SALVARSAN AND ITS USE IN TREATMENT OF SYPHILIS 267 



injection, the needle is plunged into any one of the large veins which 

 there present themselves, and which have been rendered prominent 

 by constricting the upper arm with a bandage, or a piece of rubber 

 tubing, without, however, obliterating the arterial flow. The tourni- 

 quet is then removed, the clamp opened on the rubber tube, and the 

 saline allowed to flow. If the result shows that the needle is actually 

 in the vein, the salvarsan solution is added to the small amount of 

 saline remaining in the bottle, and the infusion allowed to proceed. 

 In the end about 50 c.c. of saline are allowed to follow the salvarsan, 

 so that the tissue about the site of the puncture shall be irritated 

 as little as possible in the event of a little leakage while the needle 

 is being withdrawn. 



A very convenient apparatus for the administration of salvarsan 

 is that suggested by Gary (Fig. 16). 



FIG. 16 



Syringe for injection of salvarsan. Glass handle guides operator. Two bottles enable 

 alternate use of drug or water. 



Special care should be had that the injection is made slowly, and 

 under no circumstances should it be allowed to consume less time 

 than twelve to fifteen minutes. Want of attention to this point 

 may result in the development of serious symptoms. While it is 

 usual that the patient's face becomes flushed during the injection, 

 the infusion should be stopped at once, if sudden pallor develops, 

 or the pulse becomes weak. 



Following the injection the patient should be placed in bed and 

 should remain there for twenty-four hours or longer, according to 

 the symptoms which develop during this time. To give the injec- 

 tion in the physician's office, and then to allow the patient to go 

 home and follow his usual occupation, is a dangerous practice, 



