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days. The pain is often relieved in a few hours. The effect of salvarsan on parasyphilis, e. g., tabes dorsalis, varies. In the early stages, before extens- ive destruction of tissue has taken place, it Cheap Generic Viagra Co Uk French Kamagra often acts with astounding effect. In one of our cases of early tabes, the patient, an invalid, shortly after the injection was able to pursue his occupation of insurance collector. Another case of early tabes with oculomotor paralysis, improved wonderfullv after the injection of salvarsan; it previously resist- ed active tuercury and potassium iodide medication. The girdle pains are sometimes relieved as if by a hypodermic of morphine and often permanently. But. in advanced stages, we cannot expect salvar- san to replace the fibrous tissue with normal healthy substance. I'KI:LI.\[IN.\RY EX.\MIN.-\TI0N before TRE.■\T^^ENT WITH S.\LVARSAN. I'efore. administering salvarsan certain prelimin- aries are necessary. Tiie patient's heart, arteries, lungs, and abdominal organs should be carefully ex- amined. If there is the slightest suspicion of optic nerve involvement, an ophthalmic examination ought to be made. The blood should be tested for the Wassermanri reaction, and lesions, if present, should be. examined for spiroch.netae. Ehrlich ad- vises a careful selection of the patients and rigidlv excludes from treatment serious and advanced dis- eases of the central nervous system, myocarditis, arterial degeneration, aneurysm, previous apoplex\ . old age, severe nephritis, diabetes, stomach tumors. etc. Visceral affections of syphilitic origin oft'er no obstacle to the administration of the drug. On the contrary, splendid results have been reported following the injections in syphilitic diseases of t\v: liver, kidneys, etc. In the beginning, he advised against using it in eye affections. Since, however, it has been administered in all kinds of syphilitic eye affections with good and even brilliant results. ( Igerheimer,^'' Schanz,^^ Hirsh,^** Wechselmann and Seeligohn,'* v. Grosz^°.) COMPLIC.\TIONS. Quite recently a few reports (Rille,''^ Wechsel- mann,*- Spiethoff,*^ Kowalewski,** Matzenauer,*^ .Stern'*'') have been appearing in the literature con- cerning certain eye and ear disturbances following; injections of salvarsan. Up to the present time about forty thousand cases have been treated, with five reports of blindness. Two of these, supposedly from the Lesser clinic, Ehrlich found devoid of foundation, Cheap Generic Viagra Co Uk French Kamagra a third was transient, lasting ten min- utes, a fourth was in a case of tabes, and the fifth, reported by Finger,*' was in a patient who had previously received an energetic arsacetin and four intensive enesol cures. Concerning the auditory dis- turbances, he says: i. The}' were confined to pa- tients who received the subcutaneous injection, and were not reinjected: without exception, to patient> in the early stage of the disease, two, to six, to eight months after the injection. In the majority of them the Wassermann reaction was ne.gativc. The same e\e and ear disturbances reported by Finger, have been known to follow mercury and potassium iodide cures in recent syphilis, as report- ed by Urbantschitsch,*^ Benario,''^ and others. 2. These eye and ear disturbances were not re- ported by those who were using very large doses (Gennerich.-'^ Duhot,^" Weintraud"''). With atoxyl and arsacetin the toxic effects are noted in propor- Cheap Generic Viagra Co Uk French Kamagra tion to the size of the dose. 7,. The disturbances improved promptly after sub- sequent antiluetic treatment or following another injection of salvarsan. 4. Temporary ear affections may be due to swell- ing at the point of exit from the bony foramina by the development of Herxheimer's reaction. From these considerations Ehrlich concludes that the conditions are nerve recurrences caused by poor circulation, which prevent the salvarsan from reaching them and are not caused by the toxic effects of salvarsan. My colleague. Dr. Geraghty,''' has had an eye recurrence following intravenous injection: this is the only one I ani familiar with following this method DEATHS. Up to the present time about twelve to fifteen deaths have been reported following injections of salvarsan. These were mostly in patients who were being treated in .general medical clinics or were in- niate? of insane asylums and the injections were given in the hope of prolonging life. There is only one report"^ in the literature of death occurring in a patient Cheap Generic Viagra Co Uk French Kamagra who was Cheap Generic Viagra Co Uk French Kamagra in good physical condition at the time of injection, and in whicli the technique was RVriXA- SALFARSAN THERAPEUTICS. 819 faultless. This patient had a gumma of the larynx, and death was supposed to be due to the shock caused by the pain of an intramuscular injection of the acid solution. Fraenkel and Grouven^^ re- ported a death following intravenous injection of salvarsan. They injected 0.4 gramme of salvarsan diluted in only 20 c.c. of normal salt solution. They did not add any alkali. On account of this death thev advised against intravenous injection. Ge- ronne aptly says he would no more follow their logic than their method of injection. Schreiber and Iversen have treated intraven- ously over one thousand cases without any deaths or complications. In our own reportetl series of eighty-five case'; we have not any complications exceptmg an occasional local reaction following the careless displacement of the needle from the vein. Ehrlich knows Cheap Generic Viagra Co Uk French Kamagra of five cases where the injections were postponed and the patients died in the mean- time. Three were paralytics, one was a case of malignant syphilis and the fifth death could not be accounted for; post mortem examination showed only arteriosclerosis. If the injection had been