804 CHEMOTHERAPY 



pagne will usually control the vomiting. It may occasionally be neces- 

 sary to administer Y% grain of morphin hypodermically, especially if the 

 patient is of a neurotic temperament. Headache may occasionally de- 

 velop, and is due to a neurotic condition, constipation, anxiety, hunger, 

 or possibly to an increase in the exudate of the syphilitic process. Diar- 

 rhea may be observed in a few cases; this is readily controlled by the 

 administration of bismuth. Chills and fever are more infrequent at the 

 present time, the result probably of using freshly distilled water and 

 somewhat smaller doses of the drug. In some cases an arsenic rash, 

 in the form of an erythema, may follow injection. This is not the 

 Jarisch-Herxheimer reaction, which is found only in syphilis, the ar- 

 senic rash having been observed in non-syphilitic persons injected with 

 the drug. There is no evidence to show that salvarsan or neosalvarsan 

 will injure healthy kidneys, although a mild transient albuminuria may 

 follow the injections in some instances. When, however, the kidneys 

 have been damaged by mercury, salvarsan may give rise to an acute irri- 

 tation, and, indeed, Wechselmann ascribes many of the salvarsan casual- 

 ties to this condition, and issues the warning that, while mercury may 

 follow salvarsan, it should never precede it. The good general effects 

 following the administration of salvarsan are manifested, as a rule, in a 

 sense of well-being, and not infrequently patients who are anemic, 

 poorly nourished, and despondent in a short time become healthy, active, 

 and cheerful. This may be due in part to a psychic effect, but there 

 is frequently evidence of a far-reaching change in the nutrition of the 

 patient. 



The Jarisch-Herxheimer Reaction. This reaction manifests itself 

 in the development of a rash, the extension or aggravation of an existing 

 eruption, or an inflammatory reaction in any syphilitic tissue the result 

 of treatment. It has been observed in the course of mercurial treatment, 

 and before the discovery of the Spirocheta pallida and the Wassermann 

 reaction it was regarded as of considerable diagnostic importance. Any 

 aggravation of syphilitic symptoms following the administration of sal- 

 varsan or mercury has been interpreted as a Herxheimer reaction. The 

 cutaneous reaction is manifested by edema, redness, pain, and the 

 mucous patches show a similar reaction. Gummas become swollen, may 

 ulcerate, and show increased exudation. The lancinating pains of loco- 

 motor ataxia may be augmented, and various paralyses, due to pressure, 

 may follow in those nerves that traverse bony canals. These effects 

 are also known under the name of neurorelapses. They usually appear 

 two or three months or even four or five months after treatment, and 



