NORMAL SERUM THERAPY 833 



ized) in the proportion of 1 c.c. of solution to 10 c.c. of blood. Ex- 

 ceptionally one encounters blood which requires slightly more or less 

 citrate proportionately. Preliminary tests, 0.1 c.c. of the solution to 

 0.5, 1, and 2 c.c. of blood, respectively, being used, enable one to de- 

 termine rapidly the requisite proportions in any individual instance. 

 If the mixture is made in the syringe, in cases in which not more than 

 50 c.c. are to be transfused, the transfer can be made directly from donor 

 to recipient. If larger amounts are to be used the blood is expelled 

 into a flask containing the sterile solution of citrate, from which the 

 injecting syringes are filled. In drawing the blood it is convenient to 

 use a three-way stop-cock which communicates with the needle, with 

 a 10-c.c. syringe containing the citrate, and with a large aspirating 

 syringe. 



If the blood is to be injected at once, I heat the sodium citrate so- 

 lution to 38 C.; if the blood-citrate mixture is kept in the refrigerator 

 for some hours before injection it is well to heat the mixture before 

 injecting large amounts by placing the flask in water at 40 C. For 

 injecting large amounts (over 50 c.c.) the gravity method described 

 on page 743 and illustrated in Fig. 140 may be used. 



In giving intravenous injections to infants the longitudinal sinus 

 (Helmholz, 1 Howard 2 ) or external jugular vein may be used. To reach 

 the sinus the needle is inserted through the skin in the superior angle 

 of the anterior fontanel at an angle of 25 degrees with the scalp. A 20- 

 or 30-c.c. syringe should be used. 



NORMAL SERUM IN THE TREATMENT OF THE TOXICOSES OF PREGNANCY 

 Feiux, Freund, Rongy, and others have found injections of fresh 

 normal human serum from pregnant women, serum from placental 

 blood, and even horse serum useful in the treatment of the vomiting of 

 pregnancy. Freund has likewise observed that injections of Ringer's 

 and Locke's solutions are sometimes efficacious; he has found injections 

 of serum of some value in eclampsia, and tentatively advises its use in 

 this condition. The same observer has employed injections of normal 

 serum for the relief of the itching of pregnancy, and reports success. 

 Similar observations have been made by Veiel 3 and Wolf, 4 especially 

 after injections of serum secured from other healthy pregnant or recently 

 delivered women. 



To obtain placental serum, the following technic may be employed: 



1 Amer. Jour. Dis. Children, September, 1915, 194. 



2 Jour. Amer. Med. Assoc., 1915, Ixv, 1365. 



3 Munch, med. Wchnschr., lix, No. 35. 4 Berl. klin. Wchnschr., 1913,. 1, No. 36. 



53 



