AUTOSERUM THERAPY 841 



authors were led to use the method, however, on the basis of the investi- 

 gations of Adler, 1 Hall, 2 Swift, 3 Camp, 4 and others, indicating that no 

 arsenic or only mere traces appear in the cerebrospinal fluid after the 

 intravenous injection of salvarsan. The method has also been criticized 

 on the basis of the small amount of arsenic injected intraspinally; 

 Draper, 5 Swift, 6 and Adler 7 have shown, however, that blood drawn 

 a short time after r the intravenous injection of salvarsan contains a 

 definite although minute amount of salvarsan. It would appear, 

 therefore, that in this method of treatment salvarsan is introduced 

 directly into the cerebrospinal fluid. Beneficial effects may also 

 be due to the withdrawal of the cerebrospinal fluid with consequent 

 increased exudation into the subarachnoid space of serous products 

 from the blood-vessels of the meninges. Furthermore, as shown by 

 Flexner and Amoss, 8 the intraspinal injection of most any fluid, as 

 sterile salt solution or normal serum, results in an aseptic meningitis 

 and increasing the permeability of the choroid plexus and meninges, 

 and in this manner the salvarsan injected intravenously may be brought 

 into the cerebrospinal fluid, the intraspinal injection serving primarily 

 to excite the aseptic meningitis, although the experiments of Stillman 

 and Swift 9 showed that this probability is rather remote. 



AUTOSERUM IN THE TREATMENT OF TUBERCULOSIS OF SEROUS MEMBRANES 



Numerous investigators, as, for example, Gilbert, 10 Marcon, 11 

 Schnutgen, 12 Fishberg, 13 Pfender, 14 Robertson, 15 and others, have reported 

 favorable results in the treatment of tuberculous pleurisy with effusion, 

 cases that arise either insidiously or abruptly with pain in one already 

 tuberculous, or in one in whom tuberculosis is suspected, following 

 withdrawal of a portion of the fluid and immediate injection of from 2 

 to 5 c.c. into the subcutaneous tissues. In these cases there is usually 

 a sharp reaction, consisting of a rise in temperature, occasionally ac- 



1 Boston Med. and Surg. Jour., 1914, clxxi, 900. 



2 Jour. Amer. Med. Assoc., 1915, Ixiv, 1384. 



3 Jour. Amer. Med. Assoc., 1915, Ixv, 209. 



4 The Lancet-Clinic, 1915, cxiii, 116. 



5 Archiv. Int. Hed., 1915, xv, 16. 



6 Loc. cit. 7 Loc. cit. 



8 Jour. Exper. Med., 1917, xxv, 499 and 525. 



9 Jour. Exper. Med., 1915, xxii, 286. "> Gaz. des Hopit., 1894, 560. 



11 La Presse Medicale, 1909, No. 71, 627. 



12 Berl. klin. Wochenschr., 1909, No. 3, 97. 



13 Jour. Amer. Med. Assoc., 1913, Ix, 962. 



14 Wash. Med. Ann., 1914, xiii, 83. l5 Personal communication. 



