MENINGOCOCCUS MENINGITIS 235 



WITO tluMi substituted for the subcutaneous, beginning with one dose 

 of living diploeocci, the dose being progressively increased to two, 

 three, five, etc., oeses, then to one-half, three-quarters, one, two, 

 etc., agar slant cultures, and finally to one and a half bottles (12 oz. 

 Blake) of surface growth. As the larger injections caused very 

 severe reactions and alarming symptoms, they were discontinued, 

 and subcutaneous and intravenous injections of autolysates 1 sub- 

 stituted, the dose being gradually increased from 1 to 3 c.c. 

 and given about a week apart. Since the intravenous injections 

 of the autolysates, however, likewise produced quite serious symp- 

 toms, they also were abandoned, and at present subcutaneous 

 injections only are recommended for the whole process of immuni- 

 zation, living diploeocei and autolysates being used alternately 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, 

 however, 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 

 1 Meningococci which have been allowed to undergo self-digestion. 



