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large doses should be given and repeated at betnovate c ointment intervals of five to seven days. During the secondary stage, when betnovate scalp application a spirochetic septicemia exists, it is also de- sirous to push betnovate skin cream the drug to its physiological limit. In ordinary and latent betnovate c cream cases, it is best to start with smaller doses in order to betnovate face determine the susceptibility of the patient, and betnovate n this is especially true in cerebro- spinal buy betnovate cream cases. In myocardial and renal cases great care should be taken betnovate scalp lotion in the administration of sal- varsan. If the changes are marked, it would con- stitute absolute contraindications for the use of the drug. The drug, though powerful, has the incon- venience of being eliminated too rapidly from the body, and its action, therefore, extends over a short period of time. In order to get results it is abso- lutely essential that the drug be administered at short intervals and in as large doses as the patient can tolerate. If given at long intervals, the salvar- san introduced will cause the destruction of large numbers of the spirochetes that exist in the circula- tion ; those forming behind them will not be affected. Preparation of the patient. — Before receiving an injection of salvarsan, the patient should be in- structed not to eat for five hours and to take a cathartic the night before, in order to have a clear gastrointestinal canal. He thus avoids the severe re- action following the administration of the drug. After the injection the patient should lie down for two or three hours betnovate buy online and then, if no symptoms de- velop, he mav have a light lunch. Administration of salvarsan. — Salvarsan may be administered intravenously, intramuscularly, or sub- cutaneously. The method generally employed is the intravenous, where the salvarsan is given by the gravity method, using a greater or lesser dilution, or in a concentrated form with a twenty c. c. record syringe. In the gravity method, usually 125 to 150 c. c. dilution is made, freshly distilled water is run into the circulation, before starting the flow of salvarsan, to make certain that the needle is in the lumen of the vein. The salvarsan is then run in slowly, and, when all has entered the circulation, more distilled water is used to wash the salvarsan GOLDFADER: MODERN TREATMENT OF SYPHILIS. 407 out of the vein to avoid a phlebitis. I have seen two cases of phlebitis following the administration of diarsenol, 0.6 gramme. Both patients had pre- viously received two to three injections of salvarsan. Distilled water had not betnovate cream 0.1 followed the administration of the drug. The method which I have been using for three years is the syringe method, employing a twenty c. c. record syringe. Neosalvarsan, diarsenol, neodiarse- nol, and novarsenobenzol may be injected with a syringe. The manufacturers of arsenobenzol (Phil- adelphia) advise that tlieir preparation be diluted in }20 c. c. of boiling water, as they have reported un- desirable reactions following the use of concentrated solutions of arsenobenzol. American made salvar- san (Metz) is also very toxic in concentrated solu- tions. In giving salvarsan by the syringe the follow- ing technic is employed. The drug is dissolved buy betnovate cream online in nineteen c. c. of freshly distilled water and, when perfectly dissolved, a fifteen per cent, solution of chemically pure sodium hydrate is added drop by drop. At first a heavy yellowish precipitate is pro- duced, which clears up when sufficient betnovate gm alkali has been used. When neosalvarsan, or one of its sub- stitutes, IS used, no alkali is employed. The solu- tion is drawn up into the betnovate gm skin cream syringe, and air bubbles are expelled. The patient's arm is tiien painted with tincture of iodine, a tour- niquet is applied, and betnovate scalp solution the patient closes his hand. By gently massaging the forearm, from the betnovate n cream wrist upward, the veins become more prominent at the bend of the elbow. The left thumb fixes the most apparent vein at the bend of the elbow, so as to prevent its slipping away from the needle. Punc- ture the skin and the vein at the same time ; a flow of blood into the syringe indicates that the technic has been successful. Push the needle along the axis of the vein for about one c. c, but do not go through it. If the needle has gone through the vein, the flow ceases, and a hematoma forms. If a mistake is made, remove the needle and try another vein. At- tach the syringe to the needle before removing the tourniquet. Inject the medicine slowly, taking two to three betnovate for acne minutes to do betnovate online it. By the slow and inter- rupted injection of the salvarsan, the blood stream washes the medicine along and mixes with it. After the salvarsan has run in, inject a few c. c. of dis- tilled water through the needle to wash the salvarsan out of the vein. I have seen several betnovate ointment 0.1 cases of in- filtration following an injection of salvarsan, in which the patient experienced no pain while betnovate c receiv- ing the injection ; but pain and swelling made their appearance from a few minutes to an hour after the administration of the salvarsan.

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