472 INFECTION AND RESISTANCE 



coccus serum by immunizing horses with proved meningococcus cul- 

 tures, in his cases making a polyvalent serum by the use of many 

 different strains of the organism. The sera which he obtained were 

 highly agglutinating, somewhat bactericidal, and, according to him, 

 not antitoxic. He first succeeded in immunizing guinea pigs against 

 meningococci by injecting the serum 20 hours before infecting the 

 animals. He also treated 40 cases of meningitis in man and ob- 

 tained encouraging results in cases treated before the development of 

 hydrocephalus. Believing that possibly intraspinous injection of the 

 serum might offer advantages, he first determined by experiments 

 upon the dead body that the injection of methylene-blue intra- 

 spinously passed from the point of injection in the lumbar regions as 

 far up as the olfactory nerves. After having determined this he 

 treated 17 cases by tapping the spinal canal, taking out 30 to 50 c. c. 

 of spinal fluid and then injecting about 20 c. c. of the serum. Of 

 these 17 cases only 5 died, and Jochmann expresses himself opti- 

 mistically in consequence. 



Meanwhile Flexner 44 had been working upon the same subject, 

 laying a rather more thorough basis for therapy in careful animal 

 experimentation. He produced the typical disease in monkeys by 

 intraspinous inoculation of the meningococci and then saved the 

 animals from death by following the infection with the injection of 

 serum intraspinously six hours later. In his earlier articles he ex- 

 presses himself with much conservatism, but his studies were con- 

 tinued and extensive opportunity for testing the serum which he then 

 produced, together with Jobling, 45 was offered by the continuance of 

 the epidemic throughout the United States. 



The results with the serum produced at the Rockefeller Institute 

 have since then proved to be uniformly favorable. The method of 

 intraspinous inoculation of the serum after the removal of some of 

 the spinal fluid was the method finally adopted by Flexner as most 

 favorable, and this is the method in current use to-day. In 1908 

 Flexner and Jobling reported upon 47 cases treated with the anti- 

 serum of which 34 recovered. Of 12 additional cases reported in an 

 addendum only 4 died. In the most recent summary by Flex- 

 ner 46 records of 1,294 cases that have been treated with the serum 

 prepared at the Rockefeller Institute are analyzed. Of this num- 

 ber, unselected and treated in many different parts of the world, 

 69.1 per cent, recovered. It is of course very difficult to obtain 

 exact comparative data on the efficiency of any method of treatment 

 in a disease as irregular in its clinical manifestations as epidemic 

 meningitis, especially since the mortality attending upon different 



44 Flexner. J. Exp. Med., Vol. 9, 1907, and /. A. M. A., 1906, Vol. 47, p. 

 560. 



45 Flexner and Jobling. J. Exp. Med., Vol. 10, 1908. 



46 Flexner. J. Exp. Med., Vol. 17, 1913. 



