FRAMBCESIA TROPICA 



The preparation of the solution to be injected is as follows: One of the glass 

 phials in which salvarsan is put up in the dose of o*6 gramme is broken, and 

 the contents (0-6 gramme of salvarsan) is carefully added to 30 or 40 ex. 

 of physiological salt solution made with distilled water in a sterile stoppered 

 vessel. It is dissolved by shaking thoroughly, and by adding 1-2 c.c. (about 

 23 drops) of 15 per cent, sodium hydrate solution. A precipitate is formed 

 which redissolves. The solution should then be diluted to 300 c.c. with 

 normal saline; i or 2 more drops of sodium hydrate may be required if the 

 liquid is not clear. Each 50 c.c. of this solution contains o* i gramme of salvar- 

 san. In man, 200 c.c. should be injected, in women 150, in children less, 

 according to the rules given supra. 



For the intravenous injections special apparatus have been devised, based 

 on the principle of the Grantly douche. A convenient one, which may serve 

 for all these forms of injection, has been placed on the market by W. H. 

 Martindale. 



Precautions to be Observed. — The solution should be prepared with sterile 

 salt solution made with freshly prepared distilled water and chemically pure 

 sodium chloride. It should be perfectly clear ; it should be slowly infused into 

 the vein (200 c.c. in about eight minutes) ; it should not be cold (about the 

 temperature of the body if possible) ; the patient should be in bed, and should 

 be kept there for a couple of days. If signs of collapse occur durirg the 

 infusion, it should be stopped at once, and an injection of caffein given. 



Tartar Emetic. — ^Broden, in 19 10, and later on other observers, 

 tried antimonial preparations by intravenous injection as in sleeping 

 sickness. The results are much less sat isf act or y than with salvarsan 

 or neo-salvarsan. 



Intravenous Injections of Tartar Emetic associated with Other Drugs. — 

 Potass, iodide and mercury were associated by one of us with tartar emetic, 

 but the mercury did not seem to increase the action of tartar emetic. Here- 

 with two formulae: — 



1. Tartar emetic .. .. .. gr.iii. 



Potass, iodid. . . . . . . gr. xxx. 



Aq. dest. . , , . . . ad |i. 



2. Tartar emetic .. .. .. gr.iii. 



Potass, iodid. . . . . . . gr. xxx. 



Hydrarg. perchlor. . . . . gi". i 



Aq. dest. . . . . . . ad |i. 



One to 3 c.c. may be given diluted in 8 or 10 c.c. of sterile water by 

 intravenous injection every other day. 



Treatment by Oral Administration of Drugs. — ^When neo-salvarsan, 

 salvarsan, or their substitutes, are unobtainable, or in districts 

 where lack of medical men and skilled nurses makes any method 

 of treatment by injections difficult or impossible, treatment by oral 

 administration is very convenient, and the mixture known in the 

 tropics as ' Castellani's yaws mixture ' will be found effective in 

 many cases. 



This mixture contains tartar emetic, gr. i. ; potass, iodid., 3i-; 

 sodium salicylate, gr. x. ; bicarbonate of soda, gr. xv. ; water or 

 chloroform water, to i oz. One ounce is given three times daily 

 diluted in three or four times the amount of water, to adults and 

 youngsters of over fourteen years; half doses to children of eight 

 to fourteen years of age, and one-third or less to younger children. 



