Untoward Effects

1. Locally, there may be a cellulitis from leakage of the drug into the tissues, or phlebitis and thrombosis of the vein. 2. From the intravenous use, the immediate effects, those that occur during or within a few minutes of the injection, are of anaphylactic nature and do not occur at the first injection. They are a choking feeling or oppression about the chest with slight dyspnea, fulness in the head, flushing of the face, cyanosis and restlessness, followed sometimes an hour or more later by a chill, with fever and vomiting, and an urticarial rash or a generalized erythema. Occasionally during the injection there is a severe pain in the lumbar region. Draper reports anaphylaxis in 55 per cent. of all cases, and always with the later doses. His theory is that the drug with the patient's serum forms a new protein to which the patient is sensitized by the first dose.

The late effects, those which occur after twenty-four hours, are: a feeling of weight in the stomach, nausea, vomiting and diarrhea, with fever, headache, restlessness, and insomnia. Rarely there may be a severe illness with rapid, weak pulse, fever, jaundice, urobilinuria, albuminuria, suppression of the urine, or an arsenical neuritis. In kidney cases uremia has resulted. Fuchs reports a seven-day heart-block. A number of deaths have been reported, almost all being due to collapse in heart cases, or to nephritis, hemorrhagic encephalitis, or myelitis. Severe symptoms have been overcome by an intensive alkali-water therapy (Woodyat, Eberly).

The Jarisch-Herxheimer reaction is an intensification of the symptoms or the rash, presumably from a liberation of a large amount of the spirochetal endotoxins.

3. From the intraspinal use numbness of the feet, severe pains in the legs, temporary paraplegia, and severe headache are not uncommon; hemiplegia and paralysis of the arms have also been reported.

Contraindications And Cautions

The contraindications are: Severe disease of the gastro-intestinal tract, kidneys, heart, and arteries not due to syphilis, any acute febrile disease, even a severe cold in the head, hemorrhage as after abortion, chronic alcoholism, and lead-poisoning. Yakymoff found the toxicity in mice increased threefold if they were given a preliminary minute infection with the colon bacillus. In some cases salvarsan shows a selective action on the optic nerve, or on the auditory nerve, causing vestibular disturbance, so in diseases of the eye and ear it must be used with judgment, as it has in many instances caused a permanent blindness or deafness.

In syphilitic myocarditis or aortitis the beginning dose should be probably not over 0.15 gm., as fatalities have occurred after full dosage. Wechselmann finds its use immediately following intensive mercury treatment especially dangerous to the kidneys, but Fordyce says this is not the experience of most observers. In any case it should not be administered at less than five-day intervals. In infants the drug must be used with caution, as the liberated endotoxins may produce disastrous effects.

Use In Non-Syphilitic Cases

Salvarsan has been employed for intensive arsenic treatment in pernicious anemia, leukemia, Band's disease, splenic anemia, and kala-azar. It has also been employed in relapsing fever, frambesia, leprosy, amebic dysentery, refractory malaria, filariasis, trichiniasis, and many other conditions, with some good results and many failures. The author and others have obtained apparent cures of chyluric filariasis. It has been reported a cure in experimental trypanosomiasis.