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37
Cistern puncture was performed in four cases and on eleven occasions.
each instance, a dry lumbar puncture was previously obtained at several levels.
three cases the cistern eventually became dry with development of internal hydro
cephalus. In the fourth case, after two cistern punctures, continuity with the spinal
suprachoroid space was re-established, the patient made a good recovery and was
in good health six months after discharge from hospital.
In Cistern
In puncture.
The amount of serum given by the intrathecal route should be governed by
the amount of the fluid withdrawn, the volume of the former being slightly less
than the latter. Serum treatment is continued until meningococci disappear from
the cerebrospinal fluid. If special media are not available, the treatment can be
controlled by incubating the cerebrospinal fluid and examining it each day before
the next puncture is performed. By this method only one unnecessary dose of
serum is given and the risk of producing a serous meningitis is minimised. Daily
examination of the fluid should be continued until it becomes clear.
Better results might be obtained by the use of monovalent serum. This has
been impracticable up to the present, owing to the time taken to type the organism.
The monovalent precipitin reaction described by Maegraith (Lancet, 9th March,
1935), if it became generally available, would appear to solve this difficulty. It is
hoped to apply this method of diagnosis at this hospital.
Dosage of
serum.