746 PASSIVE IMMUNIZATION SERUM THERAPY 



Permanent drainage may be instituted in severe cases by means of small 

 catheters. While the operation is not usually dangerous, the ultimate 

 prognosis is very unfavorable. 



The Serum Treatment of Subacute and Chronic Meningitis. If there 

 is no evidence of sepsis; if the mind is clear and the neck limber; if the 

 general conditions are good and the cerebrospinal fluid is practically 

 cleared up, the affection is most likely hydrocephalitic, and may be 

 relieved by repeated spinal punctures, with removal of as much fluid as 

 is safe, using blood-pressure as an index. If meningococci are present 

 in cultures of the fluid, small amounts of serum may be injected. The 

 prognosis in these cases, however, is generally bad, as the process is pro- 

 longed and the patient finally succumbs. 



In the second form of chronic meningitis, when the meningeal 

 symptoms are active, intensified, and persistent, serum should be ad- 

 ministered every few days in the same manner and in the same dosage 

 as in the acute cases. Improvement is, however, usually temporary, 

 and the ultimate prognosis is very grave. 



Serum Sickness. Intraspinal injections of serum result in the sen- 

 sitization of the patient in just the same manner as if serum were in- 

 jected by other routes. The percentage of cases developing serum sickness 

 is likely to be high, since antimeningitic serum is not refined (Sophian 

 reports 60 per cent, of his cases as developing the condition), and while 

 the symptoms are distressing, they are seldom alarming, and fatal 

 anaphylaxis is extremely rare. Occasionally the onset of serum sick- 

 ness may be confusing, but if the meningeal condition has been respond- 

 ing as well as could be expected, it is wise to let the patient alone, rather 

 than to make additional punctures and cause further depression. Local 

 sedatives, laxatives, atropin, sedatives, and, at times, morphin, are 

 indicated. 



Results of the Serum Treatment on Meningococcus Meningitis. 

 (a) Upon the Course of the Disease. In the majority of cases the sub- 

 dural injection of a potent antimeningitic serum is followed by some 

 immediate improvement in the local suppurative meningitis and general 

 sepsis, for the temperature usually drops, the mental condition improves, 

 and delirium is diminished, although the Kernig sign may persist, partly 

 as the result of meningeal irritation and partly on account of fear. 

 Hydrocephalus is generally relieved, as indicated by lessening of the 

 pressure symptoms, as, for example, severe headache, vertigo, and 

 vomiting; breathing becomes more regular, and the pulse also becomes 

 slower and more regular. The duration of the illness is usually shortened. 



