64 THE PRINCIPLES OF IMMUNOLOGY 



60 to 80 c.c. once or twice daily during the first three days of treat- 

 ment. Three injections were followed by 150 to 300 c.c. of saline 

 daily for the first two days and once for the next two days, the 

 saline injections being made to prevent dehydration of the tissues. 

 In mild cases no saline injections were necessary. Most of the cases 

 arrived after the third day, so that they were not placed under 

 treatment at the earliest possible moment. On entering the hos- 

 pital all cases received 20 c.c. of the serum subcutaneously. Klein 

 also maintains that anti-dysenteric serum given early and in large 

 doses intravenously (60 to 100 c.c.) is efficacious. He found that the 

 use of the serum produced the best results when given during the 

 first five or six days. When the disease has entered into the inter- 

 mediate stage, from the sixth to the tenth day, the outcome of the 

 disease is irrespective of serum treatment. In the third stage 

 tenth day the use of serum is practically without value. Waller 

 treated 140 cases with the Lister Institute serum and found that 

 the early use of the serum resulted in shortening the duration of the 

 disease. He gave three subcutaneous injections of 140 c.c. at eight- 

 hour intervals during the first twenty-four hours to fairly severe 

 cases. Rosenthal, in a series of serum-treated cases, found a mor- 

 tality of 0.6 per cent. In other units the mortality was 10 to 15 per 

 cent. Sixty c.c. of sera were given by Rosenthal on the first day, 

 followed by 40 to 60 c.c. on the second, and if no improvement was 

 observed subsequent doses of 40 c.c. were given up to a 

 total of 400 c.c. Usually the stools were free of blood in forty-eight 

 hours, and their number reduced from 60 to 15 or 10 per day. 

 Lantin also thinks that the use of serum constitutes an efficient 

 specific method of treatment. He gave the serum by rectum in doses 

 from 30 to 50 c.c. Neumann used human convalescent serum in 400 

 cases. Intestinal irrigations with silver solutions were also em- 

 ployed by this author. Only six of his cases ended fatally. Jacob, 

 on the other hand, and with him also Nolf, failed to obtain success 

 with serum therapy in this disease. Jacob treated ninety cases, 

 using polyvalent sera and injecting subcutaneously or intravenously 

 doses ranging from 20 to 400 c.c. during the first or second week of 

 the disease. According to the British Medical Research Com- 

 mittee, serum treatment of bacillary dysentery is not satisfactory. 

 Nevertheless, numerous investigators showed that this method of 

 treatment has a well-established clinical value as expressed in the 

 view of Schittenhelm, who states that it should be employed in all 

 cases of more than three or four days* duration, and in all cases 

 showing toxemia and severe symptoms, and in cases where the 

 number of stools are more than twelve in the course of twenty-four 

 hours. It should be given early in the disease and in massive doses. 

 If possible the type of the infecting organism should be known prior 

 to the administration of these massive doses. This can readily be 

 done in twenty-four hours in a well-equipped laboratory. The 

 serum used should be polyvalent, because there are a number of 



