234 PASSIVE IMMUNIZATION 



Special Serum Therapy. 



i. Meningococcus Serum. Numerous investigators have attempted the 



Meningococ- production of an immune serum for man, among these Jochmann, the 



cus Immune Berlin Institute for infectious diseases, Ruppel, Kraus, Flexner and 



Serum. Jobling, and others. The sera of Jochmann (Merck) and Ruppel 



(Hochst) are produced by immunization of horses with meningococci 

 which are at first employed in dead, and later in live form. The other sera mentioned 

 are obtained by immunization with bacterial extracts or bacterial extracts plus full 

 bacteria, and therefore contain agglutinins, precipitins, bacteriotropins, amboceptors 

 and antiendotoxins. It is difficult to test the efficiency of these sera in animals, as the 

 meningococci vary greatly in their virulence toward them. Jochmann and Ruppel 

 assert that they have been successful in growing cultures extremely virulent for ani- 

 mals which they employed for the titration of the therapeutic value of the serum. In 

 the institute for infectious diseases, the method of complement fixation is taken as 

 the index of the therapeutic value of the serum. This procedure is very unreliable. 

 The protection of the serum in mice against the meningococcus endotoxin as well as 

 the demonstration of the bacteriotropic action of the serum is far more significant. 



In man, the immune serum is injected subdurally, after a quantity 

 of spinal fluid has been withdrawn to relieve the pressure. In adults 20 to 

 40 c.cm. and in children 10 to 20 c.cm. are daily injected until there is 

 clinical improvement or a fatal prognosis becomes inevitable. It is ad- 

 visable to precede the serum inoculation by a morphine injection, and to 

 elevate the pelvis for eight to twelve hours after the inoculation. The 

 earlier the serum therapy is instituted, the more favorable are its results. 

 Subcutaneous applications of the serum or employment of a serum more 

 than three months old is absolutely of no use. 



Both in the United States and in foreign countries the value of the serum as a thera- 

 peutic agent seems fairly established. In Germany, the serum is obtained gratis at 

 the institute for infectious diseases at Berlin. The serum in Switzerland is distributed 

 by the serum institute of Bern (Kolle). In the United States, the Rockefeller Institute 

 of New York first conducted its dispensation, but now it is under the supervision of the 

 New York Board of Health. 



Numerous statistics can be cited exemplifying the good results of the serum. The 

 following figures given by Levy describing the experiences in the Essen epidemic are 

 especially instructive : 



From the first of January until the first of November, 1907, the total number of 

 epidemic meningitis cases which occurred in Essen were: 



55 cases with 29 deaths = 5 2.72% mortality, 

 of these, treatment was given outside of the barracks to 



15 cases with 12 deaths = 80% mortality, 

 inside the barracks were treated 



40 cases with 17 deaths =4 2. 5% mortality, 

 of these 



14 cases were not treated with serum with n deaths as a result 

 = 78.6% mortality, 



