264 SPECIFIC MICRO-ORGANISMS 



with a mixture of many typical and atypical meningococcus 

 cultures injected subcutaneously. At first the cultures are 

 killed by heat before injection, and only one or two loopfuls are 

 given. The dose is increased and repeated every 8 to 10 days 

 until the growth on two Petri dishes is being injected. Living 

 cultures are then given, and finally old cultures which have 

 disintegrated are also used. The serum is used after the horse 

 has been treated for 8 to 10 months. Jochmann showed that 

 the subcutaneous injection of the serum is without effect upon 

 meningitis in monkeys but that when introduced into the spinal 

 canal is specifically curative. Flexner^ and his co-workers have 

 studied this very fully and there can no longer be any question 

 of the value of the serum in the treatment of meningococcus 

 meningitis. 



Cerebrospinal fluid is obtained by Quincke's puncture. For 

 children a needle 4 cm. long and with a lumen of i mm. is intro- 

 duced in the medium line directly forward so as to enter the 

 spinal canal between the second and third or the third and fourth 

 lumbar vertebrae. From 20 to 50 c.c. of fluid may be withdrawn 

 if it pomes away under pressure, and then the curative serum 

 is injected through the same needle. The fluid withdrawn should 

 be examined to establish the presence of meningitis and its variety. 

 In general the examination includes a macroscopic examination 

 and description of the appearance of the sample, a microscopical 

 numerical count of the cells present, chemical examination of 

 the cell-free fluid for excessive protein^ content, microscopic and 

 cultural examination of the sediment for bacteria and of the 



' Flexner: Harbin lectures. Journ. State Medicine, 1912, Vol. XX, pp. 257-270. 

 ^Nogufchi's test: To 0.5 c.c. of blood-free fluid add i c.c. 10 per cent butyric 

 acid, boil; add 0.2 c.c. normal NaOH and boil again. Set aside to cool. A floc- 

 culent precipitate indicates an increase in the globulin content. 



Pandy's test: Add i drop of the spinal fluid to i c.c. of a saturated aqueous 

 solution of carbolic acid. The immediate formation of a bluish-white ring or cloud 

 indicates an increased protein content. 



Ross- Jones test: Layer equal quantities of ^pinal fluid and ammonium sulphate 

 solution, saturated by boiling. A white ring indicates abnormal globulin content. 



