878 CHEMOTHERAPY 



no marked effect has been obtained either clinically or serologically, 

 a course of intraspinous injections may be considered. 



CONTRAINDICATIONS AND PRECAUTIONS IN SALVARSAN THERAPY 

 When it is remembered that millions of doses of salvarsan and neo- 

 salvarsan have been given by thousands of different physicians, by 

 many and diverse methods, the relative safety of the drug is apparent. 

 The fact remains, nevertheless, that patients have succumbed soon 

 after receiving an injection who would not otherwise have died at that 

 time. These fatalities cannot be explained on a purely toxicologic 

 basis. Recently Wechselmann 1 has reviewed the deaths following 

 salvarsan therapy and has arrived at the conclusion that "insufficiency 

 of the kidney, and not hyper sensitiveness of the brain, is the point of the 

 entire question of salvarsan fatalities. " He is very emphatic in warning 

 against mixed mercurial and salvarsan treatment, especially if salvarsan 

 is given after a course of mercury, for the latter drug is a renal irritant 

 and may lead to prolonged retention of the salvarsan, which may undergo 

 a process of reduction in the tissues and form one of the poisonous 

 products that Ehrlich has called "arsenoxid." 



Contraindications to salvarsan therapy may be divided into two 

 main groups: 



1. Those to whom the injection may be dangerous on account of 

 the reaction that may follow, as, for example, cases of early cerebral 

 lues with cranial nerve manifestations of an exudative character; also 

 cases of tabes with beginning optic atrophy. In these patients salvar- 

 san or neosalvarsan should be given with extreme caution and only in 

 small doses, and frequent examinations of the eyes should be made. 



2. Those with extensive disease of the circulatory system, such as 

 severe uncompensated heart disease, coronary sclerosis, and extensive 

 aneurysm; also cases of diabetes mellitus, severe nephritis, ulceration 

 of the stomach, and advanced tuberculosis or carcinoma. 



In this connection I may cite here the precautions laid down by 

 Wechselmann, director of the dermatological department of the Rudolf 

 Virchow Hospital, in whose clinic over 25,000 doses of salvarsan have 

 been given. These precautions are: 



1. To use the most exact technic. 



2. To employ a dose of the drug carefully adapted to the individual 



case. 



lu The Pathogenesis of Salvarsan Fatalities," translated by Martin, 1913, 

 Fleming Smith Co., St. Louis. 



