Clinical sketches illustrative of practical medicine and surgery / ed. by Noble Smith.
- Date:
- 1895
Licence: Public Domain Mark
Credit: Clinical sketches illustrative of practical medicine and surgery / ed. by Noble Smith. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![11 As to the precautions to be observed in using the serum. It must be borne in mind that the dose is a large one, and in injecting an amount of 20 cubic centimetres (over 5 draclims) of an organic substance into the tissues there is great need for very careful asepticity of the serum, skin, and instruments em- ployed. Failure in any of these directions is liable to induce septiccemia, which cleanliness would have avoided. The serum itself is sent out in an aseptic condition in stoppered bottles. The preservative generally employed is camplior, but if not recpiired for immediate use it is well to keep the liottle in a cool place and screened from the light, so as to avoid all chance of decomposition. The best form of syringe is one after the patteim of Roux, and capable of hold- ing the full 20 cubic centimetres required. It should be sterilised before use by boiling for about ten minutes in water. Some of the syringes are con- veniently made so that their cases serve as miniature saucepans in which to carry out this operation. Lastly, the seat of selection for the injections is the loose tissue between the scapulje. The part should l)e hrst carefully washed with soap and water, then dried and the injection made into the loose subcutaneous tissue. The serum is generally absorbed within a few minutes, and gives rise to no un]ileasant local effects. The syringe should be again sterilised before beiim put away, the needle being carefully cleared of the drop of serum which it contains. Among the various letters to the journals de- scribing personal experiences of this treatment, some have stated that the result has not been satisfactory ; but we find that in some of these reports the dose is considerably smaller than that recommended, such as 15 mm., and six hours later another 5 mm., in a severe case of diphtheria. Then, again, it is impossible for us to estimate the value of the foreign preparations of antitoxin serum, some of those of the manufacturing chemists in Germany being concentrated, and there- fore far more likely to be wanting in uniformity in strength, and possibly inefficient, than those jirepared as they are in this country. ^ Twenty cubic centimetres (over 5 drachms) may be injected upon the first occasion, and twenty-four hours later either the same dose, or half that amount, may be administered ; and should the svmptoms, and especially the temperature, remain serious, another dose may be given later on. This is the plan adopted by Roux, and he has never used less than a dose of 5 drachms, and has even administered as much as 4 ounces, and in one case between G and 7 ounces. Dr. Klein’s serum.—The serum sent out by Dr. Klein for the use of hospitals is accompanied by a memorandum of instructions in which it is stated that the ordinary therapeutic dose is li to 2i fluid drachms. ' ' ^ It is further advised in this memorandum that an accurately graduated glass measure, previouslv sterilised by boiling, should be taken, and the quaii- titj ot the serum required for one injection (namelv, io to 22 fluid drachms) should be poured into the measure, the bottle re-stoppered, and kept in a cool, dark place under a glass bell-jar.’ Any surplus is not to be poured back into the bottle. The smaller dose here advised is considered suffi- cient, as Dr. Klein’s preparation is more powerful tfian that above referred to. Supply of antitoxiii._We have made inquiries as to obtaining the antitoxin serum, but probably by the tune this Journal is published the facilities will be Aeiy argely increased, and the supply of antitoxin sufficient to meet the demands. The British Institute of Preventive Medicine has for some time been issuing to certain public insti- tutions a supiily of antitoxin through the instru- mentality of Dr. Klein, who has instituted a plan of producing the antitoxin much more quickly and an parently more satisfactorilj , than hitherto carried out. _ We have written to the principal firms of chemists m London to inquire whether they are able to supply t ns remedy. Several of them write to say that at present they are not in a position to do so. Messrs Arthur & Co., of Berners Street, state that they have tried to obtain antitoxin from the British Institute of Preventive Medicine ; but they are told that it is not yet decided whether the remedy will be supplied to chemists, and that probably it will not, because they do not care to run the risk of its decomposing by taieless treatment. The Institute expects to have enough serum by the middle of January to supply all England Mess... Zi.„n.e™a.. are L age^ sLt Aronson, but are unable to supply now because tlie demand abroad is in excess of the supply there. The oi.ly Hnn which seems to be prepared to supply antitoxin is Messrs. Burroughs, Wellcome, & Co who have twelve horses in their own hands under skilful sc.entiflc treatment; all the work being under the superintendence of a research scholar of the British Medical Association, who has studied the subject under Roux in Paris.](https://iiif.wellcomecollection.org/image/b2247383x_0023.jp2/full/800%2C/0/default.jpg)
