SERUM THERAPY 649 



The third horse is inoculated with toxins. Young agar cultures in Roux bottles 

 are washed off with sterile distilled water, shaken for 48 hours, O5 per cent, carbolic 

 acid added and the whole centrifuged. The supernatant liquid is toxic for guinea- 

 pigs in doses varying from 0*11 c.c. intra-peritoneally. The first inoculation for 

 the horse is a quantity equivalent to 10 times the fatal dose for a guinea-pig. The 

 horse is treated for a long time with sub-cutaneous inoculations of the toxic extracts 

 and afterwards by intra-venous inoculation ; great care has to be exercised in inocu- 

 lating these extracts since symptoms of anaphylaxis are not at all uncommon. 



The serum of the three horses is mixed in equal parts for therapeutic 

 purposes. 



C. Dopter immunizes horses solely by means of living cultures which are 

 inoculated first sub-cutaneously and later intra-venously. 



Properties of anti-meningococcal serum. The serums of animals immunized 

 by any of the above methods exhibit agglutinating, sensitizing, opsonizing 

 and precipitating properties. They possess undoubted therapeutic properties 

 in meningococcal cerebro-spinal meningitis but in no other forms of meningitis. 



Therapeutics. In meningococcal meningitis the serum should be inoculated 

 into the sub-arachnoidal space. Lumbar puncture is first performed and a 

 quantity of fluid let out equal to or rather greater than the volume of serum 

 to be inoculated : then, without withdrawing the needle a fairly large dose 

 of serum is inoculated slowly (20-40 c.c. for an adult, 15-20 c.c. for a young 

 child). The inoculation must be repeated twice, three times and even four 

 times at intervals of a few days, indications for the further use of the serum 

 being shown by the clinical symptoms and more especially by the appearance 

 of the cerebro-spinal fluid. When the latter becomes clear and limpid, and 

 the Meningococci have disappeared, and the pus cells are replaced by normal 

 poly-morpho-nuclear leucocytes or lymphocytes, no further administration 

 of serum is needed. 



5. Agglutination. 



The serum of persons suffering from meningococcal meningitis generally 

 agglutinates the Meningococcus in a dilution of 1 in 100 (Albrecht and Ghon : 

 Bettencourt and Franga). The agglutination would appear to be better 

 marked with the strain isolated from the patient than with strains recovered 

 from other sources (1 in 50). Antimeningococcal serum also agglutinates the 

 Meningococcus in dilutions of 1 in 200, 1 in 500 and even 1 in 1000. 



Note. The examination of the agglutination reaction is open to two sources 

 of error. 



I. The Meningococcus is not always agglutinated by specific serums. And 

 Kutscher observed that some strains never agglutinate at a temperature of 37 C., 

 but agglutinate very well when left at 55 C. for 24 hours : it is advisable therefore 

 when an organism has been isolated having the morphological appearances of the 

 Meningococcus but which does not agglutinate with a specific serum at 37 C. to test 

 the reaction at 55 C. 



H. Some closely related organisms are agglutinated by an antimeningococcal 

 serum. The Gonococcus is an interesting case in point. An antimeningococcal 

 serum will agglutinate both the Meningococcus and though more feebly the 

 Gonococcus, and conversely an antigonococcal serum will agglutinate the Meningo- 

 coccus as well as the Gonococcus. Dopter and Koch have however shown that if 

 an emulsion of the Meningococcus be added to an antimeningococcal serum it will 

 absorb the whole of the agglutinin while absorption with the Gonococcus will not 

 remove the agglutinin for the Meningococcus : if on the other hand an emulsion 

 of the Gonococcus be added to an antimeningococcal serum, and after the organism 

 is agglutinated the mixture be centrifuged, the clear supernatant fluid will agglutinate 

 the Meningococcus but will have no such action upon the Gonococcus. The anti- 

 meningococcal serum therefore contains specific agglutinins for the Meningococcus 

 and group agglutinins which act alike on the Meningococcus and on the Gonococcus. 



This experiment which demonstrates differences of a specific nature between the 



