METHODS OF INOCULATION 687 



physician should generally be able to detect this susceptibility and 

 avoid the dangers of anaphylaxis. In Chapter XXVIII the subject is 

 discussed in greater detail, and a method of vaccination is described 

 by which it may be possible to detect this condition; this consists of 

 rubbing a little of the serum into an abrasion on the arm (Fig. 121) 



(6) Has the patient been injected with a serum on any former oc- 

 casion? If an injection has been given, especially a few weeks earlier, 

 a reinjection of serum may cause well-marked serum sickness, but the 

 possibilities of alarming anaphylaxis are so remote that serum should 

 never be withheld if the clinical condition indicates that it should be 

 given. Not infrequently a child receives an immunizing dose of diph- 

 theria antitoxin, but develops the disease a month or two later, after 

 the immunity has disappeared. Under these circumstances antitoxin 

 should not be withheld. If time permits, the physician may inject 0.5 

 c.c. of the antitoxin for the purpose of producing anti-anaphylaxis, fol- 

 lowed in two or three hours by the remainder of the serum. // it were 

 possible to obtain it } it would be good practice to immunize the patient with 

 an ox-serum antitoxin, and then, if it was found necessary later to use an 

 antitoxin, the usual horse serum antitoxin could be employed. This w r ould 

 still further eliminate the possibility of the development of disagreeable 

 or dangerous complications. 



2. If a patient suffers from idiopathic asthma and the condition 

 known as status lymphaticus develops, serum should be given cautiously 

 because of the increased respiratory difficulties that may follow. It 

 may be well to give a preliminary hypodermic injection of atropin and 

 caff em, and then, after a few minutes, give the serum, injected slowly 

 and subcutaneously. 



3. Aside from these questions, the physician may be called upon to 

 decide if a patient is physically able to withstand the effects of an inocu- 

 lation, especially the intravenous injection of relatively large amounts of 

 serum, such as are given in the treatment of pneumonia. In diphtheria 

 in very young and weak children, when a large number of units or sev- 

 eral injections are to be given, concentrated antitoxin is to be preferred, 

 in order that injury to the subcutaneous tissues, pain, and shock may be 

 reduced to a minimum. 



METHODS OF INOCULATION 



Upon the nature and severity of the infection will depend the question 

 whether the serums are to be given subcutaneously, intramuscularly, 



