APPENDIX 307 



ously or by mouth. The dose depends upon the severity and 

 cause of the bleeding, age of the patient, etc. The average 

 adult dose is SO c.c. hypodermically or 10 c.c. intravenously. 

 If necessary, a larger dose, up to 50 c.c, may be given in two 

 or three days, and this may be succeeded by 100 c.c. a few 

 days later. There is no hard and fast rule as to the size and 

 repetition of doses. One must be guided entirely by the 

 effects. Large doses can be given without injury. The 

 dangers of anaphylaxis may be avoided by repeating the 

 injections at intervals of less than 10 days. In children 

 it is well to begin with a dose of not more than 10 c.c. 



Normal horse serum may be applied locally for the 

 control of hemorrhage from wounds. It may be injected 

 through a ureteral catheter in cases of renal hemorrhage. 



Precipitated Sebum 



Clowes and Busch (loc. cit,) first suggested that precipi- 

 tated horse serum be employed in place of the less convenient 

 fresh serum. To quote from their conclusions : " Blood 

 serum precipitated by means of a suitable mixture of acetone 

 and ether is fully as effective as fresh serum, if not sup- x'ior 

 to it. Precipitated serum is freely soluble and possesses the 

 advantage over fresh serum of being sterile, always available, 

 and retaining indefinitely its capacity to stimulate coagu- 

 lability of the blood." 



Precipitated horse serum may now be obtained in the 

 form of sterile powder under the name of " Coagulose." 

 This is easily dissolved in sterile water, and is then ready for 

 injection. The powder itself may also be applied to wounds 

 and bleeding surfaces. This powder retains its coagulating 

 properties almost indefinitely, while fresh serum loses its 

 effectiveness in a short time. 



