268 CHEMOTHERAPY 



unless indeed the dose be small, and the quantity of fluid less than 

 150 c.c. 



Other methods of administering salvarsan have practically been 

 abandoned, and we would indeed warn the practitioner against the 

 use of subcutaneous and intramuscular injections, no matter in 

 what medium the drug may have been dissolved or suspended. 

 Such injections usually cause a great deal of pain and are not 

 infrequently followed by necrosis. 



Reaction. The reaction which follows the intravenous adminis- 

 tration of salvarsan is essentially of the same character as that 

 following the injection of a corresponding amount of saline, and 

 varies in intensity with the individual case. In many instances 

 the patient is not inconvenienced in the least. At first when it was 

 not known, that it is essential to use freshly distilled, sterile water 

 in making up the solution, it was only too common to meet with 

 fairly severe reactions, viz., chills, fever, vomiting, diarrhea, etc., 

 but such symptoms are now seen only exceptionally. Symptoms on 

 the part of the nervous system, notably in connection with some of 

 the cranial nerves, which develop in relatively rare instances, either 

 during the first few days or only after several months, following 

 the use of salvarsan, are to be attributed not to any toxic action 

 on the part of the drug, but to the localization of the spirochetes, 

 and constitute an indication for the further use of the drug rather 

 than the reverse (see Neurorelapses) . 



That the known centra-indications to the use of the salvarsan 

 should, of course, be considered in connection with every case goes 

 without saying (see below). 



Neosalvarsan. Since salvarsan was first placed upon the market, 

 Ehrlich has attempted to modify the product so that its preparation 

 for injection would be simplified and the use of the caustic alkali, 

 in particular, eliminated, as some of the objectionable features 

 which are at times noted after the injection could be shown to be 

 due to this factor. The result is the so-called neosalvarsan. 



This is a condensation product of salvarsan and hydraldite (for- 

 maldehyde sulphoxylate of sodium), the reaction taking place 

 according to the equation: 



As = As As = As 



/\ /\ /\ /\ 



NH 2 | |NH 2 +HO.CH 2 .O.SONa 



OH OH 



I 



OH OH 



|NH.CH 2 .O.SONa+H 2 



