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JAMA. 1913;61(19):1698-1702. doi:10.1001/jama.1913.04350200024008.
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When salvarsan was introduced as a specific cure for syphilis its administration by deep intramuscular injections was strongly recommended. Wolbarst,1 in 1912, stated that Ehrlich believed that "salvarsan is essentially an intramuscular injection," and if pain could be avoided this method would be the one of choice. Meltzer2 showed that the intramuscular injections were absorbed more rapidly than the subcutaneous, but recommended the sacrospinal muscle rather than the gluteal as being less apt to cause pain and other complications. It was soon apparent, however, that the intramuscular injection of salvarsan almost uniformly produced intense pain; the wound healed slowly, and often was followed by large sloughing areas of necrosis which were extremely resistant to all attempts at aiding or producing complete repair. K. Martius3 concluded that this method produced necrosis in every case in which it was used. Buschke4 also stated the same fact and called attention to the numerous


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