254 PASSIVE IMMUNIZATION 



As the best results are obtained in early cases (see below) every 

 effort should be made to reach a definite diagnosis as soon as possible, 

 and to this end spinal puncture is practically imperative. If this 

 reveals a turbid fluid the antiserum may be injected at once, the 

 microscopic and bacteriological examination being carried out later. 

 If this should prove that the case was not one of meningococcus 

 meningitis, no harm will have been done, while in the event of a 

 confirmatory diagnosis, valuable time will have been gained. The 

 appearance of the fluid at subsequent examinations, aside from 

 the physical condition of the patient, will then be a fairly good 

 index as to the necessity of repeating the injections. So long as 

 this is cloudy further treatment is needed. All in all it is better 

 to inject too much and too often than too little and too infrequently. 

 Late in the disease, however, when chronic hydrocephalus has 

 developed, the treatment is useless. 



The subcutaneous or intravenous use of the serum is to be depre- 

 cated, as the results following this method of administration are no 

 better than under the expectant plan of treatment. 



One question of great practical importance which has arisen in 

 connection with the serum treatment of meningococcus meningitis 

 is whether any danger due to anaphylaxis is to be anticipated from 

 the repeated injections, particularly since these are made into the 

 subarachnoid space and since Besredka has shown that the direct 

 injection of the alien serum into the central nervous system is par- 

 ticularly fatal to guinea-pigs. So far as we can tell, this danger is 

 really a negligible quantity, especially as the daily injections in the 

 early course of the treatment do not enter into consideration, and 

 the patient usually is beyond the need of serum by the time that 

 anaphylactic reactions would be expected to occur. But even in 

 cases where the injections were continued into this period, serious 

 symptoms have not been observed. 



Results. So far as the results of the serum treatment upon the 

 course of the disease are concerned, we have sufficient evidence to 

 show that through its introduction, one of the most fatal diseases, 

 and one of the most dangerous in its late effects, even in cases where 

 recovery has occurred, has lost some of its terrors. As regards its 

 effect upon the mortality, much depends upon the time at which 

 it is instituted. Of 241 cases which had thus been injected with 

 the Flexner serum during the first three days of the malady, only 



