3Q6 DYSENTERY 



successes of vaccine therapy have been achieved. It has been 

 used in some extremely severe conditions with profound toxaemia, 

 and in no case did it render the patient's condition worse. Small 

 doses should, of course, be used in such cases, but the severity of 

 the disease need be no bar to the use of the remedy. 



Dysentery. 



Bacillary dysentery, under which heading we may include some 

 at least of the cases known as ulcerative colitis, asylum dysentery 

 and infantile diarrhoea, is in its general pathology closely akin to 

 typhoid fever. Its toxin is an endotoxin which is only set free 

 when the bacilli undergo solution, and its cure is associated with, 

 and perhaps due to, the development of a large amount of bacterio- 

 lysin. The main difference between the two diseases is that, 

 whereas typhoid fever is a self-limited disease, in which the patient 

 either dies or immunizes himself in a fairly constant period after 

 infection, in dysentery the disease has a tendency to become 

 chronic, the degree of immunity produced being sufficient to slow 

 the course of the disease, but insufficient to arrest it altogether. 

 The bacilli are in the main limited to the intestinal lesions, but 

 the fact that they have been found in the heart-blood of a new- 

 born foetus whose mother was suffering from the disease leads us 

 to believe that they may circulate in the blood ; in most cases 

 they are probably quickly destroyed, for normal serum has some 

 bacteriolytic action. 



The toxin is contained in the bodies of the organisms, which 

 are much more poisonous than those of typhoid bacilli. It may 

 be obtained by Macfadyen's method of grinding at the temperature 

 of liquid air, by aseptic autolysis at 37 C., or simply by filtering 

 old broth cultures in which some of the bacilli have undergone 

 solution. Conradi's toxin, prepared by submitting emulsions to 

 autolysis for forty-eight hours, was fatal to rabbits in doses of 

 i c.c., causing diarrhoea, subnormal temperature, etc. According 

 to Todd, the toxin is developed best in alkaline broth, and attains 

 its maximum in about six weeks, after which time it begins to 

 diminish in potency. It is more thermostable than the exotoxins, 

 resisting heating to 70 C. for one hour, and only being destroyed 

 slowly at the boiling-point. It is possible to obtain an anti-endo- 

 toxin, but the treatment of the animals has to be conducted with 

 great care. It is probable also that the serum of animals 

 immunized to the bacilli themselves contains some antitoxic 



