New-York tribune., 1907-12-31
CURE FOR MENINGITIS.
DIR. FLEXNER'S REPORT.
Wonderful Work Done zcith Nesc
Serum. by Rockefeller Investigator.

sIeanings which have come unofficially from the
Rockefeller Institute for Medical Research IN this
city are statements made in the report OF the
cerebro-spinal meningitis serum experiments by Dr.
Simon Flexner. published in 1.-The Journal OF Ex-
per1mental Medicine" 10 be circulated this week.
In an article of more than hundred and hfty
pages Dr. Flexner and DR.. J. w. Jobling, who was
associated with him in the experiments and the
treatment of patients give in detail the results
and show that the dreaded disease is not uncon-
uuerable In the treated by DR.. Flexner
and by other physicians under his direction IL -
shown that the usual mortality and recovery ig-
ures in meningitis epidemics have been reversed
and, most remarkable Of all, that the larger per
centage is on the side of recovery.
Dr. Flexner began the study of meningitis epi-
denies at the request the Department of Health
in 1gA5 and in his paper explains the manner of
preparing the anti-serum that has been so success
fully used follows:
The ant-1neningttis serum employed in the treat;
Z eLt OF & te CeS SIS u ~ made in me horse The
general method of preparation has been as folioWS:
The first incubation consisted or cultILes ol te f
dlplococcus heated to 60 degrees centrigrade Tor
thirty minutes. injected under the skin Many ait-
prepare this The first dose was the equiv
alent OF onequarter surface growth on sheep serum
agar in a test tube The dose was doubled at each
subsequent inOCulation until an amount eqadl ~
, four test tube growths could be given at HFe ~
Intravenous inocuIa9n was n4T substitutes nsn n1o for
eocc the dose was progressively Increased TO Two
one, etc. agar slant cultures, and finally 10 one
and one-half bottles twelve ounces Blake OF sur
injected into the vein caused such reactions
and alarming symptoms that they were olscon
Simultaneous and intravenous injection of an au-
tolysate was used. The doses, at hrst one
cubic centimetre later increased TO three cubic
centmetTes The inlectonS wgTG jiafion the auo
tolysate was discontinued because oi Sne etc
At the present time the subcutaneous tissues are
being used exclusively for the inoculations which
are made alternately of living diplococci and auto.
lysate at seven day Intervals iany l., nrenar
ing the living cultures and the autoysate for IN
oculation The dose of living dipococcus has been
Increased to one and one-haf bottles and OF the
autolysate to the equivalent OF one and one-hall
bottles of the cultures
Dr FIexner hen goes on to explain that the
animal eats less during the febrile period. The
local reaction IS much greater. and within few
hours a swelling appears at the site or the IN
oculatiop and extends at times from the shoulder
to the Sterile abscesses develop which dis
charge through the skin The anti-serum. 1t is ex-
planned has been titrated by the complement
deviation method devised by Koe and Wasser-
mann and tested against the autolysate in guinea
pigs. The anti-serum used ir the treatment or lhe
cases Of epidemic meningitis described by Dr.
Flexner came from horse in process OF ifnmunlza-
tion ono year or longer before being USED for fup-
plying the serum.
Forty-seven cases OF epidemic meningitis are
noted in which the anti-serum used or these
thirty-four recovered and thirteen died, the re-
coveries equalling 723 per cent and the deaths Zo
per cent. The report continues:
cases four were either fuinnant in type. in which
death took place within twentyfour 5i 10 vas
hours of the onset. or the patient coh1tIoii rs
SO extreme that death occurred in a. feW houEs
these four cases are subtracted there results
total of forty-three cases OF Tneningfns f CeIeo -
cred and nine died or 79s per cent Tecoveries ana
20i per cent deaths
To show the value OF these figures the report
gives statistics of 2So cases of epidemic mennglts
which arose in Belfast. ana reported by DR. Robb
or these 1s2 died, making mortality Of 7o43 per
cent
The majority Of the cases treated under DE- flex-
ner's direction were In children over FIVE years OF
age and In adults. The mortality usually Is nigh
est among children. but IN eight cases especially
noticed five recovered.
Included in the paper reports OF the use OF
the antserum in a number OF cities. At Akron,
Ohio the epidemic began in April, 1907. and en-
braced about twenty cases. In nine cases treated
outside the hospital eight died. DR.. W. s. Chase
reports eleven treated with the antlseruIn
in the hospital. and OF these eight recovered.
DR.. Ladd in Cleveland treated sixteen cases. and
the percentage of recoveries 6875. In ten
other cases treated there with the serum within
seveuty-two hours of the onset of the symptoms
nine recovered. making q percentage in this IN
stance of go
In the Pennsylvania Hospital, in Philadelphia, Dr.
Lonecope treated five cases. Of which four recov-
cred.
The antserum was not available for use in the
~
the severe epidemic in this city
The serum is administered by direct inoculation |
into the spinal canal in human beings, after the |
withdrawal of the cerebro-spnal fluid by means |
of lumbar puncture, the result OF observations OF
DR. Flexner on "the bactericdal effects of normal
sea and sterile eudaes upon diplococcus intracel-
lularis in vitro, and upon the curative acton OK
antdiplococcus in guinea pigs and monkeys /
infected with the diplococcus when brouSht into
immediate relation with the focus of infection" |
eral observations:
In view of the small number of cases OF epidemic |
meningitis. upon which this paper Is based iI |
would seem the wsest policy possible 10 defer all |
as a larger series of cases treated anti |
serum having been collected. a searching analysis
On the other hand. it would seem desirable TO |
recapituate the salient points brought out by tho
paper it being understood that they do not repre-
sen conclusions but merely statements f hem o5 oo-
is that once we accept the fact OF the
caused by the antserum, the early injection OF 1t |
is seduously sought The figures. small as they |
made in the first three days of the Illness as
compared with those made at later period And And
treated in the fourth nth and eighth week OF the
disease Basing tentatve aeauG.lon cue ION on se ] lTm
that long as living and multiplying dploeoeci
may be employed with hope expectation of use
full results. The serum is clearly Of no avail in
obstructive LESSONS OF the membranes
The doses of the serum used thus far rest on an
emprical basis. Whether the larger doses which |
have been used latterly are more efficient than the
smaller ones used at first can be determined only only
That the antiserum possesses certain direct
the dangers OF Observation-Disclosures would seem
he indicated by its power to neutralize intra
vitam the toxic effects of autolysate of the
diplococcus.
It is generally regarded among physicians who
have been familiar with the work that DR.. Flex-