umber 
cases. 
Recovered. 
Died. 
Per cent, 
died. 
199 
163 
36 
18.1 
346 
252 
94 
27.2 
666 
423 
243 
36.5 
338 MENINGOCOCCI! S^GONOCOCCUS—C A TARR HALLS GRO UP 
the needle with which the puncture is made until symptoms of intercra- 
nial pressure are reduced. An additional amount of spinal fluifl is then 
withdrawn to make way for the serum which is to be injected directly; 
15 to 20 cc. for young children and 20 to 40 cc. for adults. It is advan- 
tageous to elevate the lumbar region of the patient with reference to the 
head and neck, thus aiding somewhat the diffusion of the relatively 
dense serum throughout the cerebrospinal axis. The treatment is 
repeated from two to several times, until the spinal fluid is clear and 
has a normal appearance and cellular content. The serum must be 
used early in the disease to obtain the best results. Flexner^ has anal- 
yzed 1211 cases with the following mortality: 
Injection first to third day 
Injection fourth to seventh day 
Injection seventh day or later 
Similar results have been obtained in Germany with Wassermann's 
serum.2 Later observations by Flexner^ confirm these results. The 
mortality has been reduced from about 70 per cent to about 20 to 25 
per cent. 
In England, considerable attention has been paid to the production 
of monotype sera, of w^hich four are, of course, required, one for each 
individual serological type or group of the meningococcus. An effort 
is made to enrich the "anti-endotoxin" content of these sera, experi- 
ence having shown apparently that the curative potency of the serum 
depends rather upon its protective power against the poison of the 
meningococcus, than upon its content of lysins, opsonins or agglu- 
tinins. The monotypical serum for Type I has on the whole been 
found to be the most valuable, that of Group II the least satisfactory 
so far.^ Type II is less homogeneous, serologically considered, than 
the other types, which may explain in part the lesser effectiveness of 
the serum. 
The results of treatment (intraspinal injection) with the monovalent, 
or monotypical sera, are as follows: 
Mortality, 
Cases. Deaths. per cent. 
Type I 65 6 9.23 
"II 104 41 39.42 
"III 28 7 25.00 
"IV 4 3 75.00 
Untyped 48 22 45.80 
It is very probable that better results would have been attained if 
intravenous injection had been made at the same time, experience 
1 Jour. Exp. Med., 1913, 17, 553. 
- Wassermann : Deutsch. med. Wchnschr., 1907, 33, 1585. Wassermann and Leuchs; 
Klin. Jahrb., 1908, 19, No. 3. 
3 Jour. Am. Med. Assn., 1909, 52, 2016. 
■> See Special Report No. 50, on Cerebrospinal Fever, Medical Research Council, 1920. 
