MENINGOCOCCUS MENINGITIS 253 



given about a week apart. Since the intravenous injections of the 

 autolysates, however, likewise produced quite serious symptoms, 

 they also were abandoned, and at present subcutaneous injections 

 only are recommended for the whole process of immunization, 

 living diplococci and autolysates being used alterantely at intervals 

 of a week. The maximum dose of living organisms and of the 

 autolysates is one and one-half bottles. 



The process of immunization in Flexner's horses was continued 

 for a year or longer, before any of the serum was used for purposes 

 of treatment. 



Standardization. Unfortunately no method is at present avail- 

 able by which the curative or protective effect of the antimeningo- 

 coccus serum can be gauged other than by actual trial. Kolle 

 and Wassermann attempted to standardize their serum on the basis 

 of its content in complement binding antibodies, in the belief that 

 these were identical with the bacteriolytic amboceptors. This idea, 

 how r ever, has been shown to be erroneous, and the method is from 

 this standpoint therefore inapplicable. Other investigators have 

 suggested to use the bactericidal power of the serum in vivo as 

 indicator of its therapeutic properties. The values which can thus 

 be obtained are, however, approximative at best, and the same is 

 to be said regarding Neufeld's suggestion to gauge its strength by a 

 determination of its bacteriotropic titer. Kraus and Doerr, in 

 the belief that the efficiency of the serum depends upon its content 

 of antitoxins, suggest its standardization upon this basis, in a manner 

 analogous to the standardization of diphtheria antitoxin, but it is 

 extremely doubtful whether these actually play an important role, 

 and the suggestion has hence not met with favor. Under these 

 circumstances it is apparent that the main stress must be placed 

 upon the duration of the immunizing process, possibly coupled with 

 a study of its bactericidal power in vivo, and its bacteriotropic effect. 



Dosage and Mode of Administration. From what has just been 

 said, it is clear that the dosage of the serum still rests upon an 

 empirical basis. As initial dose, Flexner recommends an injection 

 of 30 c.c., which may be repeated every twenty-four hours .for three 

 or four days or longer. All injections should be made into the sub- 

 arachnoid space, care being taken that the serum is introduced very 

 slowly, so as to cause no symptoms of pressure. It is hence best to 

 allow at least as much fluid to escape as it is desired to introduce. 



