256 CHEMOTHERAPY 



that in robust men 6.0 grams of neosalvarsan, corresponding in 

 arsenical content to 4.0 grams of salvarsan, have been given within 

 seven days. 



Babies are given 0.05 and children 0.15 gram. 



A month after the last injection the Wassermann test is made. If 



this still shows a positive reaction the salvarsan treatment should 



be repeated, and may advantageously be followed by a brisk course 



of mercury. If the latter is used, a month should then elapse during 



which no medication whatever is employed, before the next test is 



made, and so on, until a negative reaction is reached. From this 



point off the Wassermann is repeated at more and more distant 



intervals for from two to three years (see Wassermann reaction). 



Contraindications to the Use of Salvarsan. At the very beginning 



of its use Ehrlich emphasized the importance of excluding all those 



cases from the salvarsan treatment, in which there w r as reason to 



assume the existence of advanced disease of the heart or of the 



central nervous system; particularly cases of angina pectoris, 



aneurysm (notably of the cerebral vessels), advanced paresis and 



cases atrophy of the optic nerve, while in other syphilitic diseases of 



the eyes as well as in advanced syphilis of the abdominal viscera 



the remedy may be advantageously employed. If any doubt exists 



in an individual case, whether the remedy should be used or not, and 



the condition of the patient so far as the syphilitic process in itself 



is concerned makes this desirable, a careful attempt may be made 



with a very small dose (0.1 gram), which, if no disturbing symptoms 



develop, may then be followed up with one of equal size or even a 



little larger. 



After all we must remember that the number of deaths which 

 can be attributed to the salvarsan itself, or to its effect upon the 

 syphilitic process, and not to harmful technique, is ridiculously small 

 in comparison to the enormous number of cases where no harmful 

 result has followed its use, and where on the contrary the greatest 

 amount of good had been accomplished. As Ehrlich has pointed out, 

 the toxicity of the salvarsan is distinctly less than that of mercury. 



Neurorelapses. Not infrequently certain functional disturbances 

 have been noted to occur in connection with some of the cranial 

 nerves, which appear very soon after the injection. Ehrlich is 

 inclined to look upon these as corresponding to the so-called Herx- 

 heimer reaction which is so frequently observed in the skin soon 



