19, 6 Lantin: Methods of Serum Application 633 
VARIOUS METHODS OF TREATMENT 
In my series various methods of administering the serum were 
used; namely, (1) per rectum alone, (2) intramuscular injection 
and per rectum (enema), (3) intramuscular injection alone, 
(4) intramuscular and intravenous injection, (5) intravenous 
injection alone. 
; CLASSIFICATION 
To classify the disease exactly under each type, as to whether 
a case is severe or mild, is not an easy task. The custom of 
using the number of stools for the basis of classification as to 
severity is in my opinion oftentimes very misleading. For 
instance, a case with few bowel movements will be classified 
naturally as mild; but such cases are not always mild. It has 
been frequently observed by me that patients are admitted to 
the department who have few bowel movements but are in very 
weak general condition, in a stuporous state, and who show 
subnormal temperature and weak pulse. To place such cases 
in the same category with mild ones is not justifiable. I empha- 
size this because many of my deaths were from this type. The 
worst kind of dysentery is that in which there are few bowel 
movements, low temperature, and weak pulse. It may be that 
the toxin acted as antiperistaltic on the digestive tract, as pointed 
out by Fisher.(4) The severity of toxemia and the general 
condition of the patient should, in my opinion, be the basis for 
classifying the disease as of the severe or of the mild type. 
FIRST SERIES 
Serum per rectum alone—This method consists of introduc- 
ing the serum through a long rubber tube, one end of which 
is provided with a funnel. The patient is in the knee-chest 
position. The serum is to be given high, and to be retained 
a long time—the longer the better. Before the serum is given, 
preliminary preparation of the patient should be observed. A 
cleansing enema of sodium bicarbonate (1.5 per cent) is given, 
to be followed by another enema of 60 to 100 cubic centimeters 
of starch solution with 15 drops of laudanum, so as to diminish 
the irritability of the intestines. The high serum enema can 
then be given half an hour after the starch enema. 
Under this method I was able to treat nine cases who were not 
very sick, whose general condition was good. The fever was not 
high, and the bowel movements were from 10 to 25 in twenty-four 
hours. My dosage varied from 30 to 80 cubic centimeters of 
