418 INFECTION AND IMMUNITY. 



fifteen minims may be injected into the nerve 

 trunks at a sitting, and the operation may be re- 

 peated on subsequent days; the needle should be 

 partially withdrawn and reinserted in different di- 

 rections during the injection. Rogers recommends 

 tying loose ligatures around the nerves after the 

 operation so that they may be readily drawn up 

 and identified for further injections. In order to 

 reach the medulla the intracerebral method of 

 Roux or that of Rogers may be utilized. Kocher 

 has devised a technic for the intracerebral injec- 

 tions. Anterior to the parieto-f rental suture and 

 to one side of the median line the scalp is pre- 

 pared, and a hole drilled through the skin and 

 skull, having its direction toward the foramen 

 magnum. By means of a long needle, the ventri- 

 cle is penetrated and the serum, after injection, 

 finds its way to the fourth ventricle to the imper- 

 iled respiratory and cardiac centers; 10 c.c. may 

 be injected. Rogers seeks to accomplish the same 

 end by a different technic. He introduces the 

 needle between the sixth and seventh cervical ver- 

 tebrae, punctures the cord deeply, and injects from 

 20 to 30 minims at a sitting. Although there is 

 danger of intraspinal hemorrhage in the proce- 

 dure, no ill effects were noted. It has been recom- 

 mended also that the cerebrospinal fluid be with- 

 drawn by means of lumbar puncture and substi- 

 tuted by antitoxin. Some physicians who have 

 used this method report favorable results. 



Second: The neutralization of all toxin which 

 is not yet bound by the nervous tissue or absorbed 

 by the motor nerves. This demands the infiltra- 

 tion of the wound and surrounding tissue with the 

 antitoxin, and injection of a sufficient amount of 



