the visible clinical manifes- 

 tations are two entirely different considerations. They are by no means 

 identical, as has been definitely shown by the complement fixation test 

 for syphilis. If a positive Wassermann reaction is to be taken as an 

 evidence of active lues requiring treatment, then it must be granted that 

 some stages of luetic infections cannot be entirely eradicated by salvarsan 

 alone, even by the intravenous application. A complete cure by one or 

 several salvarsan injections can be looked for only in the first or early 

 secondary stage of the specific infection, especially if the Wassermann 

 reaction has not yet become positive or is only weakly so. Even here 

 ultimate cure is more certain if instead of salvarsan alone, mercurial 

 treatment is added (gray oil, calomel, inunctions). In the other stages 

 there seems to be no question any longer but that one must depend upon 

 this combined therapy for lasting and ideal results. Especially does 

 this pertain to those cases of lues asymptomatica where the only evidence 

 of a still existing old infection is a positive Wassermann test. To make 

 the reaction negative in these cases is no easy task. A single intravenous 

 injection of salvarsan (0.3 to 0.6 gm.) never brings this about; neither 

 is it accomplished if a few injections of sublimate or mercury salicylate 

 are added. In the early era of the new therapy, the author obtained 

 much better results in such conditions by oft repeated intramuscular 



