278 CHEMOTHERAPY 



It is a fine yellow powder, easily soluble in water, methyl alcohol, 

 and glycerin, less easily soluble in ethyl alcohol and insoluble in 

 ether. Owing to the readiness with which it undergoes oxidation 

 and gives rise to highly poisonous products, it is marketed in little 

 ampoules from which the air has been removed and replaced with 

 an indifferent gas. 



Method of Application. While the substance was originally in- 

 jected in acid solution, i. e., merely dissolved in water, this method 

 was found inapplicable owing to the intense pain which followed 

 its use, and at present it is employed practically only in alkaline 

 solution, which is administered intravenously, and should be freshly 

 prepared just before the injection. This is done in a sterile bottle 

 of about 500 c.c. capacity, graduated in 50 c.c., and containing 

 some large sterile glass beads. The salt solution (0.65 per cent.) 

 which is used as solvent and diluent should be freshly prepared from 

 freshly distilled water and chemically pure sodium chloride. 30 to 

 40 c.c. of this are placed in the bottle and the dose of salvarsan 

 added, which then dissolves on vigorous shaking. 



To obtain the alkaline solution 0.19 c.c. of a 15 per cent, solution 

 of caustic soda (NaOH) are now added for every 0.1 gram of the 

 remedy, the immediate effect being the formation of a precipitate 

 which dissolves on shaking and then gives rise to a clear golden 

 yellow solution. This is finally diluted with the sterile saline (warmed 

 to body temperature), such that every 50 c.c. shall correspond to 0.1 

 gram of salvarsan. Taking an adult dose of 0.6 gram as example, 

 the final bulk would thus be 300 c.c. Should the solution not be 

 absolutely clear a few additional drops of the NaOH solution may 

 be added. Occasionally the fluid does not clear up upon the further 

 addition of alkali, in which event it is probably best to break a 

 new ampoule of the drug. 



To give the injection, an ordinary infusion bottle or similar con- 

 trivance (properly sterilized, of course) is arranged at the bedside 

 of the patient and charged with a small quantity of warmed salt 

 solution which should completely fill the rubber tube leading to the 

 needle, as well as the lumen of the latter. This need not be of large 

 caliber; a No. 18 (B. & S. standard) is quite sufficient in size. The 

 arm having been cleansed, at the bed of the elbow, with soap and 

 water, bichloride, alcohol, and ether, or, as has recently been advo- 

 cated, merely painted with tincture of iodine, about the site of the 



