SALVARSAN AND NEOSALVARSAN IN TREATMENT OF SYPHILIS 857 



compound are quite favorable. It has not been used very extensively 

 and is not yet available in America. 



The doses are similar to those of salvarsan, averaging 0.4 to 0.6 gm.; 

 Wechselman 1 has administered as much as 1 gram in a dose. The com- 

 pound resembles salvarsan in appearance except that the powder has a 

 greenish hue and the solutions are somewhat darker in color. Solutions 

 of the drug oxidize rapidly and must be administered promptly. 



The drug is readily soluble in warm water and does not require 

 neutralization with an alkali. It has been administered in dilute and 

 concentrated solutions dissolved in sterile distilled water and in the same 

 manner as neosalvarsan. Wechselman uses 0.4 per cent, salt solution 

 in preparing the solution. 



Methods of Preparing Salvarsan for Administration. Soon after 

 the introduction of the drug several methods of preparation and adminis- 

 tration were suggested. Many of the disadvantages attached to sal- 

 varsan treatment, and many of the bad results and complications re- 

 ported, are to be attributed to defective methods of preparation and 

 administration of the drug. 



Because of the marked stability of salvarsan and neosalvarsan, the 

 following points must be borne in mind : 



1. The ampule containing the drug must be intact. 



2. The powder must be of a yellow and not of a gray or brownish color. 

 Each ampule must be carefully examined before the contents are 



administered. 



3. The drug should be prepared for injection just prior to administra- 

 tion. 



It is not necessary to describe the earlier methods, because these are 

 now largely only of historic interest, and it is quite generally accepted, 

 from the point of view both of efficient treatment and of the comfort of 

 the patient, that the intravenous injection of a dilute solution of the di- 

 sodium salt is the best form of administration. For this reason I shall 

 briefly mention the other methods, and describe the method of intraven- 

 ous injection of the alkaline solution in greater detail further on. 



The Acid Solution. When salvarsan is dissolved in warm water or 

 warm normal saline solution, a strongly acid solution is obtained. In 

 this form the drug is most irritating and also most toxic, and when in- 

 jected subcutaneously and intramuscularly, produces severe pain and 

 necrosis. This method is seldom if ever used at the present time. 



The Mono-acid Solution. If to the watery acid solution half the 



1 Munch, med. Wchnschr., 1916, Ixiii, 271. 



