740 PASSIVE IMMUNIZATION SERUM THERAPY 



intravenously, or intraspinously (subdurally). In diphtheria, the anti- 

 toxin may be given subcutaneously unless the infection is quite severe; 

 in the latter case it should be given intramuscularly or intravenously. 

 In tetanus the serum should be given subdurally and intravenously. 

 In epidemic cerebrospinal meningitis the serum is always given sub- 

 durally. In pneumococcus, streptococcus, and gonococcus infections, 

 while the serum may be given subcutaneously or intramuscularly, it is 

 best administered intravenously. It is important for the physician to 

 know and appreciate that the route and method of inoculation and the 

 amount of serum administered are important factors in determining the 

 success or failure of serum therapy. 



f. TECHNIC OF SUBCUTANEOUS INOCULATION 



Serum given subcutaneously is slowly absorbed, and a portion of the 

 antibodies may be destroyed before they reach the blood-stream. When 

 large quantities of serum are to be given, as in pneumonia and strepto- 

 coccus infections, this method may not be permissible on account of the 

 pain and injury to the subcutaneous tissues that may result, aside from 

 the more important question of slow absorption and anchorage or de- 

 struction of the antibodies in various tissues before they reach the blood- 

 stream or the focus of disease. 



1. Injections should be given where the subcutaneous tissues are 

 loose, where movement is least marked, and preferably where pressure 

 upon the parts is least likely to occur, for some soreness, dependent upon 

 the bulk of the injection, is bound to follow. For these reasons injec- 

 tions may be given in the abdominal wall; some prefer the back, in the 

 region of the lower angle of one of the scapula, and the buttocks, but in a 

 bedfast patient pressure at these points cannot readily be eliminated. 



2. The skin about the site for injection may be prepared by an ap- 

 plication of tincture of iodin; this is washed off with alcohol just before 

 the needle is inserted. After the injection has been given the remaining 

 iodin should be removed with alcohol, to prevent the occurrence of a 

 dermatitis, and the puncture wound covered with cotton and collodion 

 or with sterile gauze fastened with adhesive straps. 



3. The syringe and needle should be sterile. Manufacturers of bio- 

 logic supplies furnish antitoxin in syringes ready for injection, and these 

 are usually convenient and satisfactory. The needle should be of 

 medium size, and larger than that used for ordinary hypodermic medica- 

 tion. All glass or glass and metal syringes that may be boiled are to be 

 preferred when a syringe is not furnished. Before boiling such a syringe 



