270 CHEMOTHERAPY 



the parasites at a single dose is apt to lead to the development of 

 serum and drug-fast strains, a large dose, cceteris paribus, is preferable 

 to a small dose; if, however, a large dose is for any reason not advis- 

 able, it is probably best to inject smaller quantities at brief intervals. 



While 0.5 gram is generally recommended as the initial dose of 

 salvarsan for men, and a slightly smaller amount (0.3 to 0.4 gram) 

 for women, some investigators have used larger quantities without 

 observing any detrimental effects. In subjects that are not in 

 robust health, or in individuals where one is in doubt whether to use 

 the remedy at all, it is best to give a small initial injection, say of 

 0.2 gram, and to repeat this dose in a few days if no unusual symp- 

 toms develop. In young babies up to the fourth month the dose 

 should not exceed 0.02 to 0.03 gram, while in children of nine or 

 ten years of age 0.1 and 0.2 gram may be given, which may be 

 injected into the gluteal muscles, the amount of liquid being, of 

 course, proportionately smaller. The pain which develops after the 

 injection may be controlled, to a certain extent at least, by hot 

 compresses. But, as I have pointed out above, one must not be 

 surprised if local necrosis develops after the use of the remedy in 

 this manner. 



If the neosalvarsan is to be employed, 1.5 gram may be given to 

 men and 1.2 gram to women, but it is recommended not to start 

 with these doses, but to give a primary injection of 0.9 gram; to 

 allow a day to intervene and then to inject 1.2, then on alternate 

 days, i. e., with a day of rest intervening, 1.35 gram and finally 

 1 .5 gram. That the dosage can be pushed, however, is shown by the 

 fact that in robust men 6 grams of neosalvarsan, corresponding in 

 arsenical content to 4 grams of salvarsan, have been given within 

 seven days. 



Babies are given 0.05 and children 0.15 gram. 



Small initial doses of either preparation are indicated whenever 

 there is reason for assuming the existence of syphilis of the central 

 nervous system and its meninges. As the latter are known to be 

 involved quite early in the course of the infection already Ehrlich 

 suggests that in early secondary cases (especially during the roseolar 

 stage), particularly when nervous symptoms of any kind exist, the 

 average initial dose (of salvarsan) should not be higher than 0.3 gram, 

 and that in suspicious cases it may be best to begin with 0.1 to 0.15 

 gram. This dose should preferably not be exceeded even at the 



