214 DISCUSSION.
In cases of this kind which we cHnically suspect, I do not think we should lay too much stress on the negative findings of the bacteriologist ; I mean as to the presence of the meningococcus, for we are familiar in other forms of disease — definite tuberculosis, for instance — with negative results, although we know the disease to be present. Accordingly, if in doubt, we should proceed in our treatment upon the clinical findings. And here it is important to remember that simple tapping gives good results with a minimum of risk. I believe Major Michael Foster, of Cambridge, treated most of his cases with tapping simply. However, though convinced that we have in tapping a very powerful means of combating the disease, I should always have recourse to serum if I could get it.
From another point of view, in regard to treatment, we should, in my opinion, proceed on clinical results rather than on bacteriological. I remember a case at the Koyal Free Hospital, a sporadic case, in which the organism was found to be a pneumococcus. The patient, a boy, did extremely well on serum treatment, and the trouble appeared to be subsiding satisfactorily ; then, for some reason, I did a tapping, and, to my surprise, found that the organism was still present. On the strength of this I gave a further injection of serum with rather bad results, suggestive of anaphylaxis ; he had a definite set back. This made me decide, in this particular case, to proceed thenceforth on clinical lines only. The boy ultimately made a good recovery.
The question of the isolation of carriers of the meningococcus raises many difficulties, and I think we may have to be content to go upon reasonable rather than upon strictly scientific lines. It is not possible to isolate diphtheria carriers for the weeks and months of the persistence of the bacilli. It is not practical politics to do so. I think the same question arises with regard to cerebro-spinal fever, the germ of which may continue for months i]i the apparent presence of complete health.
Dr. F. Hewkley : May I ask if local treatment is of any efficacy, or, if the meningococcus cannot be isolated in the cerebro-spinal fluid, and a positive result obtained by examination of the pharynx, would local treatment by the use of the serum be at all expedient ?
Major J. M. Atkinson : There is no doubt that, with contacts, spray-
