ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 799 



Many of the toxic and other ill effects attending salvarsan therapy have 

 been attributed to the use of raw and stale water. Experiments con- 

 ducted by Yakinoff show that the presence of the endotoxins of such 

 microorganisms as Bacillus coli, Bacillus pyocyaneus, and staphylococci 

 in the water, increases the toxicity of salvarsan from two to eight times, 

 the water alone and the salvarsan alone being without effect. In office 

 practice physicians may distil water by means of some simple appa- 

 ratus, such as that of Muencke. The distilled water is then sterilized 

 in an Arnold sterilizer for one-half hour, or by boiling for ten or fifteen 

 minutes. 



2. All glassware used should be carefully sterilized, usually by boiling, 

 as in the physician's ordinary office sterilizer. 



3. The ampule containing the drug is wiped off with alcohol, the 

 neck filed across and broken off, and the contents emptied into a sterile 

 50 c.c. glass-stoppered mixing cylinder containing preferably a number of 

 small glass beads. From 15 to 20 c.c. of hot (about 50 C.) sterile dis- 

 tilled water are added, and with shaking the drug passes into solution. 

 A 15 per cent, solution of caustic soda is now added drop by drop to the 

 solution in the cylinder. A precipitate of the base is first deposited, 

 and on further addition of caustic soda, aided by shaking, this is again 

 brought into solution, the fluid being strongly alkaline. The amount of 

 alkali necessary is about four drops of a 15 per cent, solution for each 

 0.1 gm. of salvarsan; thus, for 0.6 gm., 1.14 c.c., or about from 23 to 45 

 drops of 15 per cent, solution of caustic soda, would be required. Citron 

 gives the following table: 



0.2 gm. salvarsan requires 0.38 c.c. of 15 per cent, sodium hydroxid = 8 drops. 

 0.3 gm. salvarsan requires 0.54 c.c. of 15 per cent, sodium hydroxid = 12 drops. 

 0.4 gm. salvarsan requires 0.76 c.c. of 15 per cent, sodium hydroxid = 15 or 16 drops. 

 0.5 gm. salvarsan requires 0.95 c.c. of 15 per cent, sodium hydroxid = 19 or 20 drops. 

 0.6 gm. salvarsan requires 1.14 c.c. of 15 per cent, sodium hydroxid = 23 to 24 drops. 



A drop more of the alkali than is just necessary to produce the clear 

 solution should be added. If this is not done, on cooling the solution 

 may show a precipitate; this can be redissolved by the addition of a 

 drop of alkali. The drug is now in a solution of about 20 c.c., and if 

 an intramuscular injection is to be given, this is the form to be preferred. 

 Intramuscular injections are, however, likely to be painful, and should 

 be given only in those cases where it is practically impossible to give the 

 drug intravenously, as in the case of infants. For intravenous injec- 

 tion the solution of 20 c.c. is diluted with warm sterile distilled water to 

 make 300 c.c. in a second sterile cylinder or beaker, which is graduated 



