MICROCOCCUS INTRACELLULARIS MENINGITIDIS 529 



homologous to the organisms found in the patient. This method is 

 impracticable on a large scale since so many types, shading into 

 each other, are possible in this disease. However, the method is 

 used to a considerable extent in France. 



As stated in the section on the manner of entrance of the menin- 

 gococci into the subarachnoid space, it is a question now under 

 discussion whether the organisms travel along the lymphatics to the 

 base of the skull directly, or whether bacteriemia precedes menin- 

 geal infection. It is well, always, in cases of early meningitis, to 

 take blood cultures. In taking blood cultures it is best to inoculate 

 hormone glucose broth flasks containing not less than 100 c.c. of 

 culture fluid and to make a number of glucose hormone agar plates 

 with varying amounts of blood. The presence of menmgococci in 

 the blood is, of course, an indication for intravenous as well as 

 intraspinous injection of serum, a procedure which is in our opinion 

 advisable in all cases, since it is quite likely that meningococcus 

 septicemia, constant or intermittent is a regular feature of the 

 pathology of the disease. 



Serum Therapy of Meningitis. During recent years, attempts 

 have been made to treat epidemic meningitis by injections, subcu- 

 taneous and intraspinous, of meningococcus-immune serum. Wasser- 

 mann, 37 in 1907, reported results of such treatment in one hundred 

 and two patients, with a recovery of 32.7 per cent. The serum, 

 manufactured by Wassermann and his associates, was obtained from 

 horses immunized with cultures of meningococcus and with toxic 

 meningococcus extracts. More recently Flexner and Jobling 38 have 

 used a similar serum in the United States with apparently excellent 

 results. The serum, in Flexner 's cases, as in the technique first 

 used by Jochmann, is injected intraspinously after a quantity of 

 spinal fluid had been withdrawn. The cases treated by Flexner 

 and Jobling 's method have now reached large numbers, both in 

 this and foreign countries and the value of the serum as a therapeutic 

 agent seems firmly established. 



The Serum. In America polyvalent serum is used almost 

 universally. Horses, as for other serum production, are the 

 animals employed. The cultures with which the horses are im- 

 munized must be many containing representatives of the normal 



37 Wassermann, Dent, med. Woch., 39, 1907. 



38 Flexner and Jobling, Jour. Exper. Med., x, 1908. 



