METHODS OF INOCULATION 697 



Anesthesia for Subdural Inoculation. There is no doubt but that 

 lumbar puncture and the subdural injection of fluid are painful, the 

 amount of pain depending to some extent upon the degree of meningitis, 

 the method of injection, and the skill of the operator. Severe cases of 

 meningitis that are stuporous or moribund may not evince any evidences 

 of added discomfort; less toxic and robust or nervous patients may, how- 

 ever, suffer considerably and prove difficult subjects for injection. 



A local anesthetic is practically useless except for the mental effect 

 it has upon the patient who may demand it. General anesthesia for 

 lumbar puncture in meningitis adds a considerable element of danger, 

 but if it is absolutely necessary, a few whiffs of ether or chloroform may 

 be given while the needle is being inserted. In giving subdural in- 

 jections hi tetanus a general anesthetic is necessary. 



Sophian has found that if water is given through a straw while per- 

 forming lumbar puncture patients will frequently drink large quantities 

 of it and keep very quiet. 



Gravity Method. The apparatus required is very simple, and con- 

 sists essentially of a proper needle and from 12 to 16 inches of soft- 

 rubber tubing attached to a container or funnel for serum and furnished 

 with a metal tip by which it is quickly and readily attached to the 

 needle. 



Several manufacturers of biologic supplies are marketing antimenin- 

 gococcic serum in a special container, fashioned after that devised by 

 Sophian and Alexander, with the needle and tubing adapted for the 

 administration of the serum by the gravity method. Such an apparatus 

 is shown in Fig. 137. 



The physician may, however, prepare an equally efficient apparatus, 

 similar to that shown in Fig. 137, which consists of the glass barrel of a 

 20 c.c. syringe attached to 16 inches of soft-rubber tubing fitted with a 

 metal tip that holds the needle firmly and snugly. The whole is steril- 

 ized by boiling, and any quantity of serum may be administered with it. 

 The apparatus is adapted for the administration of antimeningococcic 

 serum, tetanus antitoxin, influenza serum, salvarsanized serum, or any 

 other fluid, and has given uniform satisfaction. 



The needle should be from 10 to 11 cm. in length, with a wide, rather 

 than a narrow, lumen about 1.5 to 2 mm. This is important in ad- 

 ministering serum to a case of meningitis, in which a needle with a nar- 

 row lumen may become plugged with exudate. The needle should be 

 fitted with a trocar. The tip should have a short bevel with a sharp 



