xxxiii
The operation of inoculation.
(IO) Different operators may have different methods of performing the operation of inoculation,
but it will be found convenient by all
to arrange that the person to be inocu-
lated should be instructed to sit on the ground and, for the operation, place his left elbow
on the operator's right knee, which should be covered with a towel.
Candidates for inoculation to be seated.
There are several advantages in making the people sit, both while waiting for their turn
and during the operation. In the
first place it is less tiring to the opera-
tor and to candidates for inoculation to sit than to stand, while the latter when sitting
are much easier to manage both as a crowd and as individuals than when standing.
There can be but little jostling by people waiting for their turns when all are seated, and
a person seated on the ground with his arm in the grasp of the operator is less able than
one standing up to jerk himself from the prick of the needle.
Seat of inoculation ; advantages of the left arm.
The choice of the arm as the seat of inoculation has the following recommendations. It
necessitates little exposure, an import-
ant consideration when dealing with
women. The skin on the outer side of the arm, midway between the shoulder and the
elbow, is thinner and seemingly less sensitive than that of many other parts of the body,
and certainly than that of the flank. Further, after inoculation there often is considerable
pain about the puncture, especially on movement, and it is much easier to keep the arm
at rest than the flank, for while almost every movement of the body affects the flank,
almost all movement of the arm can be avoided by the use of a sling. Persons inoculated
in the arm are thus able to be about as soon as the fever has passed off. The left arm
is chosen as it is less used than the right.
Rules which must be observed in the actual per-
In performing the operation of inoculation there are certain essential details which must
be scrupulously observed. These are
formance of the operation.
the
following:-
(T) The site of inoculation must be wiped with carbolic lotion before and after the
insertion of the needle. Should any blood ooze from the puncture on the with-
drawal of the needle, a piece of lint soaked in carbolic lotion, I in 20, should be
applied. This should be applied by the assistant who is entrusted with the duty
of disinfecting arms, who, for the performance of his duties, should be separately
provided with a bottle of carbolic lotion, I in 20, a small bowl, a pair of catch-
forceps, and a number of small pieces of lint. The lotion should be poured into
the bowl as required, and the pieces of lint, which are held in the forceps and
used for wiping the seat of inoculation, should be changed, like the lotion, when
they become dirty, the catch-forceps permitting this to be done quickly.
(2) Before each inoculation the needle must be wiped with a piece of lint soaked in
carbolic lotion, I in 20, and dipped into this lotion.
(3) Care must be taken to see that the needle is inserted with its point downwards in
order to prevent the injection of any air that may have got into the syringe.
(4) The Inoculator before inserting the-needle should always note that there is no air,
other than a few small bubbles, in the syringe. If there is more than this it will
become compressed while pressure is made on the piston and, owing to the expan-
sion of the air in the syringe, a portion of the dose which should have been injected
will escape from the needle when it is withdrawn. The inoculated person will
therefore not have received his proper dose.
(5) A fold of skin should be pinched up at the seat of the inoculation (which, as indicat-
ed above, should usually be on the outer side of the left arm about midway bet-
ween the shoulder and the elbow) and the needle inserted to about half its length
under the skin and parallel to the fold of skin. Care should be taken to see that
the needle does not go deeper than the subcutaneous tissue.
(6) The dose of prophylactic should be injected slowly.
(7) The dose of prophylactic mentioned on the bottle may safely be given to all persons in
good health between the ages of 15 and 60. Robust men may be given one or
two-fifths more without ill-effect. The following minimum proportion of the dose
marked on the bottle should be given for the different age-periods named, viz :—
From 1 year to 2 years, one-fifth.
From 2 to 5 years, two-fifths.
From 6 to 11 years, three-fifths.
From 12 to 15 years, four-fifths.
From 15 to 60 years, five-fifths.
From 60 to 70 years, three-fifths.
There are five screw-marks between each two lines marking c. c. on the stem 01
the 20 c. c. inoculation syringes. A full turn of the stop from one screw-mark to
the next will therefore indicate one-fifth of a. c. c.
(8) The operator will see that the assistant appointed for this purpose enters correctly on
the certificate of each inoculated person the dose of the prophylactic given and the
serial number of the brew. He will himself inform the assistant as to the dose
given and will see that the compounder keeps him informed as to the number of
the brew. Immediately after inoculating each person the operator will himself
stamp the inoculated persons certificate with the India rubber stamp provided.
He will take care to see that this stamp never leaves his possession, as its impres-
sion on the certificate constitutes the only proof that the person has been inoculat
ed by him.