532 PATHOGENIC MICROORGANISMS 



Sudden drops of blood pressure in either case, should lead to caution, 

 and perhaps interruption of the procedure. 



Repetition of the injections is as important as the initial injec- 

 tion, as far as cure is concerned. The action of the serum may 

 be compared somewhat to the action of anti-serum in a Pfeiffer 

 reaction in a guinea pig's peritoneum. Thus, probably some bac- 

 teriolysis and considerable stimulation to phagocytosis by opsonic 

 action may result. The spinal fluid shows changes in that the num- 

 bers of organisms are diminished and the extracellular ones dis- 

 appear. Purulent spinal fluid may become clearer and may even 

 become entirely free from organisms or leucocytes. There is prob- 

 ably a certain amount of poison neutralization by the serum. Repeti- 

 tions of the doses, therefore, must be governed to some extent by 

 the progress of the case, clinical conditions pointing to changes in 

 the meningeal inflammation, and observation of the spinal fluid. One 

 injection a day for three to six days usually controls a case that is 

 treated with sufficient promptness. 



In addition to the intraspinous administration, it is wise to inject 

 from 30 to 50 c.c. intravenously, preceding this by withdrawal of 

 blood for blood culture, and being governed as to repetition by 

 subsequent blood culture control.' 



Everyone dealing with meningitis during an epidemic must re- 

 member that occasionally meningococcus septicemia cases occur 

 which never show meningeal infection. We have mentioned these 

 in another place, but believe that more attention should be given 

 them, since they are very apt to be fatal, either without meningitis, 

 or subsequently followed by a violent meningeal involvement. Such 

 cases displayed the clinical picture of a general severe septic in- 

 fection with usually a profuse eruption in which petechial spots 

 not unlike those of typhus fever may cover the entire body. There 

 is an irregular septic temperature with a high leucocytosis and 

 sometimes delirium. Blood culture will diagnose these cases and 

 vigorous intravenoiis serum treatment would be indicated. 



Effects of Serum Treatment. The mortality of meningitis in the 

 days before serum was used varied between 60 and 80 per cent. 

 Higher mortalities have been noted in individual epidemics. The 

 average for many different parts of the world fluctuates about 70 

 per cent. Since serum treatment was begun just before the year 

 1906, a great many statistical studies have been made which are 

 of course subject to great error, owing to the fact that the treated 



