NOTES ON THE ÆTIOLOGY OF EFFORT SYNDROME
593 tory which is equipped for the examination of throat swabs for diphtheria. The culture of the meningococcus from cerebrospinal fluid is supposed to require special proteinenriched culture media from which plate cultures must be made. In the above case I obtained copious primary growths within 24 hours on ordinary coagulated blood serum slopes, such as are used for the culture of the diphtheria bacillus from swabs. The following conditions should, however, be observed: (1) the cerebro spinal
... the cerebro spinal fluid should not be allowed to become chilled before the culture tubes are inoculated ; (2) the culture tubes should preferably be inoculated and incubated within ten minutes of the removal of the cerebro-spinal fluid from the body; (3) the culture tubes should be warmed to blood heat before the inoculation by placing them in warm water. The agglutination of the meningococcus for practical test purposes, given a high-titre serum, does not seem to require the elaborate apparatus usually described, such as a water-bath regulated to 55° C. and the various tubes, pipettes, and racks required for the macroscopic method. The ordinary microscopic method, as used in the old Widal test, appears to be good enough. The dilutions can be made with sufficient accuracy by the platinum loop method. A dilution of 1 in 10 is obtained by mixing one loopful of serum with nine loopfuls of normal saline. By adding to one loopful of this dilution two loopfuls of the meningococcal emulsion on a cover-glass the organisms are suspended in a dilution of 1 in 30 of the ordinary serum. The cover-glass is inverted over the ordinary " cavity " slide, and the preparation kept in the incubator at 37° C. and examined after one hour. With a high-titre serum-say, a titre of 1 : 800-clumping of the organism and cessation of Brownian movement is well marked within that time in the case of the appropriate type serum; while in the case of the other type serums or a normal serum control the test is quite negative. /t'C?M<!7'A'S. In view of the practical importance of the subject matter of this article, I have considered it advisable to publish this preliminary communication without waiting for confirmation from a large series of cases. The method of diagnosis and treatment described can be carried out in nearly every fever hospital in the country with the minimum trouble, and possibly with great saving of life. Supplies of type antimeningococcic serum do not appear to be yet available in the ordinary market. I obtained phials of the serum for treatment from the Lister Institute, London, and small phials for agglutination purposes from R.A.M. College, London. Rcfaences.-1. Iienuedy and W'orster Drought: Brit. Med.