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ited, infiltrations which involve the sciatic nerve .vill cause severe manifestations resulting from jressure on or injury to that nerve. Injections ,'iven in the subscapular region seem more prone o inflammatory after eflfects than intragluteal injec- ions. In a recent Generic Viagra Online Uk Co paper, read at the Xew Generic Viagra Online Uk Co York \cademy of Medicine, Dr. Meltzer strongly favored he lumbar muscles as a site for the introduction 'f the salvarsan solution. Systemic effects: Of much more import than the ocal disturbances produced by the administration )f salvarsan, are the general or systemic efft-cts of he Generic Viagra Online Uk Co drug acting on the body of the syphilitic pa- ient. These systemic effects may vary Generic Viagra Online Uk Co to a re- narkable degree in dififerent individuals, depend- ng upon the manner of administration, the magni- udc of the dose nf arsenic, and the susceptibility ind idiosyncrasy of the patient to the drug. The intravenous infusion of the drug in some ases is devoid of unfavorable sequelae, and the pa- ient may show Generic Viagra Online Uk Co few, if any, signs Generic Viagra Online Uk Co of systemic dis- urbance ; in other cases, a chain of symptoms pre- ■ents itself, characterized by a rise of temperature. • omiting. and diarrhfca. In these, within one or I wo hours. after the infusion, the patient experi- i;nces a chill and the temperature may rise to ior° jO 104° F.. and even higher. In uncomplicated ■ases the temperature drops down to normal within wentv-four to thirtv-six hours. This rise of tem- perature has been ascribed to various causes Generic Viagra Online Uk Co ; the infusion per sc, the arsenic content of the drug, and the disintegration of the spirochxta;, together or separately, may pla\- parts in the production of the fever. Diarrhcea and vomiting are frequent after effects of the intravenous administration, symptoms which must be reckoned with in patients suffering from cardiac or arterial diseases. The gastroin- testinal manifestations also vary greatly in different patients, and are usually more intense after the first dose of the drug than after subsequent doses. As to the probable cause of the gastrointestinal dis- turbances, they must be ascribed to the toxic effects of the salvarsan on the mucosa, the intensity of the symptoms being, in a measure, dependent upon the magnitude of the dose. The pulse, in some patients, shows but little vari- ation ; ui others it becomes small and rapid, becom- ing normal again with the drop in temperature. Dizziness and headache may be the chief subjective symptoms for twenty-four to forty-eight hours after the infusion. The chain of symptoms following the intramus- cular injection also shows great variations in its intensity, not only in different patients, l)ut even in the same patient after repeated doses. The temper- ature may remain normal on the first day, rising to 100^ to 104° F. on the second or third day, and gradually dropping to normal in two or three days more. The pulse usually remains rapid until the temperature falls to normal. The gastrointestinal symptoms may be entirely absent or they may be trifling in character. The urine, in many cases, e.xhibits a transient albuminuria, and cases presenting symptoms of hemorrhagic nephritis have been reported, though these symptoms were Generic Viagra Online Uk Co usually of short duration. .Suppression of urine, followed by polyuria, has l)een frequently reported, and disturbances of blad- der function, dysuria, tenesmus, and retention have often been observed. The cause of these vesical disturbances has not been determined ; but, in those cases in which the salvarsan has been administered by the intragluteal method, they may be due to the mechanical pressure of the injected material on the pudendal nerve plexus. The study of the deleterious effects of the drug upon the nervous system has received a large share of attention, chiefly because of the unfavorable re- sults following the use of atoxyl and arsacetin on the optic and auditory nerves. Ehrlich himself counsels the withholding of salvarsan from all pa- tients presenting nonsyphilitic lesions of the eyes and ears. Cases of optic nerve atrophy, although few in number, have been reported, some authors contending that this dangerous result may have been caused by a previously administered arsenic compound, such as arsacetin, eiiesol. or atoxyl. Iri- tis, neurochorioretinitis, chorioiditis, oculomotor paralysis, and neuritis of the vestibular and cochlear nerves have been reported by numerous observers as following the administration of salvarsan. Labyr- Generic Viagra Online Uk Co inthine deafness, dizziness, nystagmus, and dis- turbances of the sense of equilibrium have occurred from within a few hours to several days and weeks after treatment. Two cases have been reported by l"inger, in which disturbances of the labyrinth oc- curred nine and twelve weeks after the injections 822 BALl.ESGER: SALl'ARSAN GIVEN IXTRAl'EXUUSLY. VORK JOURN were given, the Wassermann reaction being nega- tive in both, and the patients showing no signs of secondary syphilis. The author believes these cases to be examples of toxic neuritis of the auditory nerves, directly due to the salvarsan. In the parasyphilitic diseases, tabes dorsalis and progressive paralysis, the use of the drug at the pres- ent time is limited to cases in which the diseases have existed but for a short length of time; i. c. in the early stages. During these early periods, the use of salvarsan has shown some promising results. In the later stages, however, in which degenerative changes have already taken place, the drug is strongly contraindicated, as, in the majority of such cases, the existing symptoms not only have shown no improvement, but have unfortunately evidenced a decided aggravation of the disease, and in some cases death' has followed the administration of the drug. The unfavorable effects in diseases of the