APPENDIX 327 



and often a dozen or more injections are required to render 

 the Wassermann reaction negative. Obviously, with feeble 

 or prostrated patients of those manifesting a cardiovascular 

 or central nervous s^^stem lesion, the initial dose, at least, 

 must be smaller than the average. 



When a tonic and alterative effect, in conjunction with 

 specific action, is desired, full doses of the drugs at intervals 

 of several weeks, may be administered intramuscularly, or, if 

 merely the tonic, alterative effect of the drugs is desired, 

 small and frequently repeated intramuscular injections may 

 be desirable. An intramuscular method of administration 

 is that by fractional doses. 0.1 to 0.2 gramme of salvarsan 

 suspended in oil is injected every other day until a total 

 of 1.2 grammes has been given to the patient. This mode 

 of therapy applies more particularly to the treatment of 

 non-syphilitic diseases. Small intramuscular injections, lack- 

 ing sufficient remedial action, may invite relapses, conse- 

 quently it is advisable either to precede or supplement the in- 

 tramuscular injection by a full dose of the drug intra- 

 venousl}^ In all stages of syphilis, ^'ith the possible excep- 

 tion of the early primary, it is imperative to supplement sal- 

 varsan with mercury or mixed treatment. 



Methods of Preparation and Administration. — Time and 

 experience have evolved four methods -^ for the employment 

 of salvarsan and neosalvarsan : the subcutaneous, the intra- 

 muscular, the intravenous and the intraspinal or intra- or 

 subdural. 



Following the successful original experiments on animals 

 by Hata, Hoppe, in the Clinic of Professor Konrad Alt in 

 Uchtspringe, on the suggestion of Ehrlich, in September, 



^ The administration of arseno-benzol by mouth is unworthy of con- 

 sideration. The same objection obtains respecting its use as a dusting 

 powder for the chancre on account of cost if for no other reason. 



