THERAPEUTIC IMMUNIZATION IN MAN 469 



merely by the use of larger quantities of immune sera essentially 

 similar to sera used at previous times, and Cole attributes the appar- 

 ently favorable results to the fact that the blood stream can be cleared 

 of bacteria although the focus cannot itself be affected. 



Cure of such diseases, therefore, by serum treatment can hardly 

 be expected. Favorable influence of the disease by energetic serum 

 treatment may, however, be hoped for. 



In discussing this subject it must not be forgotten, however, that 

 in most of the diseases which we have classified, on the basis of pre- 

 vailing opinions, as caused by bacteria that do not form true toxins, 

 the formation of such poisons has been claimed by a number of care- 

 ful and eminent observers. In the case of the typhoid bacillus, espe- 

 cially, Chantemesse, Kraus and Stenitzer, and others have claimed 

 the existence of a true toxin and a consequent antitoxin in immune 

 sera. Similar claims have been made for the cholera spirillum by 

 Kraus and Doerr, for the streptococcus by Marmorek, and for the 

 plague bacillus by Markl and Rowland. Since these claims have 

 been made on the basis of extensive experimentation by competent 

 men the question must be left open, and the possibility of antitoxic 

 properties on the part of the sera cannot be completely ignored. 

 Since in most cases, however, the poison-neutralizing properties of 

 the immune sera in this disease have not exceeded more than 1 to 2 

 multiples of the M L D of the bacterial poisons, it does not seem 

 impossible that the apparent antitoxic properties may have repre- 

 sented merely an acquired tolerance to anaphylatoxic poisons of 

 which we have spoken in another place. 



SERUM TREATMENT IN EPIDEMIC CEREBROSPINAL MENINGITIS 



Serious attempts to produce curative sera against the epidemic 

 form of cerebrospinal meningitis were not made until 1906 and 

 1907, when this disease appeared epidemically chiefly in Europe, 

 where it appeared most severely in Eastern Germany, and in the 

 Eastern United States. 



In 1906 Kolle and Wassermann immunized three horses with 

 meningococci, using for immunization purposes the dead organisms 

 followed by living cultures and cultures shaken up in distilled water, 

 the so-called artificial aggressins of Wassermann and Citron. They 

 obtained sera of considerable potency when measured against menin- 

 gococcus cultures, and suggested standardizing the sera by comple- 

 ment fixation. They did not at this time treat human beings, but sug- 

 gested the use of the serum subcutaneously and intravenously in 

 meningitis cases. Very soon after the publication of the work of 

 Kolle and Wassermann Jochmann 43 also produced an antimeningo- 



43 Jochmann. Deutsche med. Woch., 1906, Vol. 32, p. 788. 



