868 CHEMOTHERAPY 



(a) The Immediate Symptoms. These phenomena are observed 

 during the intravenous administration of the drug or within a few min- 

 utes after the completion of the same. At times patients during in- 

 fusion of the solution will state that they taste the drug. Inquiry will 

 usually elicit the reply that the taste is like that of ether. A burning 

 sensation of the tongue or lips may be complained of; these are usually 

 the precursor of a train of other symptoms. The first objective evidence 

 of immediate reaction is flushing of the face; this may be slight and 

 transitory, or may be pronounced and accompanied by injection of the 

 conjunctive, lacrimation, edema and swelling of the lips, tongue, and 

 eyelids, an anxious expression of the countenance, nausea followed 

 by vomiting and retching, and this, in turn, by profuse perspiration. 

 In some cases cough, respiratory embarrassment, and dyspnea are 

 observed. The pulse at first is full and bounding, but later slow and of 

 very small volume, in which event it is usually accompanied by a pro- 

 nounced pallor. In severe cases the patient may lose consciousness and 

 the pulse may be scarcely palpable. In rare instances death has been 

 reported. An urticarial eruption appearing during the congestive stage 

 is one of the more uncommon manifestations, as is also a severe pain in 

 the lumbar region. These symptoms may disappear within fifteen to 

 thirty minutes, and be followed by no other phenomena, or, as more 

 commonly happens, other symptoms, as chills, develop within a brief 

 period or several hours later. This secondary complex we prefer to 

 discuss as group b, as these symptoms not infrequently appear several 

 hours after the injection of salvarsan, even when they are not preceded 

 by the vasomotor phenomena just described. 



(6) The Early Symptoms. These symptoms consist of chilliness or a 

 distinct rigor, headache, vertigo, nausea, vomiting, diarrhea, and rise 

 of temperature, usually 100 to 102 F. But few of these may be present 

 and they may be so mild as to merely make the patient feel "queer," or 

 there may be repeated chills, numerous attacks of emesis, and profuse 

 and protracted diarrhea. Occasionally severe pains in the legs and back 

 are complained of. This group of symptoms usually passes off in twelve 

 to twenty-four hours, and is followed by a feeling of lassitude or weakness. 

 More uncommonly vomiting and diarrhea, associated with some ele- 

 vation of temperature, may continue for a number of days, the patient 

 during this period being unable to retain any nourishment. In some 

 cases the urine may be scanty and contain albumin and casts. 



Various eruptions have been observed at times after the adminis- 

 tration of salvarsan, appearing either in a few hours or after several 



