SPECIAL SERUM THERAPY. 197 



basis for the anaphylactic phenomena. Other etiological factors, also come into con- 

 sideration; such as the increase of the sessile receptors with simultaneous absence or 

 marked diminution of free antibodies, and the absorption of the complement by the ambo- 

 ceptors, in vivo. 



Attempts have been made to employ the specificity of anaphylaxis for 

 diagnostic purposes, but as yet the results obtained do not justify the clinical 

 consideration of the methods. 



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 mentioned 

 sera are attained 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 towards them. Jochmann and Ruppel 

 assert that they have been successful in growing cultures extremely virulent for animals, 

 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 employed for 

 the titration 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 intraspinously, after a quantity 

 of spinal fluid has been withdrawn to relieve the pressure. In adults 20 to 40 

 c.c. and in children 10 to 2oc.c. are daily injected until either clinical improve- 

 ment or a fatal prognosis becomes manifest. It is advisable 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 older than three months 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, Rockefeller's Institute in 

 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 of the Essen epidemic are 

 especially instructive: 



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

 demic meningitis cases which occurred in Essen were: 



55 Cases with 29 Deaths =52.72% Mortality, 



