THE SERUM TREATMENT OF INFLUENZAL MENINGITIS 749 



Passive immunization by means of the subcutaneous injection of 

 antimeningitic serum was advised by Jochmann in 1906, but has not 

 come into general use. The immunity resulting from the injection of 

 from 10 to 20 c.c. of serum is only temporary, and probably lasts about 

 a month. Another drawback is the resulting serum sensitization, which 

 renders subsequent injections of serum more likely to be followed by 

 serum sickness. In the presence of an active epidemic, such as that 

 which occurred in Texas during 1912, immediate passive immunization 

 of physicians, nurses, and attendants by the subcutaneous injection of 

 15 c.c. of serum, followed by active immunization with three doses of 

 vaccine (500, 1000, and 1000 millions) at intervals of a week, may be 

 advisable. While there are no available statistics to prove the value of 

 this procedure, it is, at least, a rational one, and since there is danger of 

 contracting the disease, especially after prolonged contact, physicians 

 should practise immunization during epidemics of this dreaded disease. 

 In mixed passive and active immunization the serum probably affords 

 immediate protection, and tides over any temporary negative phase or 

 period of lowered resistance following the injections of vaccine. 



THE SERUM TREATMENT OF INFLUENZAL MENINGITIS 

 Since lumbar puncture as an aid to the diagnosis of meningitis is 

 coming into more general use, the important fact has been revealed that 

 the influenza bacillus is not an infrequent cause of severe, and usually 

 fatal, seropurulent cerebrospina"! meningitis. In 1911 Wollstein 1 col- 

 lected 58 cases of this infection, all but 6 ending fatally, and as the bac- 

 terial diagnosis of meningitis is becoming more widely known and more 

 commonly employed, the number of reported cases is increasing rapidly. 

 The mortality of 90 per cent., which is exceeded only by the tuberculous 

 and pneumococcus infections of the meninges, and the encouraging re- 

 sults following the use of a specific anti-influenzal serum in experimental 

 infections in monkeys, render this subject one of great importance from 

 the standpoint of serum therapy. 



Influenzal Meningitis. Like the acute meningeal infections in 

 general, influenzal meningitis is more prevalent among children than 

 among adults. 



Infection of the meninges is probably always secondary to infection 

 of the respiratory tract with virulent influenza bacilli, the route of in- 

 fection being chiefly through the blood-current. Direct infection from 

 1 Jour. Exper. Med., 1911, xiv, 73; Amer. Jour. Dis. Child., 1911, i, 42. 



