SERUM THERAPY 141 



relapse occurs, repeat the doses at 24-hour in- 

 tervals. 



METHOD OF INTRASPINAL ADMINISTRATION 



The technic includes that required for per- 

 forming a lumbar puncture, inasmuch as the 

 serum must be introduced into the spinal canal 

 after the withdrawal of cerebrospinal fluid. 



Preliminary The patient is placed on the 

 side (if a child, it may be advisable to first par- 

 tially etherize), with head bent forward and 

 knees drawn up. The skin in the lumbar region 

 of the back is painted with iodin, or washed with 

 soap and water and followed by alcohol and 

 ether. The operator, whose hands have been 

 sterilized, takes the sterilized needle with its 

 contained stylet in his right hand and introduces 

 the needle through the intervertebral disc be- 

 tween the third and fourth lumbar vertebrae, 

 and a little to one side of the median line; the 

 thumb of the left hand being placed between 

 the spinous processes as a guide. 



Inserting the Needle. The point for insert- 

 ing the needle may be conveniently located by 

 placing the index and third fingers of the left 

 hand on the highest points of the iliac crests. 

 The middle finger will then rest on the third 



