344 APPLIED IMMUNOLOGY 



pyramidon for headache, a mustard plaster to the epigas- 

 trium for gastric disturbance, bismuth subnitrate for diar- 

 rhcEa and an ice-cap for fever may be of some value or at 

 least pacify the patient. Most important is it that the 

 urine be examined the following day, in order to learn the 

 extent of renal irritation, if present. If albumen or casts are 

 found, urinalyses should be performed daily to determine the 

 duration of their persistence, in view of subsequent adminis- 

 tration of the drug. If the evidences of kidney irritation are 

 marked or prolonged for more than 24 to 48 hours, the 

 repetition of the injection becomes a serious consideration 

 and as a rule is inadvisable. Arsenical intoxication calls for 

 sweat baths, either electric or hydrothermic. Caution should 

 be enjoined that the patient not exert himself severely in view 

 of cardiac strain for a few days, particularly in the advent 

 of severe reactions. 



Clinical Reactionary Effects of Salvarsan. — As a rule 

 clinical reactions are commoner and severer after salvarsan 

 than neosalvarsan. The primary dose, whether the former 

 or the latter, is usually attended with greater reactions than 

 subsequent injections, although the converse of this is fre- 

 quently observed owing to the cumulative effect of closely 

 repeated administrations. The reactions probably occur by 

 virtue of two facts : Firstly, the endotoxins arising from the 

 destruction of myriad numbers of spirochsetae, and, secondly, 

 the toxic effect of arsenic itself, based upon personal idio- 

 syncrasies. 



During the administration of salvarsan, the patient not 

 infrequently experiences a sensation of warmth, fulness or 

 throbbing in the head, occasionally complaining of aching 

 of the teeth and a metallic taste in the mouth; his face is 

 usually more or less flushed. If reactions supervene, they 

 are likely to be ushered in by chilliness or a definite chill 



