APPENDIX 345 



about an hour and a half or two hours after the injection 

 of the drug. This is followed by headache, nausea and a 

 slight rise in temperature to 99-99 Mi degrees F. Vomit- 

 ing may occur, after which headache and nausea may dis- 

 appear. In severer types of reaction, nausea and vomiting 

 may persist and recur for several hours, associated with a 

 temperature rise as high as 104 degrees F. Diarrhoea is a 

 common occurrence. Rarely a cutaneous eruption of an 

 erythematous type due to arsenic may be observed. This 

 is distinctive from the Jarisch-Herxheimer phenomenon, since 

 it may occur in non-syphilitic cases. Loss of appetite for 

 a few hours or even a day or two may be observed, and occa- 

 sionally irritation of the kidneys, manifested by a cloud 

 of albumen and a shower of hyaline casts, may occur. This 

 last is a most important warning prohibiting in a few in- 

 stances the repetition of the intravenous injection of the 

 drug. Careful studies have never revealed injury to a 

 normal heart, kidneys or eyes. It is decidedly reprehensible 

 to administer salvarsan to a patient evidencing renal irrita- 

 tion from mercurial treatment. Wechselmann has ascribed 

 a number of fatalities to this procedure and insists that sal- 

 varsan should never immediately follow a vigorous course 

 of treatment by mercury. 



In the vast majority of patients, receiving either salvar- 

 san or neosalvarsan, we have observed no sign or symptom 

 other than a trivial transient rise of temperature. Usually 

 all symptoms disappear in six to twelve hours. As a result 

 of treatment, in two or three weeks, the patient invariably 

 feels better physically and mentally; his ansemia improves; 

 he gains in weight ; all lesions rapidly disappear and the pa- 

 tient is inclined to construe the symptomatic into a per- 

 manent cure. 



The Jarisch-Herffheimer Reaction. — This phenomenon, 



