256 The Philippine Journal of Science U2» 



Old salvarsan was then given in gelatine capsules by mouth 

 in daily doses of 150 milligrams. Improvement was noticeable 

 within a week and was very well marked after two and a half 

 weeks. These cases have not yet been reported in full. It is 

 evident, however, that the oral administration does not produce 

 sufficiently rapid improvement to permit its employment in 

 field work. The same objection applies to Castellani's treat- 

 ment with tartar emetic. With the impatience typical of the 

 average patient, the treatment would not be voluntarily con- 

 tinued until a cure was effected. Indeed, it has not yet been 

 demonstrated serologically that the administration by mouth 

 of either salvarsan or tartar emetic will effect the absolute 

 cure of yaws. 



However, there is some ground for encouragement in the 

 fact that salvarsan given by mouth does produce very definite 

 improvement in yaws. It hardly seems to be an unreasonable 

 chemical requirement that effective derivatives should eventually 

 be produced suitable for oral administration in the radical cure 

 of yaws. Indeed, this might afford a preliminary step toward 

 the enlargement of the field for treating and controlling the 

 related disease, syphilis. 



A very real question comes up in deciding whether neosal- 

 varsan should, under field conditions, be injected intravenously 

 or intramuscularly. The former is the method of choice, but 

 the number of men available for the Tropics who are adequately 

 trained in the very simple technic of intravenous therapy is 

 surprisingly limited. Moreover, successful injection in a dif- 

 ficult vein, with only untrained assistants to hold the child, 

 perhaps in the uncertain light of the rainy season, requires a 

 greater degree of skill than is necessary in a modern hospital. 

 The procedure is relatively laborious and time-consuming. On 

 account of the contamination with blood, a fresh syringe must 

 be used for each injection. According to the United States 

 Public Health requirements, a minimum of five minutes must 

 be employed for each intravenous injection. Therefore, ex- 

 clusive of all the time for the preparation of materials, one 

 individual under these restrictions can hardly inject more than 

 ten patients per hour. On the other hand, -for intramuscular 

 injection a single syringe, by merely changing the needle, can 

 be used repeatedly without resterilization, and one individual 

 can, without special effort, inject two or three times as many 

 cases as in intravenous work. I have had considerable expe- 



