ADMINISTRATION OF SALVARSAN AND NEOSALVARSAN 877 



tion thus far proposed. The details of this technic are given in Chapter 

 XXXI. 



Mention has also been made, in the preceding chapter, of a method 

 of intraspinous medication consisting in the injection of a combination 

 of the patient's serum and salvarsan or neosalvarsan mixed in vitro. 

 This method is to be regarded as more dangerous and probably less 

 efficient than that of Swift and Ellis, and as yet in the experimental 

 stage. Recently Fordyce l has given the following technic (Ogilvie) : 



"Fifty c.c. of blood are drawn into a centrifuge bottle and centrifuged twice. 

 It is important to have the serum clear and free from fibrin and blood-cells. To 

 obtain the requisite amount of the drug old salvarsan is mixed in the usual way, in 

 the proportion of 0.1 gm. to 40 c.c. of fluid, care being taken not to overalkalinize; 

 0.4 c.c. of this solution is the equivalent of 1 mg., and is taken as the standard for 

 measuring the dosage. For this purpose a 1 c.c. pipet graduated in hundredths should 

 be employed. The desired amount of salvarsan is added to from 12 to 15 c.c. of the 

 serum, shaken to and fro to mix thoroughly, and then placed in the incubator at 

 37 C. (98.6 F.) for one hour, after which it is inactivated for half an hour at 56 C. 

 (132.8 F.). The latter is the most important step in the technic; the spirocheticidal 

 properties of the serum are markedly increased by heating. 



"Salvarsanized serum, prepared according to this method, must be used fresh, 

 that is, within three hours of the time that it is made up. Patients should be prepared 

 for its administration as for intravenous injection, with a laxative the night before 

 and only a light meal two hours prior to the treatment. 



"A lumbar puncture is made, and an amount of fluid equivalent to the amount 

 introduced is withdrawn. While the needle is in situ, the barrel of a Luer syringe is 

 connected by means of a piece of rubber tubing. Spinal fluid is allowed to fill this 

 to expel the air, and the serum is then permitted to flow in by gravity. After its 

 administration the patient should lie flat without any pillows, the foot of the bed 

 being kept elevated for several hours. He must be kept in bed for at least twenty- 

 four hours, in some cases forty-eight or seventy-two hours. Failure to do this may 

 result in unpleasant symptoms, as pain in the extremities, headache, anesthesia, 

 and bladder and rectal paresis." 



The proper dose is still a matter of doubt, and a note of warning must 

 be sounded against employing too large amounts. Fordyce believes 

 that the limit of safety lies within 0.5 mg. It is better to begin with a 

 dose of 0.25 mg., repeating or gradually increasing this according to the 

 tolerance of the patient. The intervals between doses should be two 

 weeks or longer. 



In the treatment of syphilis of the central nervous system the in- 

 travenous method may first be tried, giving a series of six or eight in- 

 jections of salvarsan, beginning with a dose of from 0.25 to 0.3 gm., and 

 injecting it at intervals of from one to two weeks. At the end of this 

 time the blood and spinal fluid should be tested, and if it is found that 

 1 Jour. Amer. Med. Assoc., 1914, Ixiii, 552. 



