68 ANAPHYLAXIS AND ANTI-ANAPHYLAXIS 



should always be given first, as though the person 

 injected were in an anaphylactic condition. This 

 recommendation is particularly useful in cases where 

 the serum must be introduced by intravenous or 

 intrathecal inoculation. 



Having established this fact, which route shall we 

 choose for vaccination ? The choice should be 

 dictated solely by the state of the patient and by the 

 necessity for more or less rapid intervention. Take, 

 for example, a patient attacked with cerebro-spinal 

 meningitis; it is in this case, in practice, that there 

 is most to be feared from serum mishaps. Several 

 cases may be brought forward as instances. You 

 are called to a patient who presents the symptoms 

 of meningitis. If, for the sake of accuracy in diag- 

 nosis, you prefer to wait for the laboratory tests 

 before intervening, and put off the injection of serum 

 into the spinal cavity till the next day, do not go 

 away without having injected lo to 20 c.c. of serum 

 subcutaneously. The patient will be none the worse 

 for it. His meningitis, if such it be, will not be 

 reheved, but he will benefit by the subcutaneous injec- 

 tion, from the an ti -anaphylactic point of view. If 

 the next day you have decided to perform a lumbar 

 puncture and to inject antimeningococcic serum, he 

 will be vaccinated against anaphylaxis, and will be 

 able to tolerate there and then, without untoward 

 symptoms arising, 30 to 40 c.c. of serum injected into 

 the spinal canal. 



Let us take another case. You are in the midst 

 of an epidemic of cerebro-spinal meningitis, and there 

 is no doubt about the diagnosis. You have decided 

 to inject intrathecally 20 to 30 c.c. of serum. If it 

 is not a very urgent case, begin by giving an intra- 

 spinal inoculation of 2 c.c; allow one or two hours 

 to elapse, then reinject by the same route the total 

 dose of serum — ^that is to say, 20 to 30 c.c. If the 



