742 PASSIVE IMMUNIZATION SERUM THERAPY 



2. TECHNIC OF INTRAMUSCULAR INOCULATION 



As shown experimentally by Meltzer and Auer, absorption occurs 

 much more quickly when inoculations are given into the muscles than 

 when they are given into the subcutaneous tissues. For this reason anti- 

 toxin should be given intramuscularly in severe cases of diphtheria, as 

 the technic is just as simple as that of a subcutaneous injection. When- 

 ever the physician desires more speedy absorption than that which fol- 

 lows a subcutaneous injection, and the intravenous route cannot, for 

 some reason, be adopted, the inoculation should be given in the muscles, 

 preferably those of the buttocks. 



The technic is the same as that employed for subcutaneous injections, 

 except that the needle is plunged deeply into the muscles. If the most 

 muscular portions are selected for injection, there will be little or no 

 danger of injuring a nerve. If desired, the syringe may be detached 

 after the needle has been inserted to ascertain if a vein has been entered, 

 which would be shown by a flow of blood. If this occurs, the needle 

 should be withdrawn slightly and passed in another direction. 



3. TECHNIC OF INTRAVENOUS INOCULATION 



The necessity of administering serum intravenously in order to 

 obtain the best results, or any result at all, is becoming more and 

 more apparent. In severe cases of diphtheria the best results are 

 obtained when the antitoxin is given intravenously; in the treatment 

 of tetanus the tetanus antitoxin should be administered intra- 

 venously as well as intradurally, and both antistreptococcus and anti- 

 pneumococcus serums should always be given by the intravenous route. 

 Recent reports indicate that the proper serum treatment of these in- 

 fections requires large doses given intravenously. Physicians should, 

 therefore, be prepared to give intravenous injections. Since the use of 

 salvarsan in the treatment of syphilis has become so popular many 

 workers have perfected themselves in the technic of intravenous adminis- 

 tration, but there is still great hesitancy about giving intravenous in- 

 jections, although the methods are relatively simple and easily mastered. 

 With nervous patients the injections can be made practically painless 

 by the preliminary infiltration of the skin about the site of puncture 

 with a few drops of a sterile 1 per cent, solution of eucain. 



Syringe Method. When small amounts of fluid are to be injected, 

 as from 5 to 20 c.c., a syringe is employed. 



1. It is best to use an all-glass syringe, or at least one with a glass 

 barrel, for the physician can then assure himself that all air has been ex- 

 pelled and that the fluid is free from solid particles. Further than this, a 



