SALVARSAN IN THE TREATMENT OF SYPHILIS 255 



seen in the case of the powder itself, if the ampoule was not absolutely 

 air-tight; such preparations should be discarded. 



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

 of saline (for dosage see below). 



Reaction. The reaction symptoms following the use of neosalvarsan 

 are said to be less marked than those observed after the injection 

 of the older product. Elevation of temperature, however, occurs 

 here, as there, a few hours after the first injection, while gastro- 

 intestinal symptoms are noted only exceptionally. With large 

 doses exanthems have been observed between the eighth and the 

 twelfth day, which may be avoided, however, if smaller amounts 

 be given. 1 



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

 locidal drug that does not effect the complete destruction of all 

 the parasites at a single dose is apt to lead to the development of 

 serum and drug-fast strains, a large dose, cceteris paribus, is preferable 

 to a small dose; if, however, a large dose is for any reason not advis- 

 able, it is probably best to inject smaller quantities at brief intervals. 



While 0.5 gram is generally recommended as the initial dose of 

 salvarsan for men, and a slightly smaller amount (0.3 to 0.4 gram) 

 for women, some investigators have used larger quantities without 

 observing any detrimental effects. In subjects that are not in 

 robust health, or in individuals where one is in doubt whether to use 

 the remedy at all, it is best to give a small initial injection, say of 

 0.2 gram and to repeat this dose in a few days if no unusual symp- 

 toms develop. In young babies up to the fourth month the dose 

 should not exceed 0.02 to 0.03 gram, while in children of nine or ten 

 years of age 0.1 and 0.2 gram may be given, which is best injected 

 into the gluteal muscles, the amount of liquid being, of course, 

 proportionately smaller. The pain which develops after the injection 

 may be controlled, to a certain extent at least, by hot compresses. 



If the neosalvarsan is to be employed, 1.5 gram may be given to 

 men and 1.2 gram to women, but it is recommended not to start 

 with these doses, but to give a primary injection of 0.9 gram; to 

 allow a day to intervene and then to inject 1.2, then on alternate 

 days, i. e., with a day of rest intervening 1.35 gram and finally 1.5 

 gram. That the dosage can be pushed, however, is shown by the fact 



1 Reports coming in while the above account has been running through the 

 press are less in favor of the neosalvarsan than of the salvarsan proper. 



