838 SERUM THERAPY 



Cummer, 1 Walker and Haller 2 on the treatment of a number of cases of 

 tabes dorsalis, paresis, and other syphilitic infections of the central nervous 

 system showed that this method of treatment possesses distinct value. 

 Cutting and Mack, 3 Myerson, 4 and Mapother and Beaton 5 have reported 

 unfavorable or indifferent results. Intraspinal injections were advocated 

 by Swift and Ellis in the treatment of these diseases as an adjuvant to 

 intravenous injections of salvarsan, as a part of an intensive medi- 

 cation aiming to bring salvarsan into intimate contact with the para- 

 sites in the most direct and safest manner. While this form of treat- 

 ment has, in a large percentage of cases, effected a marked improve- 

 ment in the subjective symptoms and has modified the underlying 

 pathologic tissue changes, as evidenced by the disappearance or im- 

 provement of objective signs and serobiologic findings in the cere- 

 brospinal fluid, it must still be considered in the experimental stage, 

 for sufficient time has not yet elapsed to permit an estimate of its ulti- 

 mate effect to be made. It is especially indicated in early and incip- 

 ient cases of syphilitic infections of the nervous system. It is self-evident 

 that it cannot be expected to cure cases in which marked tissue destruc- 

 tion has occurred, but if it serves to cure early and incipient cases of 

 tabes and paresis, or at least tends to arrest their progress and possibly 

 the further progress of more chronic cases, and gives symptomatic 

 relief, then this mode of therapy is a valuable one. At present it is ap- 

 parent that, in the hands of careful and competent persons, and with the 

 strict observance of the original technic, the method is relatively devoid 

 of danger and constitutes a new, rational, and valuable addition to the 

 treatment of diseases that may otherwise prove intractable to the ordin- 

 ary antisyphilitic measures. 



Technic. From 0.6 to 0.9 gm. of salvarsan or neosalvarsan is in- 

 jected intravenously. One hour later 40 c.c. of blood are withdrawn 

 directly into centrifuge tubes and allowed to coagulate, after which it may 

 be centrifugalized. The following day 12 c.c. of serum are pipeted off and 

 diluted with 18 c.c. of sterile normal salt solution. This 40 per cent, 

 serum is then heated at 56 C. for one-half hour. After lumbar puncture 

 the cerebrospinal fluid is withdrawn until the pressure is reduced to 

 30 mm. cerebrospinal fluid pressure. The barrel of a 20 c.c. Luer syr- 

 inge (which has a capacity of about 30 c.c.) is attached to the needle by 

 means of a rubber tube about 40 cm. long. The tubing is allowed to fill 



1 Archiv. Int. Med., 1916, xvii, 82. 



2 Archiv. Int. Med., 1916, xviii, 376. 



3 Jour. Amer. Med. Assoc., 1914, Ixvii, 903. 



4 Boston Med. and Surg. Jour., May 7, 1914. 



5 The Lancet, London, 1914, clxxxvi, 1103. 



