iiiininnised against all the strains, should be used. When it is known what strain is responsible for a particular epidemic, then, of course, a monovalent strain can be used. No statistics are as yet available, but I am informed that the treatment of cases b}- the polyvalent serum supplied by the Lister Institute has been highly successful.
Major J. M. Atkinson : 1 thank you very much for your kind remarks on this paper. With reference to Fleet-Surgeon Bassett Smith's remarks, he asks, " How is it that people suffering from the disease themselves are not more infective." I think the reason is that the meningococcus in the naso-pharynx is so easily contaminated by contact wiili the saliva. It is difficult to understand the meningococcus coming from the phar nx without being contaminated by the saliva. In most cases of spitting, and even of kissing, contact with the saliva renders it in a very .short time practically innocuous. This is the reason why they use West's swab in examining the nasal pharynx of contacts.
With regard to the four das, after finding two negative results, the contacts ujay be discharged to duty. A fairly trustworthy result should be available in four (jr five d;is.
I think one iujportant point in the clinical liistory is the comparative slowness of the pulse with the high temperature; this is a very important diagnostic point. In each of these cases the pulse was 80^ to 86^ when the temperature was 101-" F. and higher; another symptom is the intense headache met with in this disease. "As Surgeon-General Bruce says, one cannot form valuable deductions from a few cases; we have only had four cases, but I thought our experience might prove of interest.
