CEREBRO-SPINAL MENINGITIS III 



then three-quarters of the amount you intend to judge in addi- 

 tion. Then fit the syringe to the needle, and inject the serum 

 very slowly and gently. After the injection, keep the patient 

 flat on his back with the foot of the bed raised for an hour 

 or so, so as to let the serum gravitate towards his head. The 

 injection must be made with the most rigid aseptic precau- 

 tions, and the serum and syringe should be warmed to the 

 body temperature. 



If a vaccine is employed, it is advisable to prepare one from 

 the patient himself; failing this, a stock vaccine may be tried. 

 The commencing dose may be 25 to 100 millions, increasing 

 gradually to 500 millions, and given at intervals of two to 

 three days, or when the clinical symptoms seem to suggest. 

 Others use smaller doses I to 5 millions. I am of opinion 

 that the treatment is of very decided value in the more chronic 

 forms of the basic meningitis of children, but have had little 

 experience with it in epidemic cerebro-spinal fever in adults : 

 in no case should it be allowed to replace repeated lumbar 

 punctures. 



The meningococcus is now known to be frequently found in the 

 throat and posterior nares, and in some cases at least patients or 

 healthy persons (" carriers ") have carried the disease in this way 

 and infected others, causing an attack of the disease. Hence it is 

 all-important (i) to isolate cases of cerebro-spinal fever until the 

 throat is free from meningococci, and (2) to examine all contacts and 

 to isolate those who are found to be carriers. The investigation of 

 suspected carriers falls into three parts : 



i. Collection of the Material. The best apparatus for the pur- 

 pose is West's swab (Fig. 24). This consists of a glass tube with a 

 curved end, containing a wire with a terminal swab. When not in 

 use this is withdrawn within the tube, the end of which is plugged 

 with cotton-wool, and the whole sterilized. To use it, remove the 

 cotton-wool plug, pass the swab on the flat to the back of the soft 

 palate, and then turn it vertical, with the tip upward. (It may be 

 necessary to use a tongue depressor, but it can often be dispensed with 

 after a little skill has been acquired.) Next push the outer end of the 

 wire until the tip of the swab protrudes an inch or so from the end of 

 the glass tube, push the whole onwards until the swab can be felt to 

 be touching the posterior nares, and rotate it from side to side, so as 

 to sweep the pharyngeal wall thoroughly. Then pull back the swab 

 into the tube, and withdraw the whole. If possible, inoculate your 

 plates at once, and put them: in the incubator. If this is impossible, 

 replace the plug, and plate put within half an hour or less if it can 

 be done. 



