MENINGOCOCCUS MENINGITIS 243 



with the diplococcus the microorganisms disappeared without 

 marked phagocytosis, though more slowly than in the cases in which 

 outpouring of leukocytes was considerable. 



Preparation of the Antimeningococcus Serum (according to Flexner 

 and Jobling) . Horses are first injected subcutaneously with cultures 

 of the diplococcus that have been heated for thirty minutes at 

 60 C., as many different strains being used collectively, as possible, 

 so as to give rise to a polyvalent serum. As first dose the equivalent 

 of a quarter surface test-tube growth on sheep-serum agar is recom- 

 mended. At each subsequent injection the dose is doubled until 

 an amount equal to four test-tube growths is given at intervals of 

 five to seven days. 



In the earlier work of Flexner and Jobling, intravenous inoculations 

 were then substituted for the subcutaneous, beginning with one dose 

 of living diplococci, the dose being progressively increased to two, 

 three, five, etc., oeses, then to one-half, three-quarters, one, two, 

 etc., agar slant cultures, and finally to one and a half bottles (12 oz. 

 Blake) of surface growth. As the larger injections caused very 

 severe reactions and alarming symptoms, they were discontinued, 

 and subcutaneous and intravenous injections of autolysates 1 sub- 

 stituted, the dose being gradually increased from 1 to 3 c.c. and 

 given about a week apart. Since the intravenous injections of the 

 autolysates, however, likewise produced quite serious symptoms, 

 they also were abandoned, and at present subcutaneous injections 

 only are recommended for the whole process of immunization, 

 living diplococci and autolysates being used alternately at intervals 

 of a week. The maximum dose of living organisms and of the auto- 

 lysates is one and one-half bottles. 



The process of immunization in Flexner's horses was continued 

 for a year or longer, before any of the serum was used for purposes 

 of treatment. 



Standardization. Unfortunately no method is at present avail- 

 able by which the curative or protective effect of the antimeningo- 

 coccus serum can be gauged other than by actual trial. Kolle 

 and Wassermann attempted to standardize their serum on the basis 

 of its content in complement binding antibodies, in the belief that 

 these were identical with the bacteriolytic amboceptors. This idea, 



1 Meningococci which have been allowed to undergo self-digestion. 



