APPENDIX 331 



ana?sthetized, preliminaril}^, by injecting through the needle, 

 in situ, two cubic centimetres of a one per cent, or five cubic 

 centimetres of a one-half per cent, novocain solution. Post- 

 ing ectional pains or reactive painful infiltrations may be 

 combated locally with hydrothcrapeutic measures, as the hot- 

 water bottle, hot compresses, etc., and internally the adminis- 

 tration of pyramidon has proved very effectual. Patients had 

 best remain in bed for some time after the injection. 



Unfortunately, no patient who has ever received salvar- 

 san or neosalvarsan intramuscularly desires it a second time 

 by that method, and any patient who has had the drug ad- 

 ministered both intravenously and intramuscularly invariably 

 prefers the former because of the lesser pain. Certainly 

 there are occasions when, by force of circumstances, it be- 

 comes necessary or expedient to use the intramuscular 

 method, but these exceptions must be few in number. 



Intravenous Administration. — The intravenous adminis- 

 tration of salvarsan and neosalvarsan in dilute solution is 

 the best method and the mode of therapy of the future. The 

 consensus of opinion among those of widest experience is 

 that salvarsan is more effective than neosalvarsan. A rou- 

 tine procedure with the authors is to commence treatment 

 with neosalvarsan, which, if well tolerated, is supplemented 

 by salvarsan. We firmly believe in the intensive form of 

 treatment, with proper observance of precautions and con- 

 tra-indications, attempting thereby to eradicate the disease ; 

 particularly is this true in the primary stage of syphilis, 

 when the indication for the intravenous administration of 

 arseno-benzol is just as acute as the scalpel in a well-defined 

 case of appendicitis. In the early days of the chancre, es- 

 pecially before a positive Wassermann is obtainable, it is 

 possible to cure syphilis by one or more injections of sal- 

 varsan alone; in the late primary usually, and throughout 



