796 PASSIVE IMMUNIZATION SERUM THERAPY 



injected, the funnel may be lowered and the spinal fluids allowed to 

 flow out. When the symptoms have disappeared, the injections may be 

 continued and satisfactorily completed. 



3. When the physician cannot administer the serum by the gravity 

 method or under blood-pressure control, the injection may be given by 

 means of a syringe (see p. 752). It should be given slowly, and the 

 patient observed closely in order to detect the general symptoms of 

 collapse. The amount of serum injected should not be larger than the 

 amount of cerebrospinal fluid withdrawn. According to Sophian, the 

 average doses are as follows : 



DOSE OF ANTIMENINGITIC AMOUNT OF FLUID 

 SERUM WITHDRAWN 



1 to 5 years 3 to 12 c.c 12 c.c. 



5 to 10 years 5 to 15 c.c. 15 c.c 



10 to 15 years 10 to 20 c.c. 20 c.c. 



15 to 20 years 15 to 25 c.c. 30 c.c. 



20 years and over 20 to 30 c.c. 40 c.c. 



The injection of too large a dose of serum may be followed by head- 

 ache, pain in the back and legs, and restlessness. W^hen the amount of 

 serum injected exceeds the amount of spinal fluid withdrawn the symp- 

 toms just named must be regarded as the signal to stop; otherwise they 

 may be disregarded. 



Intravenous Injection. During epidemics of meningitis it may be 

 possible to detect cases in the bacteremic stage when meningococci are 

 present in the blood and clear fluid is collecting in the ventricles. In 

 these and in all severe fulminant infections it is good practice to inject 

 from 30 to 100 c.c. of serum intramuscularly or intravenously. It is 

 advisable to secure a culture of blood in ascites dextrose broth in all 

 cases in adults and older children. If sufficient serum may be obtained 

 and the expense is a secondary consideration, an intravenous or intra- 

 muscular injection, given at the outset and once or twice during the acute 

 stage, may benefit the patient by neutralizing toxins and possibly pre- 

 vent complications due to the entrance of meningococci into the blood- 

 stream. Furthermore, as shown by Flexner and Amos, 1 in poliomyelitis 

 the intraspinal injection of serum increases the permeability of the cho- 

 roid plexus and meninges, permitting the passage of immunity principles 

 from the blood into the cerebrospinal fluid. For this reason the intra- 

 venous or intramuscular injection of anti meningitis serum in conjunc- 

 tion with intraspinal injections may be particularly advantageous in 

 the treatment of severe infections. 



1 Jour. Exper. Med., 1917, xxv, 499 and 525. 



