PRACTICAL APPLICATIONS 373 



gococci, and this power is increased in meningitis. He states, 

 however, that the opsonic power of the blood was not altered 

 during the disease. 



The treatment differs in the acute and chronic stages. In the 

 very acute cases the only hope appears to be in the use of 

 a serum, coupled of course with the more ordinary remedial 

 measures, such as repeated lumbar puncture. This probably acts by 

 removing the inert cerebro-spinal fluid (which is almost deficient 

 both in opsonin and in complement), and causing the exudation 

 of fluid containing a larger amount of protective substances. In 

 more chronic cases, and especially in posterior basic meningitis, 

 the use of vaccines, either alone or in conjunction with serum, is 

 more promising. 



Several sera have been prepared Kolle and Wassermann's, 

 Jochmann's, Ruppel's, Flexner's,and Burroughs and Wellcome's 

 and very diverse reports have been published concerning their 

 value. Small differences exist in the methods of preparation, 

 but in all cases large doses of organisms, dead or living, are 

 injected, either subcutaneously or into the veins. The potency of 

 the serum is tested either by agglutination or by the absorption of 

 complement. According to Houston and Rankin, some of the 

 therapeutic sera in common use have very slight opsonic 

 power and are devoid of agglutinating properties. It seems quite 

 clear that the serum is useless if given hypodermically, and the 

 observers who have obtained beneficial results (Flexner, Levy, 

 and others) have injected the serum into the spinal canal after 

 removing an equal amount of cerebro-spinal fluid by lumbar 

 puncture. The dose is 20 to 30 c.c., repeated several times at 

 intervals of twenty-four hours. Some patients (adults) have 

 received as much as 340 c.c. The injections may cause vomiting 

 and unconsciousness, but no permanent inconvenience ; they are 

 painful, and this is attributed to the use of carbolic acid as a 

 preservative agent. The treatment must be commenced early, 

 and in view of the results of Levy, in whose practice the deaths fell 

 from 78-57 per cent, to 6-25 per cent., and Flexner, who reduced 

 the mortality to 20 per cent., seems to be of decided value. Other 

 observers have, however, been less successful. 



The use of serum from convalescent cases of meningitis (which 

 they find to possess marked bactericidal properties) has been 

 suggested by MacKenzie and Martin. The blood is collected by 

 venesection, whipped, and centrifugalized, and the serum used 



