ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 803 



the vein and the saline solution or water from the tubing the nozle of 

 the latter is fitted into the needle quickly and securely while the latter 

 is held firmly in the vein. The appearance of bulging at the side of the 

 vein and the occurrence of pain indicate that the needle has not been 

 properly inserted. In this event the clamp should be fastened, the 

 needle withdrawn, the tourniquet adjusted, and another vein punctured. 

 It is useless to attempt to enter the same vein at the same point. 



4. The introduction of a full dose of salvarsan or neosalvarsan will 

 usually take from ten to twenty minutes or thereabouts. If the flow is 

 retarded, the needle may be turned gently and slightly so as to change 

 the relation of the bevel to the wall of the vein. 



5. When salt solution forms the first portion of the injection, no 

 harm has been done if perivascular infiltration occurs. This method 

 gives added assurance to the operator; indeed, it should never be 

 omitted when salvarsan is being injected, and it is a good general rule to 

 have the first portion of the injection consist of normal salt solution. 



6. After the requisite dose has been injected, a few cubic centimeters 

 of salt solution are again permitted to flow into the vein, so that the tub- 

 ing and needle are washed free from salvarsan, and at no time does the 

 drug come in contact with the tissues. 



7. The needle is then quickly withdrawn, and the site of the punc- 

 ture sealed with collodion and cotton after the iodin has been removed 

 by washing with alcohol. 



After-care of the Patient. In the majority of instances the adminis- 

 tration of salvarsan is not followed by unpleasant symptoms. This 

 depends, however, to a considerable extent upon the nervous constitu- 

 tion of the patient. Many persons will complain of a feeling of fullness 

 and may perspire freely for a short time. There may be slight pain at 

 the site of injection and in the axilla of the injected side. As was pre- 

 viously mentioned, salvarsan should be administered at the patient's 

 home or in a hospital, followed by rest in bed until the next morning. 

 When neosalvarsan is injected, robust persons may, after resting for an 

 hour or so, travel homeward. Occasionally severer reactions follow 

 salvarsan administration, and these may be considered under the head 

 of after-effects. 



After-effects of Salvarsan. Within an hour or two after its admin- 

 istration arsenic is excreted by the kidneys and bowels and nausea may be 

 complained of. If catarrh of the stomach is present, severe vomiting may 

 ensue. The nausea is relieved by sipping a little hot water; hot applica- 

 tions over the stomach and small amounts of carbonated water or cham- 



