ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 859 



For infants suffering from congenital syphilis the dose is from 0.006 

 to 0.01 gm. of salvarsan for every two pounds of body weight, so that a 

 child of eight pounds would receive from 0.024 to 0.04 gm. of salvarsan. 

 To older children, weighing from 40 to 60 pounds, 0.2 to 0.3 gm. may be 

 given. 



Dosage of Neosalvarsan. This preparation is less toxic than sal- 

 varsan, and may be administered in larger doses, as from 0.6 to 0.9 gm. 

 The same general rule as to the physical condition of the patient should 

 apply here in deciding the dosage. At the present time the tendency 

 is to give adult patients about 0.6 gm. for three, four, and more injec- 

 tions at intervals of a week or so. 



Frequency of Injections; Intensive Treatment. As was just stated, 

 there is a distinct tendency among those of large experience to regard 

 salvarsan as a more potent spirocheticid than neosalvarsan. As pre- 

 viously mentioned, the original idea of sterilizing the patient with one 

 large dose of the drug has been largely abandoned, especially in the 

 treatment of syphilis in any but the earliest stages. A large number of 

 smaller doses are being given, and the results are controlled by the 

 Wassermann reaction with blood and cerebrospinal fluid, in addition to 

 the cytologic changes in the latter. Thus from 0.3 to 0.5 gm. of sal- 

 varsan or neosalvarsan is given every week or twice a week for three, 

 four, or ten doses and more, depending upon the clinical results and the 

 serologic findings. In this connection it must be remembered that a 

 negative Wassermann reaction is of little value if blood has been with- 

 drawn within one week of the last treatment. (See Chapter XXIII.) 

 While it is the common practice to administer a number of doses of sal- 

 varsan or neosalvarsan, and to follow this with mercury and then with 

 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. 



