828 PASSIVE IMMUNIZATION SERUM THERAPY 



Physicians have usually administered the serum by intraspinal injec- 

 tion, but the experiments of Flexner and Amoss 1 ascertained that an 

 aseptic meningitis set up by an intraspinal injection of any serum per- 

 mits the passage of immunity principles from the blood into the cere- 

 brospinal fluid. Therefore the intravenous injection of serum may 

 influence the course of the disease. In the serum treatment of epidemic 

 poliomyelitis Amoss and Chesney state that the following conditions 

 should be observed: (1) Early and prompt diagnosis and treatment; (2) 

 intraspinal injection of immune serum; (3) intravenous or intramuscular 

 injection of immune serum; (4) the serum employed should be collected 

 from cases which have recently passed through an attack of poliomye- 

 litis, as it is to be supposed that the serum will contain a greater amount 

 of immune principles in this early period than after the lapse of many 

 years. The use of serum from recently recovered persons otherwise 

 healthy involves no risk in transferring the microorganism of poliomye- 

 litis, as the virus has never been detected in the circulating blood of 

 human beings even in the first days of the disease. 



Blood should be collected under aseptic precautions and the serum 

 separated, submitted to the Wassermann test, cultured for sterility, and 

 kept in a cold place preferably without the addition of a preservative. 

 The addition of 0.2 per cent, tricresol does not impair the curative power. 

 In children 10 to 20 c.c. of serum may be injected intraspinally, and 

 20 to 30 c.c. intramuscularly or intravenously. Adults should receive 

 larger doses. If given before the onset of paralysis one injection may be 

 sufficient; in cases in which some degree of paralysis develops soon 

 after the injection, reinjection twelve to twenty-four hours later may be 

 advantageous. 



If normal human serum is employed it should be injected intra- 

 spinally; the good effects occasionally observed may be due to the aseptic 

 meningitis produced with consequent increased permeability of the 

 choroid plexus, and the passage into the cerebrospinal fluid of immunity 

 principles from the blood. 



Pneumonia. Weissbecker, 2 Huber and Blumenthal, 3 and others 

 have employed convalescent serum in the treatment of lobar pneu- 

 monia with apparently encouraging results. If this form of therapy 

 is employed it is necessary to ascertain the serologic type of the pneu- 

 mococcus producing the pneumonia in both donor and recipient and 

 use the homologous serum. 



1 Jour. Exper. Med., 1914, xx, 249; ibid., 1917, xxv, 499. 



2 Ztsch. f. klin. Med., 1896, xxx, 312; ilrid., 1897, xxxii, 188. 



3 Berl. klin. Wchnschr., 1897, xxxiv, 671. 



