ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 871 



Gemerich believed that organic contamination of the water by sapro- 

 phytes was the cause of a number of unfortunate consequences. He 

 believed that certain poisonous substances in the bacteria are not de- 

 stroyed by boiling, and that they may produce febrile reaction in the 

 patient. Fresh distilled water that did not contain bacterial bodies 

 was less apt to produce fever. 



Arzt and Kerl, Nobel and Peller, Wachenfeld, and others do not admit 

 the "Wasser fehler" as the cause of fever. Luitheln and Mucha also 

 dissent from this view, and regard the fever as due to a resorption of 

 broken-down cell products; headache, vertigo, and vomiting are also 

 regarded by them as due to this cause. Neisser had previously, in 1910, 

 advanced the view that the febrile symptoms were due to the rapid 

 destruction of innumerable spirochetes and the setting free of endo- 

 toxins which reached the blood-stream and induced the symptoms. 



Emery believed that contamination of the water with copper, leas, 

 or silicates from the distilling apparatus, increased the toxicity of sal- 

 varsan and caused reactive manifestations. 



Gonder, at the request of Ehrlich, carried out on animals some experi- 

 ments on the toxicity of salvarsan solutions to which small quantities 

 of calcium and magnesium salt, which are commonly found in tap-water, 

 were added. He found that these increased the toxicity of the drug. 



Matzenauer believed that alkali which was dissolved out of the glass 

 container was a factor in reactions. 



Dreyfus counseled doubly distilling the water and boiling the in- 

 fusion apparatus in distilled water and not in ordinary water. 



From this mass of divergent opinions it is difficult to draw any clear 

 and definite deductions. While the "water error" is a factor in reactions, 

 it is probably much less constantly responsible than has been alleged 

 by Wechselmann and others. Many of the factors referred to are doubt- 

 less capable of causing fever and gastro-intestinal symptoms in certain 

 patients, but no one of these causes is responsible for the majority of 

 the reactions. There are other faults of technic which may likewise 

 be responsible for reactions, such as the use of too hot or too cold water, 

 too acid or too alkaline solutions, the employment of too small or too 

 great a volume of water, the too rapid infusion of the solution, etc. 

 Then, too, the improper preparation of the patient for the injection or 

 improper after-treatment. The intravenous administration of the drug 

 shortly after the eating of a meal or the partaking of food too soon after 

 the injection may induce gastro-intestinal reactions. Physical over- 

 exertion immediately before or directly after treatment may likewise 

 be responsible for reactive phenomena. 



