206 MODERN BIOLOGIC THERAPEUSIS 



and general reactions do not appear usually un- 

 til four or five hours after, at which time the pa- 

 tient is ready to retire; and, by morning, the 

 entire reaction may have passed. It is wise to 

 caution against active exercise such as riding 

 or tennis on the following day, since it tends 

 to aggravate the reaction. The first dose should 

 not be given to women during or near the time 

 of the menstrual period. The vaccine is inject- 

 ed subcutaneously, and not into the muscles or 

 into the skin. This is necessary to secure slow 

 absorption. Deep muscular injections, because 

 of the rapid absorption, are more apt to pro- 

 duce severe reactions and pain on movement. 

 The best location for the injection is the outer 

 surface of the arm over the insertion of the del- 

 toid muscle, where the subcutaneous tissue is 

 abundant. 



REACTION 



Each dose of vaccine is followed by a local re- 

 action which varies little, either with the size 

 of the dose or the idiosyncrasy of the individual. 

 Usually there is a red and tender site about two 

 inches in diameter at the point of inoculation. 

 This first appears in six or eight hours and 

 reaches its full development in about twelve 



