204 Captain H. S. Ranken. Treatment of Human [Dec. 23, 



atoxylate of mercury, etc. Over 1400 intravenous injections have been 

 given, and three deaths have occurred which can be attributed to the 

 treatment. All these fatal cases were amongst the first 150 injections. 



The method of administration is the same as that of an ordinary intra- 

 venous injection of saline solution given hydrostatically through a needle of 

 somewhat large bore.* 



The dose of antimony is stirred with about half an ounce of normal saline 

 in a small glass mortar and becomes a temporary suspension. Two ounces 

 of saline are then poured into the funnel and tubing, the needle is inserted 

 into any vein in the forearm and the clip opened. As soon as it is seen that 

 the saline is flowing freely into the vein, and there is no swelling round the 

 site of the puncture, the suspension of antimony is poured into the funnel 

 and the mortar is washed out, with a little more saline, into the funnel in 

 order to leave no residue. The antimony is allowed to run into the vein, the 

 funnel being gently shaken from time to time, and, when it is on the point 

 of becoming empty, more saline is poured in. The window in the rubber 

 tubing should be watched, and after all traces of antimony have passed it 

 some more saline is allowed to run in to clear it out of the part of the tubing 

 below the window ; the clip is then closed and the needle withdrawn. 

 About six ounces of saline seems to be a sufficient quantity, and the time 

 occupied in giving an injection varies from three to seven minutes — 

 depending on the calibre of the vein and the bore of the needle employed. 



I have found it possible, without any hurry, to give as many as 10 injec- 

 tions in an hour ; I mention this to show that this method of treatment is 

 feasible on a large scale. 



The question of dosage is one of considerable importance. The dose 

 usually given was one grain. Large doses up to three grains have been 

 given, but these seem to be attended with risk and have been given up for 

 the present ; it is probable, however, that in good, selected cases one and a 

 half, or even two, grains may be safely given. Several cases of extreme 

 susceptibility have been met with, however, so that the initial dose should be 

 one grain. The interval between the doses seems to be of the greatest 

 importance. Four days would seem to be most suitable, but injections have 

 frequently been repeated on the third day after a dose ; they should certainly 

 not be postponed any later than the fifth day. A few of the earlier cases 

 were treated with weekly doses ; two of these were very susceptible and 

 were unable to take doses at shorter intervals ; both cases have relapsed. 



The usual course of treatment has been five doses at intervals of four days, 



* The size of the one I have used is "No. 19 of Imperial Standard Wire Gauge 

 internal diameter and No. 15 external. 



