866 CHEMOTHERAPY 



the Record, Luer, and Burroughs- Wellcome syringes are recommended. 

 The arm of the patient is prepared as described above and a tourniquet 

 applied, which may be quickly released by the operator with least dis- 

 turbance. The needle is now passed into a vein, and after a free flow of 

 blood appears the syringe is gently adjusted and the injection slowly 

 made (at least one or two minutes should be required) . Great care should 

 be exercised that none of the solution enters the tissues. The syringe 

 shown in Fig. 139 is particularly well adapted for this work, as it enables 

 the physician to puncture the vein with the syringe containing a small 

 amount of salt solution, and also enables him to wash in a small amount 

 of the same at the close of the operation and thus avoid injecting salvar- 

 san into the tissues. 



Intravenous Administration of Neosalvarsan in Concentrated So- 

 lution. Neosalvarsan, being less toxic than salvarsan, may be readily 

 administered in concentrated solution. The dose of drug to be admin- 

 istered is dissolved in 20 c.c. of warm, sterile, freshly distilled water in a 

 small cylinder and requires no neutralization. The clear solution is 

 now taken up into a sterile syringe and injected in the manner described 

 above. 



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- 

 pagne will usually control the vomiting. It may occasionally be neces- 

 sary to administer y % grain of morphin hypodermically, especially if the 

 patient is of a neurotic temperament. Headache may occasionally de- 

 velop, and is due to a neurotic condition, constipation, anxiety, hunger, 



