APPENDIX 333 



of the chemical and aseptic precautions, prepares the solution 

 for intravenous administration. 



Preparation of Salvarsan Solution. — In Fig. 61 are 

 shown the various reagents, solutions, glass vessels and ap- 

 paratus useful for the preparation and administration of 

 salvarsan intravenously. All apparatus, as described in the 

 outfit (Fig. 62), here recommended, including thermometers, 

 burette, etc., may be sterilized by boiling. The ampoule of 

 the drug is best antisepticized by submersion in a cold solu- 

 tion of bichloride or formalin, after noting that it is intact 

 and its content in no way oxidized. The water and saline 

 solution employed for solution and dilution of the salvarsan 

 must be sterile and freshly distilled. Chemically pure sodium 

 chloride must be used in making the saline solution. The 

 common laboratory or commercial distilled water is usually 

 not sterile. Clinical experience has demonstrated that reac- 

 tions following the administration of salvarsan are more 

 common when spring, tap or stale water is used than when 

 freshly distilled water is the diluent. Whether or not this 

 increased toxicity is due to the interaction of the endotoxins 

 of the contained flora and arseno-benzol or is referable to 

 other causes, it is advisable to employ freshly distilled water. 

 This may be readily obtained in sufficient quantities by an 

 apparatus (Fig. 63) capable of being installed in the physi- 

 cian's office. Sterilization may then be assured or completed 

 in an Arnold sterilizer for one-half hour. The use of sterile 

 freshly distilled water and chemically pure salt solution and 

 the preparation of the salvarsan solution immediately before 

 intravenous injection are imperative conditions. 



Twenty to forty cubic centimetres of warm (110° to 

 120° F.) sterile freshly distilled water, (W, Fig. 61) are 

 placed in the graduated glass stoppered cylinder or mixer 

 (M) containing a dozen or more small glass balls. The 



