248 CHEMOTHERAPY 



antisyphilitic agents and remain unmolested only to multiply and cause 

 a focal disease of the nerve. 



A few reports of severer complications such as meningomyelitis, or 

 death, due to salvarsan may be found in the literature. Upon careful 

 review these instances reveal some responsible factor other than salvarsan 

 alone. In this connection a possible independent bacterial infection 

 existing at the time of the salvarsan injection (as a grippe or cold) is 

 especially to be emphasized. 



4. As centra-indications for the use of this medicament, Ehrlich 

 mentions more serious disturbances of the cardio-vascular system, more 

 advanced degeneration of the central nervous system, fetid bronchitis as 

 well as cachexias, unless these be a direct consequence of syphilis. Each 

 case, however, should be considered by itself and not as belonging to one of 

 the above wide groups; thus while a mild valvular defect is a cardiac dis- 

 turbance it does not per se necessarily centra-indicate treatment; only 

 severe decompensation should be the inhibitory factor. The same may 

 be said of aneurysms and renal disturbances. In incipient tabes, in 

 early paralysis and epilepsy of syphilitic origin a prospect of success can be 

 held out, provided the treatment is commenced immediately after the 

 very earliest appearance of symptoms. The doses of salvarsan employed 

 here should be smaller, because the susceptibility is greater. In syphilis 

 of the liver the author has observed rather poor results. Others 

 report the contrary. Luetic infections of the eye, even beginning optic 

 atrophy, offer no centra-indication. In general, tuberculosis is no danger 

 signal. 



5. The mode of application of salvarsan is of paramount importance. 

 It may be administered intravenously, intramuscularly or subcutaneously. 



It can be prepared in an alkaline or acid solution, as a neutral sus- 

 pension or in an oil emulsion. At present the method of choice is the 

 intravenous injection of an alkaline solution. 



The advantages of this procedure are the absence of any pain, complete 

 resorption of the entire quantity injected, very rapid action, almost no 

 by-effects. The only disadvantage is that the salvarsan is excreted very 

 rapidly so that in about four days it has almost entirely left the system. 



The Technique of the Intravenous Salvarsan Injection. 



(a) Preparation of the Alkaline Solution. About 30 to 40 c.cm. of 

 0.85 per cent, sterile salt solution are measured in a narrow-necked, 

 graduated glass-stoppered sterile cylinder of 300 c.cm. capacity, containing 

 about 50 sterile glass beads. (In the official instructions accompanying the 

 salvarsan, it is advised to use plain distilled water instead. In the author's 

 experience it has not been found necessary to make matters somewhat com- 

 plicated by using distilled water here and further on salt solution. He 



