116 VACCINE AND SERUM THERAPY. 



favorable as those obtained by the injection of a serum prepared 

 by Flexner and Jobling. 



The method of preparation of the curative meningococcic 

 serum of Flexner and Jobling, is to inject into the horse first in- 

 creasing doses of killed meningococci, later increasing doses of 

 living meningococci and finally increasing doses of an extract of 

 meningococci. The extract injected contains the endotoxin liber- 

 ated by the action of a meningococcus autolytic enzyme which as 

 Flexner has found, is able to destroy the cell substance of the 

 meningococcus. 



The action of Flexner and Jobling's serum, according to the 

 originators, is three fold. It exerts an anti-toxic action, is bac- 

 tericidal and is bacteriotropic or opsonifying. Of these effects- 

 clinicians who have used the serum emphasize especially the ap- 

 parent anti-toxic action. 



Flexner and Jobling have summarized the results of the treat- 

 ment of 400 cases of epidemic cerebrospinal meningitis. Accord- 

 ing to this summary it has been found by the various clinicians 

 using this serum, that the period of illness can be shortened, the 

 chronic lesions largely prevented and the percentage of mortality 

 markedly reduced. Probably the principle reason for the differ- 

 ence in efficiency of Flexner and Jobling's serum as compared to 

 Kolle and Wasserman's and Jochman's specific sera lies in the 

 method of application. Flexner and Jobling have emphasized the 

 importance of reaching the causal organisms with the serum. For 

 this reason lumbar puncture and withdrawal of a certain amount 

 of cerebrospinal fluid is first made, after which, without removing 

 the needle, injection of the serum is made directly into the sub- 

 arachnoid space of the spinal cord. Recently the persist ance of 

 Diplococcus intracellularis in the lateral ventricles, after apparent 

 death of the organism in the spinal sub-arachnoid space, has been 

 emphasized by Knox and Sladen. For the treatment of this con- 

 dition, Gushing and Sladen have suggested the advisability of ven- 

 tricular puncture and injection of ant i -meningococcus serum. 



The results which have been obtained by the use of anti- 

 meningococcus serum as made by Flexner and Jobling, have been 

 so beneficial in acute and chronic cases of meningitis due to the 

 Diplococcus intracellularis that its use is indicated as a specific 

 therapeutic measure. 



