EMPLOYMENT OF BLOOD SERUM 265 



cently treated two cases of cerebrospinal meningitis with fairly good 

 results. Hodenpyl treated a case of carcinoma with the patient's own 

 ascitic fluid with apparent success. He used this fluid in large quanti- 

 ties in a number of cases but only with transient success. Risley also 

 applied this method of treatment in sixty-five cases of cancer, using 

 ascitic fluid from cancer cases and also other body fluids from non- 

 cancerous cases. No encouragement for this method has been found 

 in experimentally inoculated mouse cancers and the subsequent history 

 of Hodenpyl's cases showed no permanent improvement. Auto-serum 

 therapy has further been applied in obstinate and chronic skin troubles, 

 such as psoriasis, dermatitis herpetiformis, pemphigus, lichen ruber, 

 lichen planus, urticaria and squamous eczema. The serum is used in 

 doses of 30 to 40 c.c. and repeated from two to six times at intervals 

 of from three to five days. 



Auto-serum Therapy in Syphilis. Perhaps the most widely 

 used auto-serum therapy is the salvarsanized auto-serum in the 

 treatment of parasyphilis. The treatment of syphilis of the ner- 

 vous system with salvarsan or neosalvarsan alone has not given 

 the results expected. This is because the choroid plexus filters 

 out these compounds, preventing their entry into the cerebrospinal 

 fluid. It has been shown by Plaut that the serum of patients who have 

 received salvarsan possesses antisyphilitic power, while normal serum 

 fails to display this characteristic. Similarly Meirowsky and Hart- 

 mann and Gibbs and Calthrop obtained good results in the subcutaneous 

 treatment of lues with serum of salvarsanized patients. According to 

 Swift and Ellis, salvarsanized serum inhibits the treponema more in- 

 tensively if heated to 56 C. for half an hour. These facts formed the 

 underlying principles for the treatment of late syphilis with salvarsan- 

 ized serum. Swift and Ellis injected salvarsanized serum intrathecally 

 in a number of cases of tabes dorsalis and in other manifestations of 

 neurosyphilis, and reported most encouraging results in both clinical 

 and immunological manifestations. This work has since been confirmed 

 by a large number of authors. The treatment is of special value in the 

 earlier stages of neurosyphilis. Unfavorable results have been ob- 

 served, as for instance the spasmodic retention of urine. As a result 

 of long standing of the salvarsanized serum prior to its use, the drug 

 may become oxidized with a marked increase in toxicity. 



Method of Treatment. Six-tenths to nine-tenths gram of salvar- 

 san or neosalvarsan is injected intravenously. One hour later 40 c.c. of 

 the patient's blood is withdrawn, allowed to coagulate and centrifuged. 

 Twelve cubic centimetres of the sterile serum is diluted with 18 c.c. of 

 sterile physiological salt solution to make it a 40 per cent, dilution and 

 heated for half an hour at 56 C. A lumbar puncture is then per- 

 formed, and 25 to 30 c.c. of fluid is withdrawn, and the serum very 

 slowly injected. Swift and Ellis recommend the gravitation method of 

 injection to prevent a sudden increase in intrathecal pressure. The 

 patient is then kept in bed for twenty-four hours and the foot of the 

 bed elevated for part of this time. The reaction is usually of a mild 



