The basis of the method is the observation that hypertonic salt solution, injected intravenously, will dehydrate the central nervous system, and that restoration of fluid begins at about the sixth hour. If a drug is injected into the circulation just at the time when the restorative formation of spinal fluid is taking place, it appears that a large quantity is carried into the subarachnoid spaces with the fluid, as on a flood tide.
Method:
1. 8 A.M. Patient is put to bed.
2. 10 A.M. Intravenous injection of 100 cc. of 15% saline, warmed and administered slowly by gravity. The symptoms produced by this injection are mild and transitory.
3. No food is permitted at midday.
4. 4 P.M. Neo-arsphenamine is injected with the usual technic.
5. 8 P.M. Light nourishment is allowed. Patient is kept under observation, preferably in bed, for the ensuing thirty-six hours.
Atoxyl.—The first drug to offer hope of cure was sodium arsanilate, atoxyl, which contains about 26% of As. This is best given in doses of about 0.5 gram (7½ gr.) in about 15 cc. of sterile distilled water intramuscularly. Several cases of optic neuritis were reported but the drug is still a standard treatment. We give the atoxyl at intervals of five days, Manson gives 3 grains every third day.
Probably the best treatment is one in which three doses of atoxyl are followed by from 10 to 15 daily or every other day injections of 0.1 gram (1½ gr.) of tartar emetic. The course is repeated after an interval of three weeks. It is advisable to give a hypodermic of caffein a few minutes before the tartar emetic to lessen depression. Kérandel received the atoxyl-tartar-emetic double treatment and ascribed his cure to the tartar emetic. Tartar emetic is also given intravenously, 0.1 gram in 150 cc. water.