562 INFECTION AND IMMUNITY. 



a minimum dilution activity of a 1 to 5,000 dilu- 

 tion of the antiserum is proposed." 



Flexner and Jobling conclude from a study of 

 serum, the spinal fluid, that the most important action 

 of the serum depends on bacteriolysis and 

 increased phagocytic action. They give the follow- 

 ing instructions for the use of the serum : 5 



"The antiserum should be kept in a refrigerator 

 until it is to be used, when it should be warmed 

 to the body temperature before it is injected. 



"The antiserum is to be introduced directty into 

 the spinal canal after the withdrawal of cerebro- 

 spinal fluid by means of lumbar puncture. 



"The quantity of antiserum to be used at a sin- 

 gle injection should not exceed for the present 

 30 c.c. It is desirable, although it would not 

 appear essential, to withdraw from the spinal canal 

 at least as much fluid as the amount of antiserum 

 to be injected. The injection should be made 

 slowly and carefully to avoid the production of 

 symptoms due to increased pressure. This pre- 

 caution should be exercised especially where the 

 quantity of cerebrospinal fluid withdrawn is less 

 than the amount of antiserum to be injected. 



"The injection of the antiserum should be 

 repeated every twenty-four hours for three or four 

 days or longer. Whether any advantage will be 

 gained by more frequent or more numerous injec- 

 tions than here indicated a wider experience must 

 decide. As much as 120 c.c. of the antiserum have 

 been injected into the spinal canal in four days 

 without causing unpleasant symptoms. 



"The evidence indicates that the earlier in the 

 course of the disease the injections are made the 



5. Flexner, S., and Jobling, J. W. : Jour. Exp. Med., 1908, 

 p. 190. 



