ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 867 



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. 



Reactive Manifestations After the Use of Salvarsan. The various 

 reactive symptoms which not uncommonly follow the administration 

 of salvarsan or its congeners, have been assigned by different clinical 

 observers to widely diverse causes. The generally accepted views have 

 undergone considerable modification from time to time. At the present 

 day our knowledge of the subject is still imperfect and unsatisfactory. 

 The hypotheses which have been advanced but inadequately explain 

 the phenomena. The subject is particularly complicated because the 

 physiologic and toxicologic effects of a relatively new and extremely 

 complex compound are not accurately known. Dr. Schamberg, Dr. 

 Raiziss, and I 1 have devoted considerable time to experimental studies 

 bearing upon the causative factors involved in the production of salvar- 

 san reactions, and the following summarizes our results and views upon 

 this subject: 



In order that the phenomena developing after the administration 

 of salvarsan may be better discussed we have thought it wise to classify 

 the symptoms into three groups: (a) the immediate symptoms, (6) the 

 early symptoms, and (c) the late symptoms. 



1 Jour. Cutan. Dis. inch Syph., April, 1917. 



