EMPLOYMENT OF BLOOD SERUM 255 



serum follows intrathecal administration, and in 1907 successfully 

 applied serum treatment of the disease during an epidemic in Akron, 

 Ohio. The following table, taken from Worster, Drought and Mills 

 Kennedy, " Cerebrospinal Fever," London, 1919, gives the results ob- 

 tained by several investigators. 



No. c Serum Cases not 



Author of treated * i, m treated treated with 



cases mortality serum mortality 



Flexner . . 1294 (collected) Flexner 30.9% 70% 



Netter 



Dunn . 



Robb . 



Dopter 



ioo Flexner 28.0% 49% 



40 Flexner 22.5% 70% 



300 =*= Flexner 30.0% 72% 



402 Dopter 16.4% 65% 



Levy 165 [ v^ssermann } l8 ' 8 ^ 52 % 



Steiner . . . 2280 (collected) 37 .0% 77% 



Schoene . . 30 Jochmann 30.0% 53% 



Although many English investigators have been successful in the use 

 of anti-meningococcus serum, several experienced men have advised 

 against its use. This is largely because of the fact that Gordon, Ellis 

 and others have demonstrated several types or groups of the meningo- 

 coccus, and it is believed that sera should be prepared against each 

 type in order to obtain the best results. Rolleston has compiled the 

 following table of results with various types of anti-meningococcus sera : 



Brand of serum Mortality Recoveries 



Flexner 22.3 per cent. 77.7 per cent. 



Gordon 18.7 per cent. 81.3 per cent. 



Pasteur Institute 44.5 per cent. 55.5 per cent. 



Burroughs-Wellcome ... 33.3 per cent. 66.7 per cent. 



Mulford 50.0 per cent. 50.0 per cent. 



Lister Institute 54.5 per cent. 45.5 per cent. 



Gordon's and Flexner' s sera have so far given the best results. It 

 is advisable to test the agglutinative power of a serum prior to its use, 

 using a strain freshly isolated during the epidemic. The serum should 

 agglutinate the organism in a dilution of at least one to five hundred. 

 The lack of a definite potency standard makes it impossible to judge 

 accurately the value of any given serum. As in diphtheria and other 

 diseases, the early use of serum is of the greatest importance. Flexner 

 found that if the serum was given in the first three days the mortality 

 was 1 8 per cent., if given from the fourth to the seventh day it was 

 27 per cent., and if given later 36.5 per cent. Similar figures were 

 obtained by Rolleston, Gray, Robb and Worster-Drought. If neces- 

 sary, the injections should be repeated. According to Park, it is advis- 

 able to give not less than four daily injections unless the case is already 

 convalescent when it comes under observation. If the organisms or 

 symptoms do not disappear, the injections of 10 c.c. to 25 c.c. of serum 

 should be continued for many days. Finally, as a result of army experi- 

 ence, Herrick believes that the disease is in most if not all cases a 

 general bloodstream infection with secondary meningeal involvement 

 and therefore advises the use of large doses of anti-meningococcus 

 serum intravenously as soon as the diagnosis is made in addition to 



