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downwards, into the fluid which has been tilted near to the mouth of the tube or
bottle by an assistant ; and with the right hand draws out the piston and sucks the
fluid up into the syringe. During this process the oblique opening of the needle
may be kept resting upon the glass of the vessel, but without pressing upon it. The
assistant, by gradually lifting the far end of the tube or bottle, is to so regulate the
flow of the fluid that the needle point remains constantly bathed in it ; and, as he is
doing so, the operator slowly lowers his right hand which holds the head of the piston,
thus keeping the same relative position of the bottle and the syringe ; otherwise the
point of the needle, or even the needle itself, is apt to get bent.
VIII.—During the sucking-up of the fluid, the barrel of the syringe and even
the nozzle of the needle must not be allowed to come in contact with the mouth or
the contents of the bottle.
IX.—When the piston is drawn up to the uppermost point, all bubbles of air
should be emptied from the syringe by holding it up vertically with the needle up-
wards, and gently pressing on the piston head from below.
X.—The operator should carefully avoid wasting the prophylactic fluid. The
contents of every tube or bottle should be used up to its last drop before another is
opened, unless no more patients are present to be inoculated ; in which case the
contents remaining in the bottle should fce thrown away, and not kept over to the
following day.
XI.—When the inoculation wcrk is over for the day, it is important that the
syringe should be washed carefully with carbolic lotion again in the manner detailed
in paragraph I. Otherwise it is liable to get solid matter deposited on its inner
walls, and also to get infected. The needle should be dried and touched on the outer
surface with a trace of vaseline to prevent- its getting rust-covered, and a wire should
be passed and left in it. A rust-covered needle is cleaned on a sharpening stone.
When the syringe is being used daily, and only for inoculation of the same prophy-
lactic material, it is sufficient, when beginning work on the following day, to wash it
out with carbolic lotion as mentioned in paragraph I, and to keep it soaked with the
lotion for half an hour or so.
XII.—The following is the technique for Irypodermic injection in men. Put the
stopper on the piston rod of the syringe so as to mark exactly the dose to be injected.
Hold the barrel of the syringe in your right hand, between the middle and ring fingers
on one side and the thumb on the other, and place the index finger on the head of the
piston rod, without pressing upon it. Pick up with your left hand, between the
index finger and the thumb, a fold of skin where the needle is to be inserted, avoid-
ing carefully big subcutaneous vessels. Make a slabbing puncture with the needlo
into the skin, parallel to the length of the fold, and so as to inject strictly subcutane-
ously (on no account into the muscles) remove the hand holding the fold, and press
the piston rod home. Withdraw the needle by a rapid movement, and only then
apply a finger to tho point of the skin where the needlo had been inserted, and press
upon it for a few seconds to prevent the fluid, or a drop of blood, oozing out of it.
In case a drop of blood does come out after the needle, a thin layer of clean cotton-
wool should be applied, for a minute or so, over the opening.
Circular.
In addition to the precautions laid down in the Circulars regarding Inoculation,
forwarded with this office No. P-6472, of 19th September 1899, and No. P-6846, of
28th September 1899, the following should in future be adopted :—
(1) The place of inoculation should first be cleaned thoroughly with car-
bolic acid solution.