SUMMARY. 425 
folds of the abdomen at the sides between the last rib and 
pelvis. 
(3) In a case when a patient is not seen until symptoms 
of poisoning have set in, the same amount of serum should be 
given by injection direct into a vein. But when the snake is 
large and the bite is a full one with both fangs, an extra dose 
should be injected. 
(4) If serum has been injected under the skin, and if the 
patient seems to be developing alarming symptoms, inject at 
least 25 c.c. direct into a vein. 
(5) For intravenous injection, a vein of the forearm should 
be selected for preference. The vein should be made prominent 
by pressure above. The syringe and needle should be held 
almost parallel to the vein, keeping the oblique opening at the 
point of the needle upwards. The operator steadies the vein with 
his left hand and introduces the needle. When the needle is kept 
parallel to the vein with the slant at the point upwards, steady 
pressure carries it into the vein without difficulty, and avoids 
puncturing both walls of the blood-vessel. As soon as the needle 
is in the vein, remove the pressure above, and slowly inject the 
serum. A local subcutaneous swelling appearing during the 
operation of injection shows that the needle is not in the vein, 
and a fresh attempt should be made to introduce it. 
(6) If there are any albuminous deposits or flocculi in the 
bottle, the serum should be filtered through the corner of a clean 
linen pocket-handkerchief or a piece of clean rag into a wine- 
glass or other convenient receptacle, previous to using it. This 
is not essential if injecting under the skin. 
If boiling water be at hand, dip the cloth into it and wash 
out the vessel before straining. A weak solution of perman- 
ganate of potash or boracic acid would do instead of boiling 
water, for sterilizing the cloth and vessel. 
(7) The serum syringe should be perfectly clean. The best 
plan is to boil it in water to which some borax has been added. 
Then dry and put it away in its case, ready for use. Examine it 
occasionally to see that the needle is not getting rusty. 
If any weak antiseptic such as boracic acid or permanganate 
in solution be at hand, wash the site of the proposed injection 
with it. If no antiseptic is to be had, then rub the spot clean. 
(8) An albuminous precipitate in the bottle does not indicate 
