VALUE OF SALVARSAN AND NEOSALVARSAN IN SYPHILIS 879 



3. To make careful observation by the most exact chemical and 



microscopic examination of the urinary secretion when em- 

 ploying salvarsan. This holds good particularly when the com- 

 bined treatment is employed. 



4. The conjoint use of salvarsan with heavy mercurial treatment is 



dangerous! If one will use the combined treatment, then let 

 him give mercury very carefully many days after giving the 

 last salvarsan injection, but he should not reverse this rule. 



5. Consider carefully every general reaction or rise of temperature 



following the use of salvarsan, and make a thorough investiga- 

 tion as to its causes. 



VALUE OF SALVARSAN AND NEOSALVARSAN IN THE TREATMENT OF 



SYPHILIS 



It is too soon to judge of the ultimate value of salvarsan in the treat- 

 ment of syphilis. It may be stated, however, that the immediate effects 

 are so beneficial that the drug is to be regarded as the best we possess 

 for the treatment of lues. As is to be expected, the best results are se- 

 cured when the remedy is administered early, and, of course, when tissue 

 changes have occurred no drug can be expected to restore a lost func- 

 tion, although it may bring about considerable improvement by causing 

 the disappearance of syphilitic tissue. In long-standing cases salvarsan 

 may, at least, hold the symptoms in abeyance, and effectively prevent 

 progress of the disease. It is especially valuable in patients who cannot 

 tolerate mercury. The remarkable efficacy of salvarsan is attested by 

 the rapidity with which spirochetes disappear from primary sores and 

 from secondary lesions, the manner in which they disappear being fre- 

 quently little short of marvelous. There can be no doubt but that sal- 

 varsan is a powerful spirocheticide, having but remarkably little toxic 

 effect upon the body-cells. It would appear that in order to rid the 

 tissues of the spirochetes it is only necessary to bring the drug into con- 

 tact with them. For this reason newer and better methods of adminis- 

 tration are bound to increase the value of the drug. Barring the well- 

 recognized contraindications, salvarsan may be used in practically all 

 stages of the disease. In the later stages of the infection, in which the 

 central nervous tissue is involved, the physician must bear in mind the 

 possible danger of a neurorelapse or a Herxheimer reaction occurring. 

 While salvarsan may do no good in late cases, since it cannot restore lost 

 nerve tissue, it may alleviate symptoms and prevent progress of the in- 



