232 PASSIVE IMMUNIZATION 



CHOLERA 



Although a number of different attempts have been made to produce 

 an active antiserum for the treatment of Asiatic Cholera, nothing of 

 real value has as yet been accomplished. This is probably owing 

 to the fact that while the symptom complex of cholera is evidently 

 largely the result of an intoxication, the toxins in question are 

 probably only in small part true toxins, but essentially endotoxins 

 against which antitoxins are produced only to a slight extent, if 

 at all. 



The only preparation of this order which deserves any considera- 

 tion, is the antiserum of Kraus, in the production of which the El 

 Tor vibrio was used as antigen. This organism, it may be recalled, 

 was obtained by Gottschlich in 1905 from the intestinal contents of 

 pilgrims who had died at El Tor from dysentery, and is not identical 

 with the true cholera vibrio, but evidently very closely related to 

 it. But unlike the cholera vibrio, the El Tor furnishes a true toxin 

 in fairly large amount, against which an active antitoxin can be 

 obtained. This latter, according to Kraus, neutralizes the toxin 

 of true cholera as well, and more efficiently than the antitoxin 

 resulting from immunization with the latter. He has therefore 

 recommended it for the treatment of Asiatic cholera. From the 

 reports which have thus far been obtained it is, however, scarcely 

 possible to reach a definite conclusion regarding its value. Ketscher 

 and Kernig used the serum in 119 severe and moderately severe cases, 

 with a death rate of 58 per cent, in those who had received subcu- 

 taneous injections, and one of 50 per cent, when used intravenously; 

 while the general death rate among the non-injected cases was 63.4 

 per cent. The verdict among those who have had experience with the 

 serum seems to have been that the serum treatment produced a 

 favorable rather than an unfavorable impression, which, after all, 

 is scanty praise. 



Jegunoff administered the serum intravenously, together with 

 physiological salt solution, giving 140 c.c. of serum with 500 to 700 

 c.c. of saline to start with, and a second injection of 80 to 120 c.c. 

 of serum within seven and one-half to twenty-three hours after the 

 first. 



