Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/12

 Lieut.-Col. Mervyn (tORDon has shewn that in the present epidemic there arc four or more distinct sti'ains of virulent meningococci.

TREATMENT.

Antimeiiingococcal scriiiii should l)e injected intraspijially after the removal of an e(]ual amount of cerehro-spinal fluid. The serum should be warmed to the bod' temperature, at least 20 c.c. injected, and the foot of the bed should be raised after the injection. The dose should be repeated daily if nectessary. The indication for further serum should be the turbiditx of the fluid drawn off; if it is still tui'bid it is well to awe more serum. Intercurrent conditions should be treated as they arise, special care being taken of the eyes. The indication for further serum is propoi'tionate to the number of the meningococci still present, as found by examining u film of the withdrawn cerebro-spinal fluid.

Many aver that mere lumbar puncture without the injection of any serum is, in many cases, curative. Should the disease be met with sufficiently early, treatment by daily lumbar puncture would hold out considerable hope of success. Our failure, in the first months of the present epidemic, to secure the excellent results attained by serum injection in America was apparently due to the fact that we relied largely on sera obtained from American sources ; whereas the types of meningococci prevailing in this epidemic differed from those found in the United States.

MORTALITY.

The mortality in cerebro-spinal fever is undoubtedly higher in the epidemic than in the sporadic cases. In epidemics, the mortality prior to the introduction of serum treatment was about 70 to 80 per cent. Since the serum treatment, the mortality in epidemics has fallen to about 30 to 40 per cent.

CARRIERS.

Carriers have been already discussed, but the spread of an epidemic of cerebro-spinal fever is not explained by the discovery of the coccus in the naso-pharynx of actual patients, for disease rarely spreads by direct contact from patient to patient.

This diificultv was solved when Alluecht and Giiox found that the