SALVARSAN IN THE TREATMENT OF SYPHILIS 281 



Like salvarsan, the new product is a yellow powder, which is 

 readily. soluble in water, but unlike the original it forms a neutral 

 solution so that no addition of alkali is necessary before use. As 

 its "initial" toxicity at the same time is less (1 gram corresponding 

 to 0.66 of salvarsan), and its spirillocidal action even more intense 

 than that of salvarsan, still better results may be anticipated from 

 its use. 



The solution should be prepared just before injection, but it is 

 necessary to use a salt solution of lower concentration, i. e., one not 

 stronger than 0.4 per cent., as otherwise it will be turbid, and appar- 

 ently more toxic. As in the case of salvarsan, moreover, only freshly 

 distilled or sterile water should be used. While the temperature of 

 of the saline may be as high as 20 C., the liquid should not be heated 

 after solution has taken place, for fear of causing the formation of 

 poisonous oxidation products. For the same reason, it is recom- 

 mended not to shake the solution unnecessarily. Older solutions turn 

 a reddish color, and the same is seen in the case of the powder itself, 

 if the ampoule was not absolutely air-tight; such preparations 

 are dangerous and should be discarded. 



For injections, 0.6 to 1.5 grams may be dissolved in 200 to 250 c.c. 

 of saline (for dosage see below). 



Under no circumstances should the neosalvarsan be used sub- 

 cutaneously or intramuscularly, as the chances of its oxidation and 

 hence of a material increase in its toxicity would thus be much 

 increased. Nor is it admissible, even if the drug is to be administered 

 intravenously, to prepare the solution in bulk for several patients, 

 as the time interval elapsing between the first and subsequent injec- 

 tions might be sufficient to cause the oxidation of the drug. The 

 general idea underlying the administration of the neosalvarsan is 

 thus to cut down the time exposure of the drug or its solution to 

 the air to a minimum. 



Reaction. The reaction symptoms which follow the use of the 

 neosalvarsan are usually insignificant, while neglect of the instruc- 

 tions just given may be expected to produce the symptom-complex 

 of acute arsenical poisoning. With large doses exanthems have been 

 observed between the eighth and the twelfth day, which may be 

 avoided, however, if smaller amounts are given. 



Dosage and Frequency of Injection. As the injection of any spiril- 

 locidal drug that does not effect the complete destruction of all 



