246 CHEMOTHERAPY 



injections in large doses 0.6 to i.o gm. per injection than by the intravenous 

 method. He had to abandon this, however, on account of the danger 

 from the large quantities of arsenic thus administered. 



In order to change such positive reactions it is sometimes necessary 

 to give as many as four or five intravenous salvarsan injections (0.6 gm.) 

 within a period of three to four weeks, and at the same time undertake 

 mercurial inunctions or injections; then one or two additional salvarsan 

 injections (0.6 gm.) and finally large doses of iodides extended over a 

 long period of time. After a rest of two months the entire procedure 

 may have to be repeated. Naturally this plan of treatment can be 

 varied in many ways. It is not advisable, however, to continue with 

 salvarsan too long. It is borne well, but its effect ceases. Whether 

 the spirochetes acquire a resistance toward arsenic has not been definitely 

 proven, although animal experiments of Ehrlich and Hata favor this 

 view. 



The value of salvarsan in para-syphilitic diseases has to a degree been 

 misjudged on account of the early sensational communications of Alt 

 who claimed to have cured general paralysis. Corroborative evidence 

 by others has been lacking. The treatment of cerebrospinal lues on the 

 other hand is frequently attended by remarkably good results, and when 

 one considers how closely this affection may simulate tabes, tabo-paral- 

 ysis, or paresis, it is appreciated with what care the diagnosis of true 

 paralysis should be made. Here, while occasionally a certain symptom 

 complex may be improved there is not sufficient evidence to claim a 

 cure by even 'this latest most remarkable antisyphilitic agent. 



Salvarsan has been of service also in other than spirochete infections. 

 Most trustworthy are the results in tertian malaria (Iversen and Werner) 

 furunculosis orientalis (Nicolle and Flu) and bilharziosis ( Johannides) . 

 In anthrax and scarlet fever the general experience as yet allows of no 

 definite conclusion. How great a help salvarsan as an arsenic compound 

 will be in the blood diseases is still to be determined. 



The effects upon certain animal diseases, African glanders (lymph- 

 angitis epizootica), and the spirillosis of fowls, have been very encouraging. 



3. Harmful results from salvarsan have been described by various 

 investigators. As a general rule no deleterious effects are observed 

 with the intravenous injections of properly prepared solutions. The 

 intramuscular and subcutaneous injections were frequently attended 

 by severe local reactions which at times led to skin and muscle necroses. 

 Also toxic exanthemata simulating scarlet fever were met with. Blindness, 

 such as has been ascribed to atoxyl or arsacetin, has not been reported. 

 On the other hand, fever, vomiting and diarrhea often occur but in most 

 instances are probably due to bacterial contamination of the injected 

 solution. Still, the sudden breaking up of the large number of spirochetes 



