778 SERUM THERAPY 



biologic findings in the cerebrospinal fluids. Subsequent reports by 

 Hough, 1 McCaskey, 2 Riggs, 3 Cutting and Mack, 4 Eskucken, 5 Boggs 

 and Snowden, 6 and Mapothes and Beaton 7 of a number of cases of 

 tabes dorsalis, paresis, and other syphilitic infections of the central 

 nervous system showed that this method of treatment possesses dis- 

 tinct value. It was advocated by Swift and. Ellis in the treatment of 

 these diseases as an adjuvant to intravenous injections of salvarsan, as 

 a part of an intensive medication aiming to bring salvarsan into intimate 

 contact with the parasites in the most direct and safest manner. While 

 this form of treatment has, in a large percentage of cases, effected a 

 marked improvement in the subjective symptoms and has modified the 

 underlying pathologic tissue changes, as evidenced by the disappearance 

 or improvement of objective signs and serobiologic findings in the 

 cerebrospinal fluid, it must still be considered in the experimental stage, 

 for sufficient time has not yet elapsed to permit an estimate of its ulti- 

 mate effect to be made. It is especially indicated in early and inci- 

 pient cases of syphilitic infections of the nervous system. It is self- 

 evident that it cannot be expected to cure cases in which marked tissue 

 destruction has occurred, but if it serves to cure early and incipient cases 

 of tabes and paresis, or at least tends to arrest their progress and possibly 

 the further progress of more chronic cases, and gives symptomatic re- 

 lief, then this mode of therapy is a valuable one. At present it is ap- 

 parent that, in the hands of careful and competent persons, and with the 

 strict observance of an aseptic technic, the method is relatively devoid 

 of danger and constitutes a new, rational, and valuable addition to the 

 treatment of diseases that may otherwise prove intractable to the ordin- 

 ary antisyphilitic measures. 



Technic. From 0.6 to 0.9 gm. of salvarsan or neosalvarsan is in- 

 jected intravenously. One hour later 40 c.c. of blood are withdrawn 

 directly into centrifuge tubes and allowed to coagulate, after which it may 

 be centrifugalized. The following day 12 c.c. of serum are pipeted off and 

 diluted with 18 c.c. of sterile normal salt solution. This 40 per cent, 

 serum is then heated at 56 C. for one-half hour. After lumbar puncture 

 the cerebrospinal fluid is withdrawn until the pressure is reduced to 

 30 mm. cerebrospinal fluid pressure. The barrel of a 20 c.c. Luer syr- 



1 Jour. Amer. Med. Assoc., 1914, Ixii, 183. 



2 Jour. Amer. Med. Assoc., 1914, Ixii, 187. 



3 Jour. Amer. Med. Assoc., 1914, Ixii, 1888. 



4 Jour. Amer. Med. Assoc., 1914, Ixvii, 903. 



6 Munch, med. Wochenschr., 1914, li, No. 14. 



6 Arch. Int. Med., 1914, xiii, 970. * Lancet, London, April, 1914, 18, 1. 



