798 CHEMOTHERAPY 



salvarsan again, this method must be regarded as containing an element 

 of danger, especially since Wechselmann has drawn attention to the 

 fact that mercury acts as an irritant to the kidneys. It may be stated 

 that, in general, most cases of syphilis require a number of injections 

 of salvarsan; this number depends upon the age and nature of the 

 infection, and should be controlled by the Wassermann reaction with 

 both blood and spinal fluid. 



Preparation of the Patient. In view of the fact that many of the 

 fatalities due to salvarsan have been ascribed to defective kidneys, 

 especially to kidneys damaged by the previous administration of mercury, 

 it should be a routine measure to have the urine thoroughly examined for 

 sugar, albumin, and casts previous to the administration of salvarsan 

 or neosalvarsan. 



While thousands upon thousands of injections have been made with- 

 out ensuing untoward results, still the administration of this drug is not 

 without danger, and the physician should familiarize himself with the 

 contraindications, and subject his patient to a careful physical examina- 

 tion before undertaking this form of therapy. This subject will be 

 discussed further under the head of Contraindications to Salvarsan 

 Therapy. 



In the majority of cases, however, no contraindications exist and no 

 elaborate preparations are necessary. The rectum should be emptied 

 before the injection is given, and it is best to administer the drug on an 

 empty stomach. After receiving salvarsan the patient should rest over- 

 night under direct supervision, as in a hospital, the injection being given 

 during the afternoon or early evening hours. The same practice should 

 be followed with neosalvarsan, although in thousands of instances pa- 

 tients have received an intravenous injection, rested for an hour or so, 

 and then returned to their homes. 



Preparation of Salvarsan Solution. As previously mentioned, the 

 physician should examine the ampule containing the drug to convince 

 himself that it is intact. The solution should be prepared just before it is 

 injected. On account of the oxidation that occurs it is unsafe to use the 

 drug if the ampule has been open for a number of hours, and for the 

 same reason it is not good practice to prepare a bulk solution for a num- 

 ber of patients unless the physician is certain that he will be able to make 

 the injections quickly and without interruption. 



The clear alkaline solution is most generally used. It is prepared 

 as follows: 



1. The diluent should consist of sterile and freshly distilled water. 



