738 PASSIVE IMMUNIZATION SERUM THERAPY 



treatment. Of 1394 cases treated with serum during the Texas epi- 

 demic 1 (1912), the mortality was 37 per cent., as compared with a mor- 

 tality of 77 per cent, among 562 cases receiving no serum. 



Good results have been reported by many observers with Joch- 

 mann's, Kolle and Wassermann's, Ruppel's, Paltauf s, and Dopter's 

 serums, and the serums have been prepared by several commercial 

 biologic laboratories, so that the curative value of antimeningococcus 

 serum is definitely established. 



Nature of Meningococcus Meningitis. Bacteriologic and patho- 

 logic evidence indicates that the first stage of meningococcus meningitis 

 consists of a meningococcus bacteremia, the virulent meningococci 

 gaining access to the blood-stream through the upper air-passages. 

 Later the infection becomes localized in the spinal and cerebral meninges. 

 It is probable that the microorganism causes a primary nasopharyn- 

 gitis, and in some instances the meninges may be infected by direct 

 extension through the sphenoid and ethmoid sinuses. The main symp- 

 toms and lesions of the disease, and several of the complications, for 

 example, the paralyses, eye complications, deafness, hydrocephalus, 

 and mental disturbances, are probably directly due to suppuration of 

 the meninges, with involvement of accessory and motor nerve-roots, 

 meningeal irritation, and pressure from the accumulation of exudate 

 in the ventricles and subarachnoid space. Complications, such as 

 arthritis, pyelitis, endocarditis, adenitis, etc., are due to the bacteremia, 

 which may become chronic and be accompanied by deposits of menin- 

 gococci in the various tissues and organs. In addition to these com- 

 plications there is probably a varying degree of general toxemia, due to a 

 soluble toxin or endotoxin liberated through lysis of the cocci. 



Treatment of Epidemic Meningitis. Although cerebrospinal menin- 

 gitis may be considered primarily as a general infection, in the majority 

 of instances local suppuration of the meninges constitutes the main 

 lesion. For anatomic and physiologic reasons, however, it is impossible 

 to treat the disease according to the ordinary principles governing the 

 treatment of localized suppuration, as, for example, by continuous 

 drainage and by cleansing the affected parts with germicidal solutions. 

 Unaided, the leukocytes and body-fluids are generally unable to destroy 

 the cocci and terminate the infection before serious harm to important 

 nerves and nerve-centers has resulted, so that epidemic meningitis, with 

 a mortality of from 75 to 90 per cent., and followed by more or less 



* Sophian: Epidemic Cerebrospinal Meningitis, St. Louis, 1913. Report of Dr. 

 btemer, President of the Texas State Board of Health. 



