76 CHEMOTHERAPY 



have given neosalvarsan, directly into the spinal canal. The results, 

 however, were either dubious or frankly dangerous, and the injections 

 were followed by severe and alarming symptoms, due mainly to the pro- 

 duction by the drug of direct irritation upon the sensitive nervous sys- 

 tem. Ravaut 1 has found that the use of hypertonic solutions of neo- 

 salvarsan are better borne and of value in the treatment of special cases. 

 Wile 2 has also employed this method, and has found it of some value in 

 cerebrospinal syphilis. Tabetics presenting no bladder or rectal symp- 

 toms were found to do especially well. As is to be expected, the earlier 

 the treatment is instituted, the better are the results. This form of 

 treatment is, however, to be regarded as dangerous, and is to be used 

 only in selected cases, and with a full understanding of the risks incurred. 

 Wile has given the following technic: 



"The solution used for injection consists of a 6 per cent, solution of neosalvarsan 

 in distilled water. This solution is hypertonic, and made of such concentration that 

 each minim must contain 3 mg. of the drug. The dosage injected is from 3 to 12 

 mg. that is, from one to four drops of the solution, which is made up as follows: 



"An ampule containing 0.3 mg. of neosalvarsan is dissolved in 5 c.c. of freshly 

 distilled water. If the ampule contains 0.6 gm., 10 c.c. of water are used. In both 

 solutions each drop will contain 3 mg. of the drug. The syringe employed for the 

 injection is accurately graduated in drops. The patient is placed in a position for 

 lumbar puncture, either sitting or lying, according to the choice of the operator. 

 The puncture is then made with the needle, the end of which fits the graduated 

 syringe. After a few drops of the spinal fluid have flowed out of the cannula, or a 

 greater quantity if a diagnostic puncture is desired at this time, the syringe is fitted 

 into the needle, and the fluid is allowed to run back into the syringe barrel, thus 

 mixing with the amount of the drug in the barrel. The mixed spinal fluid and drug 

 are then gently forced into the canal, and slight suction is made on the syringe to 

 withdraw a second amount of fluid, which washes out the needle. This is then reintro- 

 duced, the needle is quickly withdrawn, and the patient placed in the Trendelenburg 

 position, in which position he is allowed to remain for at least one hour." 



INTRASPINOUS INJECTION OF SALVARSANIZED SERUM 



In this method the salvarsan or neosalvarsan is injected intrave- 

 nously in the usual manner, and shortly afterward blood is withdrawn, 

 the serum separated, heated to 55 C. for half an hour, and a portion 

 injected intraspinously. In this technic, which has been worked out 

 largely by Swift and Ellis, the drug is highly diluted, and therefore is 

 not likely to produce much irritation. In addition, some of the good 

 effects may be due to the presence of antibodies in the serum itself. 

 This method constitutes the most useful form of intraspinous medica- 



1 Ann. de Med., 1914, 1, 49. 



2 Jour. Amer. Med. Assoc., 1914, Ixii, 1165; ibid., 1914, Ixiii, 137. 



