254 CHEMOTHERAPY 



The oily suspension may be made by simply triturating the salvarsan in 

 fatty oils i : 10; Ol. Amygdal. dulc, OL Sesami, Ol. Olivae, Paraffin, lodipin. 



The subcutaneous injection is made between the shoulder-blades at the 

 sides of the vertebral column and in a downward direction. It is best 

 however to discard this method entirely. 



The intramuscular injection is made in the upper outer quadrant of 

 the gluteal region; it should be given deeply and very slowly, so as not to 

 injure the muscles. The sciatic nerve must be carefully avoided. This 

 method is chosen when the intravenous application is impossible (small 

 veins, excessive fat) or when the injections cannot be repeated and a 

 prolonged action is essential. A favorite plan is to give one to two 

 intravenous injections followed by one to two intramuscular ones. 



Owing to the difficulty with which the salvarsan solution is 

 Neosal- prepared, and its marked irritating local effect, Ehrlich pro- 



varsan. duced a modification of this substance eliminating these two 

 characteristics. This new chemical agent, neosalvarsan , is a 

 condensation product of formaldehyde sulphoxylate of sodium (CH 2 - 

 (OH)O.SO.Na) and salvarsan. Its composition is dioxydiamidoarseno- 

 benzol-monomethane sulphinate of sodium. It consists of a yellowish 

 powder of peculiar odor and dissolves very easily in water, with a com- 

 pletely neutral reaction resulting. 



The average single dose of neosalvarsan is half again that of salvarsan 

 as it contains only 66 per cent, salvarsan. On account of its non-irritat- 

 ing properties, it is very readily administered by intramuscular injec- 

 tion. Subcutaneous injection must be avoided, owing to the danger of 

 infiltration. 



The preparation of the new solution is exceedingly simple. The 

 powder dissolves in freshly distilled water with hardly any shaking. A 

 0.4 per cent, saline solution may be used instead of the plain water, 

 provided it is made from chemically pure sodium chloride and freshly 

 distilled water. As with salvarsan, solutions of neosalvarsan must be 

 injected immediately after their preparation. The temperature of the 

 injected fluid should not rise above 20-22 C. (68 to 71.6 F.). Warm- 

 ing the liquid must be avoided. 



For intravenous injection 25 c.cm. of distilled water or saline are re- 

 quired for each 0.15 gram neosalvarsan; but if desired it may be admin- 

 istered in much more concentrated solution as it is by the intramuscular 

 method; for example, 0.6-1.5 gm. in 10-15 c.cm. of fluid. This quantity 

 can be injected by means of a 15 c.cm. glass syringe, thus eliminating 

 the use of large or complicated apparatus. Especially in children is this 

 of advantage. 



The injections of neosalvarsan are without a doubt better borne than 

 a corresponding dose of salvarsan. On this account the new remedy 



