MENINGOCOCCUS MENINGITIS 245 



The subcutaneous or intravenous use of the serum is to be depre- 

 cated, as the results following this method of administration are no 

 better than under the expectant plan of treatment. 



One question of great practical importance which has arisen in 

 connection with the serum treatment of meningococcus meningitis is 

 whether any danger due to anaphylaxis is to be anticipated from the 

 repeated injections, particularly since these are made into the sub- 

 arachnoid space and since Besredka has shown that the direct in- 

 jection of the alien serum into the central nervous system is par- 

 ticularly fatal to guinea-pigs. So far as we can tell, this danger is 

 really a negligible quantity, especially as the daily injections in the 

 early course of the treatment do not enter into consideration, and 

 the patient usually is beyond the need of serum by the time that 

 anaphylactic reactions would be expected to occur. But even in 

 cases where the injections were continued into this period, serious 

 symptoms have not been observed. 



Results. So far as the results of the serum treatment upon the 

 course of the disease are concerned, we have sufficient evidence to 

 show that through its introduction, one of the most fatal diseases, 

 and one of the most dangerous in its late effects, even in cases where 

 recovery has occurred, has lost some of its terrors. As regards its 

 effect upon the mortality, much depends upon the time at which 

 it is instituted. Of 241 cases which had thus been injected with 

 the Flexner serum during the first three days of the malady, only 

 25.3 per cent, died, while a delay of from one to four days beyond 

 this period increased the death rate to 27.8 per cent., and a still 

 further delay to 42.1 per cent. The general death-rate of 712 treated 

 cases was 31.4 per cent., as contrasted with the usual mortality of 

 from 53 to 90 per cent. By eliminating all those cases where the 

 patients were first seen in an already hopeless condition, but injected 

 nevertheless, Flexner calculated an average mortality of 25.4 per 

 cent. Similar results have been reached with the sera prepared by 

 Wassermann, Jochmann, and Dopter. The latter claims an average 

 mortality of only 16.47 per cent. (402 cases) for his serum, as con- 

 trasted with one of 65 per cent, in untreated cases; Schone one of 

 27 per cent, for Jochmann's serum (in a relatively small number 

 of cases), and Dopter one of 18.35 per cent. (158 cases) for that of 

 Wassermann. 



The immediate effect upon the malady is also quite favorable; 



