APPENDIX 341 



the most popular and best form of intraspinal treatment for 

 syphilis thus far proposed. 



The technic, slightly modified from the original of Swift 

 and Ellis, is as follows: The patient should receive the same 

 preliminary preparation as for salvarsan or neosalvarsan, of 

 which the former is preferable and more effective. Usually 

 the full adult dose of salvarsan is administered intravenously. 

 Prior to the injection of salvarsan it is assumed that suffi- 

 cient spinal fluid has been obtained by lumbar puncture 

 (Fig. 66) for the various tests necessary in the control of 

 the number of intraspinal injections, namely, the Wasser- 

 mann reaction, the lymphocytic count, Noguchi's butyric 

 acid test for globulin or Nonne's phase reaction. One-half to 

 one hour after the intravenous injection of salvarsan, about 

 40 cubic centimetres of blood are taken in centrifuge tubes 

 from a vein of the opposite arm. This may be allowed to 

 stand until the following day for the separation of the serum 

 or, as is the practice of the authors, immediately centrifuged 

 and IS cubic centimetres of the serum pipetted off and di- 

 luted with 18 cubic centimetres of sterile normal salt solution. 

 This forty per cent, dilution of serum is activated by heat- 

 ing at 56° C. in a water-bath for one-half hour. On the 

 occasions of the second and third treatments, the strength 

 of the serum is commonly increased to 50 and 60 per cent, 

 dilutions. The 30 cubic centimetres of diluted serum are then 

 carefully and slowly injected by lumbar puncture after ap- 

 proximately an equal amount of spinal fluid has been with- 

 drawn. Theoretically, the intraspinal injection is best done 

 by the gravity method (Fig. 67) ; practically, it can be and 

 is properly accomplished by the faultless use of a syringe, 

 injecting very slowly (Fig. 68). The patient may be per- 

 mitted to lie on his side or sit with his back arched. Im- 

 mediately after the injection, the patient must lie down and 



