For the employment of serum it is necessary to be in possession of a sterilisable syringe of the capacity of 10 c.c., similar to those used in the treatment of diphtheria.
If the life of the patient be not immediately in danger, care should first be taken to have the syringe boiled, or at least to rinse it out with boiling water, making sure that the piston fits tightly, and that the syringe itself is in good working order.
Should a syringe of 10 c.c. not be available, any kind of Pravaz syringe, previously washed out with boiling water, may be employed, but in this case the use of so small an instrument renders it necessary to give several painful injections.
The entire contents of a bottle of serum (10 c.c. of liquid serum, or 1 gramme of dry serum dissolved in 10 c.c. of boiled water) should be injected into the subcutaneous areolar tissue of the abdomen, on the right or left side. There is no advantage in making the injection at the actual spot bitten; the serum is best and most rapidly absorbed when injected into the loose tissues of the abdominal wall ([fig. 95]).
Fig. 95.—Technique of the Injection of Antivenomous Serum beneath the Skin of the Abdomen.
If it has been impossible to apply the treatment until several hours after the bite, and if the latter has been inflicted by a poisonous snake of large size or belonging to a very dangerous species, such as the Cobra or Indian Krait, it is preferable to inject into the patient three whole doses of serum at once.
In cases in which the phenomena of serious intoxication have already appeared, and when asphyxia threatens, one must not hesitate to inject 10 or even 20 c.c. of serum directly into a vein. For such an injection it is most convenient to choose a superficial vein at the elbow or wrist, or on the back of the hand.
The introduction of serum into the veins is never dangerous if good care be taken not to allow either bubbles of air or particles of precipitated albumin to enter.
It is not advisable to repeat the injections beneath the skin or into the veins unless the general symptoms appear to become more acute.