860 CHEMOTHERAPY 



While thousands upon thousands of injections have been made with- 

 out ensuing untoward results, still the administration of this drug is not 

 without danger, and the physician should familiarize himself with the 

 contraindications, and subject his patient to a careful physical examina- 

 tion before undertaking this form of therapy. This subject will be 

 discussed further under the head of Contraindications to Salvarsan 

 Therapy. 



In the majority of cases, however, no contraindications exist and no 

 elaborate preparations are necessary. The rectum should be emptied 

 before the injection is given, and it is best to administer the drug on an 

 empty stomach. After receiving salvarsan the patient should rest over- 

 night under direct supervision, as in a hospital, the injection being given 

 during the afternoon or early evening hours. The same practice should 

 be followed with neosalvarsan, although in thousands of instances pa- 

 tients have received an intravenous injection, rested for an hour or so, 

 and then returned to their homes. 



Preparation of Dilute Salvarsan Solution for Intravenous Injection. 

 As previously mentioned, the physician should examine the ampule 

 containing the drug to convince himself that it is intact. The solution 

 should be prepared just before it is injected. On account of the oxidation 

 that occurs it is unsafe to use the drug if the ampule has been open for 

 a number of hours, and for the same reason it is not good practice to pre- 

 pare a bulk solution for a number of patients unless the physician is cer- 

 tain that he will be able to make the injections quickly and wjthout 

 interruption. 



The clear alkaline solution is most generally used. It is prepared 

 as follows : 



1. The diluent should consist of sterile and freshly distilled water. 

 Many of the toxic and other ill effects attending salvarsan therapy have 

 been attributed to the use of raw and stale water. Experments con- 

 ducted by Yakimoff and Yakimoff show that the presence of the endo- 

 toxins of such microorganisms as Bacillus coli, Bacillus pyocyaneus, and 

 staphylococci in the water increases the toxicity of salvarsan from two 

 to eight times, the water alone and the salvarsan alone being without 

 effect. In office practice physicians may distil water by means of some 

 simple apparatus, such as that of Muencke. The distilled water is then 

 sterilized in an Arnold sterilizer for one-half hour, or by boiling for ten or 

 fifteen minutes. 



2. All glassware used should be carefully sterilized, usually by boiling, 

 as in the physician's ordinary office sterilizer. 



