22,8 Sellards: Public-health Aspects of Yaws 257 



rience in Santo Domingo with both methods. After six weeks 

 of intravenous work at Monte Plata, intramuscular injection 

 was adopted at San Cristobal where two hundred cases of yaws 

 in the granulomatous stage were treated. At the outset, it 

 was hoped that the slow absorption from the intramuscular 

 injection would largely obviate the reactions. The results were 

 disappointing in this respect; the reactions were very common, 

 and some of the chills were severe. The therapeutic results 

 however were excellent; the lesions healed promptly, and very 

 few patients required more than two injections. These results 

 are not surprising in view of the accepted teaching regarding 

 the pharmacological action of the salvarsans. According to 

 the consensus of opinion, salvarsan per se is not efficacious 

 against the treponema, but it is readily oxidized in the tissues 

 to a more active product. In the gastrointestinal tract there 

 is no tendency toward oxidation, but in the blood stream oxida- 

 tion takes place easily, and in the muscles it occurs still more 

 rapidly. 



The most serious drawback to the intramuscular procedure 

 consists in the very extensive and at times painful induration 

 at the site of injection. Absorption takes place very slowly. 

 In some communities this method of treatment would seriously 

 injure the confidence of the people, and it would be essential 

 to employ intravenous injection. 



To many it may seem very radical to recommend such a toxic 

 agent as neosalvarsan for mass treatment in field operations. 

 However, it was successfully employed in Santo Domingo for 

 more than 1,200 patients. This was accomplished without 

 any trained workers for assisting during the injection or in 

 the immediate after-care of the patients. It was necessary to 

 violate, in minor respects, many of the conditions laid down 

 by the United States Public Health Service for the administra- 

 tion of neosalvarsan. In the first place an excellent grade of 

 distilled water was prepared almost daily in the camp for 

 making up the solutions. However, a sufficient supply of dis- 

 tilled water was not available for boiling syringes; rain water 

 especially collected from a clean canvas tent was employed, 

 although the water remaining in the syringes necessarily con- 

 taminated the solution of salvarsan slightly. In the intraven- 

 ous injection of children, especially a struggling child, it was 

 by no means possible to adhere to the required time of five 

 minutes for the entire injection. For the sake of economy, 



