THE MENINGOCOCCUS GROUP 297 



among individuals residing in areas where but few sporadic cases 

 have been reported. The percentage of positive examinations varies 

 considerably. Dieudonne 1 found about 12 per cent, of normal soldiers 

 in a garrison at Munich, where an outbreak occurred, gave positive 

 cultures from the nasopharynx. Bruns and Hohn 2 found 465 carriers 

 among 3154 healthy individuals in a community where the disease 

 was epidemic. They also found the percentage of carriers was great- 

 est when the epidemic was at its height. Usually these carriers are 

 temporary carriers; smaller numbers become permanent carriers or 

 periodic carriers. 3 



Serum Therapy. Many attempts have been made to prepare sera 

 for the treatment of epidemic cerebrospinal meningitis, and two 

 preparations have stood the test of actual practice, Kolle and Wasser- 

 mann's 4 serum and the serum prepared by Flexner and Jobling. The 

 method of immunization adopted by Flexner and Jobling appears 

 from available data to be essentially that of Wassermann. It is as 

 follows: horses- are injected subcutaneously, first with dead cultures 

 of meningococci, secondly with live cultures, and finally with auto- 

 ly sates of cultures. The latter are prepared by suspending virulent 

 meningococci in sterile water for two days at 37 C. and injecting 

 the supernatant fluid. The serum thus produced appears to combine 

 phagocytic properties, increasing the destruction of the organisms by 

 leukocytes; bacteriolytic properties, killing and dissolving the cocci, 

 and possibly some antitoxic properties as well. It is essential, as 

 Flexner has pointed out, to inject the serum directly into the spinal 

 canal. This is accomplished by lumbar puncture. The turbid spinal 

 fluid is allowed to escape through the needle with which the puncture 

 is made until symptoms of intercranial pressure are reduced. An 

 additional amount of fluid is then withdrawn to make way for the 

 serum which is injected directly, 15 to 20 c.c. for young children and 

 20 to 40 c.c. for adults. The treatment is repeated from two to several 

 times, until the spinal fluid is clear and has a normal appearance and 

 cellular content. The serum must be used early in the disease to 

 obtain the best results. Flexner and Jobling 5 have analyzed 328 

 cases with the following mortality : 



Per cent. 



Injection during first to third day of disease mortality 19.9 



Injection during fourth to seventh day of disease .... mortality 22.0 

 Injection after seventh day of disease mortality 36.4 



i Loc. cit. 2 Klin. Jahrb., 1908, xviii, 285. 



3 Mayer and Waldmann, Munch, med. Wchnschr., 1910, 475. Mayer, Waldmann, 

 Furst and Gruber, Miinchen. med. Wchnschr., 1910, 1584. 



4 Deut. med. Wchnschr., 1906. 5 Jour. Am. Med. Assn., 1908, li, No. 4. 



