266 PASSIVE IMMUNIZATION 



veins at the bend of the elbow, to which end a MacRae puncture 

 needle will be found most convenient, the blood being aspirated 

 directly into large tubes. The serum is allowed to separate out 

 overnight (in the ice-box), and the following morning is diluted to 

 40 per cent, with normal saline. At that time approximately 15 

 c.c. of spinal fluid are withdrawn and replaced by 30 c.c. of the 

 diluted serum, which has previously been heated for one-half hour 

 at 56 C. and then brought to the temperature of the body. The 

 patients are kept in bed for twenty-four hours, the foot end being 

 raised for about one hour following the treatment. 



After two or three weeks the injection is repeated and so on, 

 according to the symptoms of the individual case. As a rule there 

 is but little reaction after the injection, except in tabetics in whom 

 lightning pains may occur, or become more violent for a while, if 

 they previously existed. 



Results. Too little tune has elapsed since this method of treat- 

 ment was first advocated, and too small a number of patients has 

 as yet been treated to warrant any far-going conclusions. 



Swift and Ellis mention four tabetics, in whom the cell count in 

 the cerebrospinal fluid promptly fell to normal, while the globulins 

 decreased in amount much more rapidly than during the previous 

 treatment with salvarsan and mercury alone; at the same time the 

 Wassermann reaction in the spinal fluid became negative in two 

 of the patients, even when 0.5 c.c. of fluid was used in the test. 

 In two other patients, however, the treatment had little effect on 

 the Wassermann. 



As the writers suggest, future experience may show that the best 

 results may be obtained by further enforcing the beneficial effect 

 of the serum by the addition of neosalvarsan. They mention that 

 in one instance the patient received 0.5 milligram of the neosalvar- 

 san diluted with 12 c.c. of normal serum plus 18 c.c. of normal saline, 

 as a first injection, which was followed ten days later by one of 

 1 milligram, similarly diluted, without causing any undue reaction. 



Other writers who have followed the plan of treatment suggested 

 by Swift and Ellis have likewise noted a certain effect upon the 

 cell count, the globulin content, and at times also upon the Wasser- 

 mann, but it is doubtful whether any real good has as yet been 

 accomplished clinically. 



My own inclination in the treatment of these cases would be 



