ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 875 



Various explanations for this phenomenon have been offered: Ehrlicfr 

 believes that it indicates failure of the injected dose to produce complete 

 destruction of the spirochetes, with temporary stimulation of the micro- 

 organisms to increased multiplication and activity. He very perti- 

 nently compares the neurorelapse or Herxheimer reaction to the extensive 

 development of individual bacterial colonies on agar plates, when but 

 few microorganisms are present, as contrasted with their small size 

 when the number is large. The so-called provocative positive Wasser- 

 mann reaction may be considered as a part of this reaction. 



INTRAMUSCULAR INJECTION 



As was previously stated, this route of administration is not gener- 

 ally employed at the present time because of the local irritative effects 

 of salvarsan especially. When slow absorption and elimination are de- 

 sired, or when intravenous injections are impossible, as in the case of 

 very young children, this method may be adopted. When salvarsan is 

 to be given, the clear, concentrated alkaline solution is generally used. 

 Neosalvarsan is to be preferred, because it is less irritating than sal- 

 varsan. It may be given in a concentrated aqueous solution or sus- 

 pended in sterile oil with the addition of a local anesthetic, such as 

 eucain or creosote, after this formula: Salvarsan, 0.4 or 0.6 gm.; creosote 

 (beechwood), gtt. ij ; sterile liquid petrolatum, 5 c.c. Mix well in a sterile 

 mortar. The injections are made, under strict antiseptic precautions, 

 in the gluteal region, into the upper and outer quadrant of the muscles. 

 The syringe and the needle should be sterilized and the injection pre- 

 pared. After cleansing the skin with alcohol the needle is quickly 

 and boldly plunged into the deep tissues. The syringe may then be 

 detached to ascertain if blood flows, which would show that a vein has 

 been punctured and require a reinsertion; if blood does not appear, 

 the barrel should be reattached and the injection slowly given. 



Intraspinous Injection of Neosalvarsan. Owing to the fact that a 

 drug injected intravenously may not reach the tissues of the central 

 nervous system, salvarsan and neosalvarsan have not fulfilled the early 

 expectations, apparently chiefly for the reason that they cannot reach 

 the spirochetes. It would seem, therefore, that adequate treatment of 

 syphilis of the central nervous system consists in the direct application 

 of the remedy to the infected tissues themselves. Wechselmann 1 and 

 Marinesco 2 have injected salvarsan, and Marie and Levaditi 3 and others 



1 Deutsch. med. Wochenschr., 1912, 38, 1446. 



2 Zeitschr. f. phys. u. Therap., 1913, 17, 194. 



3 Bull, et Soc. med. d. h6p., Paris, November 18, 1913. 



