DISCUSSION. 21 H
Then another point. Major Atkinson said he would let a man go after four days with two negative swabs. In the first place I think it is a dilticult thing to get the result of the first swab out on the fourth day, and it would take the same period, or longer, to get out the second, so it
would not be until about ten days. In the bacteriological description it is stated that the culture is made from the throat direct on to the plate, and grown 24 hours and sub-cultured, and the agglutination tests applied. There is no mention of any fermentation reactions whatever. I should not like to take any positive opinion of any case upon that.
Then another point. ^Nlajor Atkinson referred to Flexner serum. In a letter I received he (Flexner) said the serum was not good, but he thought that was because on the market there was some American serum which was old and was not reliable, and as there has not been an epidemic in America for some time, the serum was consequently not so powerfully anti-toxic as it should have been. This year he made fresh serum, which he supplied to us for use, and that serum has been more favourable than any other we have used.
Major TooGooii : Following the remarks of the last speaker, perhaps I may be allowed to mention an epidemic, a small localised out-break which occurred in the south-east of London. Clinically, all these cases were quite indistinguishable from cerebro-spinal fever of the meningococcus origin, but the organism which was isolated both from the throat and also from the cerebro-spinal fluid was a short bacillus of the zeroid type. As I say, clinically speaking, the outbreak exactly resembled that of cerebro-spinal fever, and yet the organism appeared to be entirely different.
Dr. Harrington Sainsbury : I think that during the prevalence of an epidemic of this type it is very important that we should investigate all cases of headache that persist. The second case ^Major Atkinson referred to was under my care at the Military Hospital, Richmond, and I was puzzled over it. The patient did not seem particularly ill ; there were no rigidities in neck or arms ; no rash. I did hnnbar puncture and obtained a fluid which looked rather doubtful, but which the bacteriologist's report shewed to be definitely raeningococcic in nature. We thought the patient should make a good lecovery, and this ho did.
