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'.. beginning to clear up under the usual treatment while u episcleritis developed on temporal half of right eye. - er intramuscular injection with salvarsan, o.l gramme a one week later 0.25 gramme, in neutral suspension, the li eye continued to improve, but three days after the sec- injection an interstitial keratitis developed on the right e progressed slowly for ten days, then gradually dimin- ii d. Within six weeks after the injection, all irritation c ed and the corneje were practically clear. Wasser- n m reaction still +++• 'he salvarsan was given after the crisis in the li eye. It is of special interest to note that an i; rstitial keratitis began three days after the sec- injection, but ran an aborted course. ASE X. Boy, twelve years. Wassermann reaction - — f~|-. Completely developed interstitial keratitis on b I eyes, corneae opaque, beginning vascularization on all i". s. Atropine potassium iodide, hot compresses. Sal- V ^an, 0.3 gramme in neutral suspension intramuscularly ii cted. No immediate effect. One week later less photo- p jia, vessels slowly progressing. Cornea clearing at p phery, five weeks after injection, the irritation had n -ly subsided ; there was a central opacity from three to 1 • millimetres in diameter. n this case the progress toward recovery was p haps a little more rapid than is usual by ordi- n y treatment. '1 tabes and paresis, salvarsan has been used in a 2ry considerable number of cases. Ehrlich has r :atedly warned against the use of the drug in a cases of advanced degeneration of the central n v-ous system. But these patients, who often suf- f unendurable pains and other grievous miseries, '-■ nor for a trial of the new remedy. Now, it must b :lear that a degenerated nerve tract which has b 1 replaced by connective tissue is about as likely ti esume its function as the stump of an amputated li ) to grow a healthy leg. Nevertheless, as Erb a Nonne have pointed out, there may be mixed Costo Del Cialis Da 20 Mg ii vith the sclerotic tissue foci of active syphilitic p :esses, and on these the remedy may have a fa- V able action. Certain it is that in a large num- h of cases of Costo Del Cialis Da 20 Mg tabes, there has been a marked im- p vement in some distressing symptoms after the II of salvarsan ; paretic sphincters have resumed tl r function, girdle and lancinating pains have (i ippeared, at least for a time. In paresis the rc- i s have been on the whole less favorable, Costo Del Cialis Da 20 Mg and I ■^ uld sum up my impressions by saying that if ti case is sufficiently advanced to make a positive Costo Del Cialis Da 20 Mg li liy comatose after an injection of salvarsan and dji ten days after the injection. 'Ve come now to our last question. What are the cctions to or the dangers of the new drug ? The niedy has been used now in over 30,000 cases. ■' few deaths have followed its use. In testing a new drug on so large a scale, and in so grave a dis- ease as syphilis, it is but natural that mistakes should have been made. They need not happen again. The few recorded deaths have occurred in patients with advanced degenerative lesions of the central nervous system, with myocarditis, in debili- tated, cachectic individuals, and in Costo Del Cialis Da 20 Mg moribund infants. We may assert with reasonable confidence that the enormous dose of arsenic given in the form of sal- varsan does no harm. In thousands of cases, fur- thermore, the drug has been used more than once; two, three, and more reinjections have been given without damage to the patient Costo Del Cialis Da 20 Mg — without, on the one hand, establishing an immunity on the part of the spirochastse or, on the other hand, oversusceptibility on the part of the patient. Properly employed and in suitable cases the drug seems to be harmless. The fear of a neurotropic action of the drug, like the effect of atoxyl and arsacetin on the optic nerve, has been constantly borne in mind, and the fact that the drug is used to-day in a hundred well conducted clinics of Europe after a trial of si.x or eight months may give us some assurance that the fear of a spe- cial action on the optic ner\'e is unfounded, .\toxyl atrophies occur in from a few weeks up to seven months after treatment with atoxyl. Unless an ef- fect on the nerve is produced with salvarsan after an unprecedentedly long period, I think Costo Del Cialis Da 20 Mg we may re- gard its use as safe in this respect. It must be noted, however, that Finger is Costo Del Cialis Da 20 Mg of a different opinion. In his publication of November 24th, ° he gives the histories of four cases in which the nervous apparatus of the eye, and in three cases of the ear, was affected at an early period in the history of the disease, when such lesions are at least uncommon in syphilis. He believes that Costo Del Cialis Da 20 Mg the innocuousness of salvarsan on the nerves of these special organs is by no means established, and flatly warns the medical public against the general use of the drug. The authority of Finger carries great weight ; but against it I should place the experience of Neisser, Gennerich, Schrciber. and a hundred other excellent observers who are to-day using the drug more than ever. It seems to me that all of Finger's cases, except one. may be explained in the light of Wechselmann's observation — that about three per cent, of his large series of cases of syph- ilis in the secondary stage of the disease showed more or less grave lesions of the optic nerve with- out loss of vision — as examples of such early nerve involvement as part of the syphilis, and not as the effect of the salvarsan. In his cases the observed lesions developed between two and three months after the injection. It seems incredible that among the 20,000 or more cases injected now more than three months ago, and many of them more than six months ago, there should not have been a large number of such sensory nerve injuries observed if salvarsan were responsible for them. The single exception in Finger's list is a case of optic nerve atrophy occurring two and a half years after in- fection and three months after treatment with sal- varsan. In an article just published, Ehrlich"