The action and uses of Salvarsan

Abstract

CHEMISTRY: Salvarsan is thedi-hydrochloride of dioxy-diamido-arseno-benzol. It is a pentavalent arsenical compound.

SOLUTION FOR INJECTION: The di-sodium salt of Salvarsan was used for intravenous injections. It is dissolved in .85% normal saline, and is diluted so that every 40 c.c's of the solution contains .1 grammes of Salvarsan.

DOSAGE: In practically every case .5 grammes Salvarsan was injected each time. As a rule not less than two injections were given at intervals of fourteen to twenty-one days. If necessary a further injection was administered, the indications being controlled by the Wassermann reaction.

APPARATUS USED: The apparatus used was the one devised by Gibbard.

DIAGNOSIS OF CASES: All cases treated had the diagnosis confirmed by either emonstrating the Treponema Pallidum in serum from the lesions, or by the performance of a Wassermann reaction. After treatment and progress of cases were controlled by the Wassermann reaction.

PREPARATION OF PATIENT FOR THE INJECTION: Patients were taken into hospital the evening before the injection was to be given. They were given a mild purge and only a light meal was allowed on the morning of the injection. Before treatment all were carefully examined, special attention "being paid to the circulatory, nervous, digestive, and urinary systems.

EFFECTS FOLLOWING THE INJECTION OF SALVARSAN: Rigors, a rise of temperature, headache, nausea and vomiting, and occasionally diarrhoea, follow the administration of the drug. The face and eyes "become congested and the pulse and respiration accelerated. Cyanosis was noted in a few cases. All these effects nave generally passed over "by the following day.

Action on Skin and Mucous Membranes : Applied, in alkaline solution, to the unbroken skin or mucous membranes produced no effects. If abrasions were present slight irritation with hyperaemia was noted.

ACTION ON THE GASTRO-INTESTINAL TRACK: Salvarsan is an irritant causing vomiting, and not infrequently diarrhoea with colicy pains.

ACTION ON THE CIRCULATION: The cutaneous vessels of the face and chest are dilated by the injection of Salvarsan, and probably the vessels of the splanchnic area are similarly affected. On perfusing the vessels of a frog with the drug it causes them to dilate.

The heart is accelerated in rate and may become slightly irregular and even dilate. In the frog the heart ceases in diastole, the ventricles being first to cease contracting. In the dog a similar effect is produced, the organ becoming engorged with blood .

As a result of the weakening on the heart's action,and the dilatation of vessels,the blood pressure falls.

ACTION ON THE WHITE BLOOD CORPUSCLES: A well marked leucocytosis is set up, due to the increase of the polymorphonuclear cells. The opsonic index is not affected.

ACTION ON THE RED CELLS AND HAEMOGLOBIN: Salvarsan causes a rapid increase in the red cells and haemoglobin where these are deficient, the increase being more marked, at first in the haemoglobin.

THE COAGULATION TIME of the blood is not affected.

ACTION ON THE NERVOUS SYSTEM: Well marked headache follows the injection of the drug, due probably to its toxic action on the cells of the cortex. The sensory and motor nerves are not affected by the drug.

ACTION ON THE URINARY SYSTEM: No bad effects were observed. In one case albumin in the urine disappeared after the injection of Salvarsan.

ACTION ON METABOLISM: Rapid increase in weight and a great improvement in general condition, with a sense of well-being follows the injection of Salvarsan

ELIMINATION: Salvarsan is mainly excreted, in the urine, but it is also present in vomited matter and foeces.

THERAPEUTIC EFFECTS: (1) IN SYPHILIS - Salvarsan causes a rapid disappearance of the lesions in all stages of the disease and accomplishes this in extremely short periods of time. The Wassermann reaction can, in all cases, be changed from a positive to a negative.

A permanent cure is probably effected by the use of Salvarsan alone with supplementing it with Mercury.

THERAPEUTIC EFFECTS: (2) IN LUPUS VULGARIS: Great benefit follows the administration of the drug in this condition

THERAPEUTIC EFFECTS: (3) MALARIA: Good results follow its use in Malaria., especially the Benign Tertian form of the disease. It may succeed in accomplishing a cure where quinine has failed, this being especially marked in Malignant Malaria.

THERAPEUTIC EFFECTS: (4) PIROPLASMO CANIS: The administration of Salvarsan to dogs suffering from this condition gave rise to extremely satisfactory résulté, complete cure followed the intravenous injection of the drug in the case of two Irish terrier pups treated in this way. A great field of usefulness in the treatment of this and the allied conditions of Texas Fever, and Bilary Colic in horses, is apparently open to the use of the drug.