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neosalvarsan. In my own practice the use of neo- salvarsan has almost entirely supplanted that of sal- varsan for the following reasons : First, simplicity of preparation. Second, minimizing the number of preparation ingredients, and thereby reducing by that much the possibility of faultv technic. 358 SQUIER: DI.IGMOSIS .IXD TREATMENT OT syi'lllLlS l.\ WOMEN. I'liiril. ilic possibility of the einployiii>-nt of ;i smaller volume of fluid for injection. i'ourtli, diminished toxicity, with less reaction. Mode of ciiiployiiioit. The intravenous nicthoii i> employed by me in practicallv all cases, inasmuch as no method of preparation of the drug has thus far been advanced which assures the patient a pain- less intranniscular injection of a sufficient amount of the drug ; and the additional reason that there are many factors quite bexond oiu' control aft'ecting the rate of ab.sorption of the remedy when thus admin- istered. Imf'ortancc of freshly distilled water. The em- ployment of water distilled on the da\- of adminis- tration cannot be overestimated. Inasnnich as it has been conclusively proved that, for the most part, excepting in florid cases, the violent reactions fol- lowing the employment of neosalvarsan are due chiefly to the absorption of proteid products of dead bacteria contained in the water of dilution when any length of time has elapsed between distillation and use ; whereas with faultless technic these reactions will rarely be encountered. Freshly distilled water should be used not only for the solutions, but Generic Mesterolone also in the sterilization and cleansing of glassware, tubing, etc. Time of administration. One should not, as here- tofore, await the onset of secondary symptoms. This because it is of the utmost importance to society to render these patients innocuous at the earliest possi- ble moment, and in the light of recent advances in laboratory technic (dark field illumination for s{>iro- chcvta) one need not await the time necessary for the appearance of a positive Wassermann reaction. If we hope for an early cure of the patient, treat- ment must be instituted at the earliest manifestation of the disease. Dosage. No fixed rule ma}- be followed as to dose ; each case being treated according to the particular indications. It is my custom in robust pa- tients showing no contraindication to give the neo- salvarsan equivalent of 0.6 grannne of salvarsan as soon as the diagnosis is confirmed ; from three to five such doses being administered at weekly inter- vals. -At the end of the series no delay is made in ascertaining the blood reaction, to determine the efficacy of the treatment, as that has already been arnply demonstrated, and my chief concern is no: one of scientific interest, but to cure the patient. The much heralded cures by a dose or so of salvarsan which we were led to believe possible from the early reports of the drug and its actions, have failed lo materialize with any sufficient degree of regularity to justify our discontinuing all treatments at this early period on account of the negative complement fixation reaction. It is my practice, therefore, to at once institute a vigorous and, with few intermis- sions, a persistent mercurial course. In women pa- tients the doses will generally be smaller. An aver- age maximum will be found to be the equivalent of Buy Mesterolone 0.4 gramme of salvarsan. As to hospital and office treatments. While many men of known conservatism regard this remedy as within the realm of office treatments, I have as yet been unable to bring myself to their viewpoint, and still conduct this procedure under the strictest asep- tic precautions in a hospital, and advise rest in bed or in the reclinnig iK)sition for five or ten hours fol- lowing the treatment. 1 will admit, however, that this may be due to a surgical training which has im- pressed me that e\en the operation of intravenous injection is one which carries with it some risk. Contraindications — Neurorccidives, etc. The pre- liminary routine examination of eyes, heart, Mesterolone Online kidneys, and nervous system should, of course, be instituted, though it must be admitted that a decision as to where the indications end and the contraindications I>egin requires a pretty fine discriminating ability. Undoubtedly, I should not hesitate to employ the drug in a progressive luetic eye invasion, nor may a nephritis coexisting with a strongly positive Was- sermann reaction in an otherwise robust patient be considered a deterring factor, as these complications have on numerous occasions been greatly improved after its use. Blindness. A rare but none the less terrifying eventuality after salvarsan medication has by some been attributed to the toxicity of the drug, but this, it would appear, has been amply disproved by suc- ceeding with additional injections of the drug in clearing up a number of these cases. At any rate, it must be by this time clear to all who have used it that neosalvarsan is by all odds the most innocuous form of arsenic. Conditions necessitating caution in the adminis- tration of ncosak'arsa)!. In chronic alcoholics, cases giving evidence of Mesterolone Tablets myocarditis, arteriosclerosis, and lesions of the cerebrospinal system the administra- tion of these drugs should be conducted with the utmost caution, and at first in minimum dose, with a view to ascertaining the patient's degree of tol- erance. Mercurial medications. A broad conception of

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