TREATMENT 



elbow made turgid by applying an elastic band round the arm. 

 The needle, already attached to the syringe containing the solution, 

 is inserted in one of the veins; if blood appears in the liquid, it 

 means that the needle is in the vein, and the piston of the syringe 

 is then very slowly and gradually pressed down until all the liquid 

 has been injected. 



Three to six injections of neo-salvarsan at three to six days' 

 interval are generally sufficient to obtain a cure, though in a number 

 of cases one injection is sufficient to make all the symptoms dis- 

 appear. If one injection only is given, 0-4 to 0*6 gramme should 

 be injected; when a course of three or more injections is carried out 

 ve often give 0-3 gramme the first time, 0-4 gramme the second 

 ime, and o-6 gramme the third time and afterwards. 



The patient should keep, if possible, at complete rest in bed for 

 everal hours after the injection, and in individuals with weak 

 eart the injection of neo-salvarsan may be preceded by a hypo- 

 dermic injection of caffein. The patient may complain at times 

 of headache, and there may be a rise of temperature, but very 

 seldom are serious symptoms caused by the drug, though cases 

 of transient coma, delirium, epileptiform crisis, nephritis, and 

 jaundice have been recorded. 



•■ Salvarsan. — Salvarsan may be given by intramuscular, subcutaneous, or 

 intravenous injection; by the mouth in alkaline solution; and also by the 

 rectum in the form of enemas or suppositories. We recommend the intra- 

 muscular and intravenous injections. The administration by the rectum in 

 our experience does not give any good result, and of the oral administration 

 we have no personal experience. 



Intramuscular Injections. — The injection is generally given in the buttocks, 

 with the usual precautions as regards the disinfection of the skin, and the use 

 of a sterile all-glass syringe. The quickest method of disinfecting the skin 

 is to paint it with tincture of iodine. The dose to be given in adult males is 

 0*40 to 0*50 gramme; in adult females and thin individuals 0-30 and 0*40 

 gramme. A dose exceeding 0*60 gramme should never be given either in 

 males or females. In children the dose is 0-03 to 0-04 gramme for each year 

 of age, or o-oo8 gramme for each kilogramme of weight. 



The injection of salvarsan in the same dose can be repeated after two or 

 three weeks, if the first one has not been completely successful. The drug is 

 not easily soluble, and various methods of preparing the liquid to be injected 

 have been described. The simplest method is Ehrlich's. The salvarsan 

 powder (0*30 to o-6o gramme) is rubbed with a little methyl alcohol (pure) in a 

 sterile vessel, and then mixed with 10 to 20 c.c. of normal salt solution. 



An alkaline or neutral solution is preferable, and is prepared by rubbing the 

 drug in a sterile mortar with 10 to 20 drops of a 15 per cent, solution of sodium 

 hydrate, and adding 8 to 10 c.c. of sterile distilled water, stirring continuously. 

 In order to prepare a clear solution, it generally requires i c.c. to 1-2 c.c. of the 

 sodium hydrate solution for o-6 gramme of salvarsan; a suspension of the drug 

 in olive-oil or some other fatty material may also be used. A good prepara- 

 tion of this type, which we have often used, is by Pasini. 



The suspensions in oil may often be given with advantage subcutaneously 

 in the interscapular region. The intramuscular or subcutaneous injection 

 of salvarsan, especially the acid solution, is generally painful, and is followed 

 by a hard infiltration, which lasts for some weeks. Occasionally a slough 

 forms, which has to be removed surgically. 



Intravenous Injections. — The dose is smaller than for the intramuscular 

 injection, 0*4 gramme for men and 0-3 gramme for women being sufficient. 



