SPECIFIC THERAPY WITH BACTERIOPHAGE SUSPENSIONS 547 



injection of serum at the same time that I administered the bacterio- 

 phage, that convalescence was retarded, probably as a result of serum 

 reaction complications. 



Serum may perhaps be indicated in those cases where the toxic 

 symptoms are manifest at the time when the bacteriophage treatment 

 is given; in all others serum causes more bother than benefit. It seems, 

 indeed, that everything may not have been considered, for in a recent 

 publication, Pereira^°°* reports on 23 cases of bacillary dysentery 

 treated at the Hospital Sao Pedro at Porto Allegre. All of these were 

 treated solely by the ingestion of bacteriophage suspensions, despite the 

 fact that the Shiga bacillus was isolated from the stools of a majority 

 of the patients. The conclusions of Pereira, presented below, confirm 

 my first observations, and those of da Costa Cruz as well. 



The anti-dysentery bacteriophage constitutes a specific treatment for the bacil- 

 lary dysenteries, whether they be caused by the Shiga bacillus or by the para- 

 dysentery organisms. 



Without causing general reactions, the ingestion of this principle modifies 

 completely, within a very short space of time, the evolution of the dysenteric 

 syndrome. Recovery, in a clinical and in a bacteriological sense, is complete. 



By the use of the bacteriophage the development of carriers is avoided, for 

 dysentery bacilli are never found in the excreta of patients who have been treated 

 by the ingestion of the bacteriophage. 



Pereira ends his discussion by suggesting that a milk diet is contra- 

 indicated during treatment with the bacteriophage, and this is indeed 

 quite logical, for it is obviously necessary to carefully avoid everything 

 which may change the reaction of the contents of the intestinal tract 

 toward the acid side. 



A final observation of Pereira is noteworthy, for he is of the opinion 

 that since the systematic application of the method of treating the 

 dysenteries by means of the bacteriophage was instituted, the mortality 

 from enteric diseases in general has considerably diminished at the 

 hospital. Serum treatment, he adds, comes far from giving as conclu- 

 sive results. t 



But to obtain such results I can not emphasize too strongly the point 

 that it is absolutely indispensable that the bacteriophage be of maxiynum 

 virulence for the bacterium upon which it is to act. If it is impossible to 



* The Oswaldo Cruz Prize, having been awarded to Pereira for his work, it 

 would seem that the Institute itself must sanction his conclusions, and that they 

 must agree with those obtained at the Institute itself. 



t Recently Spence and McKinley^«° have again confirmed the value of bacterio- 

 phagic therapy in bacillary dysentery. 



