SALVARSAN IN THE TREATMENT OF SYPHILIS 253 



injection, the needle is plunged into any one of the large veins which 

 there present themselves, and which have been rendered prominent 

 by constricting the upper arm with a bandage, or a piece of rubber 

 tubing, without, however, obliterating the arterial flow. The tourni- 

 quet is then removed, the clamp opened on the rubber tube, and the 

 saline allowed to flow. If the result shows that the needle is actually 

 in the vein, the salvarsan solution is added to the small amount of 

 saline remaining in the bottle, and the infusion allowed to proceed. 

 In the end about 50 c.c. of saline are allowed to follow the salvarsan, 

 so that the tissue about the site of the puncture shall be irritated 

 as little as possible in the event of a little leakage while the needle 

 is being withdrawn. 



Especial care should be had that the injection is made slowly, and 

 under no circumstances should it be allowed to consume less time 

 than twelve to fifteen minutes. Want of attention to this point 

 may result in the development of serious symptoms. While it is 

 usual that the patient's face becomes flushed during the injection, 

 the infusion should be stopped at once, if sudden pallor develops, 

 or the pulse becomes weak. 



Following the injection the patient should be placed in bed and 

 should remain there for twenty-four hours or longer, according to 

 the symptoms which develop during this time. To give the injec- 

 tion in the physician's office, and then to allow the patient to go 

 home and follow his usual occupation, is a dangerous practice, 

 unless indeed the dose be small, and the quantity of fluid less than 

 150 c.c. 



Reaction. The reaction which follows the intravenous adminis- 

 tration of salvarsan is essentially of the same character as that 

 following the injection of a corresponding amount of saline, and 

 varies in intensity with the individual case. In many instances the 

 patient merely experiences chilly sensations within an hour or two, 

 while in others there is an actual shaking chill, which may indeed 

 develop before the patient has been returned to the bed. Often 

 there is a feeling of congestion about the head, and quite commonly 

 more or less profuse sweating. Moderate temperature elevation 

 also is common (100 to 101.5 F.), while occasionally there is a more 

 vigorous reaction (to 102 or even 103 F.). Vomiting is not unusual, 

 and at times diarrhea occurs. Other symptoms than these will 

 rarely be observed, if care be taken to follow the directions given 



