66 THE PRINCIPLES OF IMMUNOLOGY 



100,000 minimal lethal doses. Forssman and Lundstrom were also 

 successful in their immunization attempts, using attenuated toxins. 

 Wassermann immunized horses and produced sera of undeniable 

 value in animal experiments. In this country sera were prepared 

 by Graham, Brueckner and Pontius, Buckley, Hart, Meyer, Hurwitz 

 and Taussig, Burke, Dickson, and Howitt mainly for experimental 

 purposes, using rabbits, sheep, goat, cattle, and dogs for immuniza- 

 tion. According to Dickson and Howitt, laboratory experiments 

 show that the antitoxin may protect against the action of the toxin 

 for at least twenty-four hours after the administration of one test 

 dose of toxin, but the effectiveness is, to a certain extent at least, 

 dependent upon the amount of toxin injected. Like tetanus anti- 

 toxin, botulinus antitoxin should be given early if it is to be effec- 

 tive, and even in well-established cases it is strongly advisable to 

 give antitoxin in massive doses, because Kob has demonstrated that 

 this toxin may persist in the blood nine days after the poisoning. 

 If symptoms of botulism, such as hypersecretion of mucus from 

 mouth and nose, visual disturbances, aphonia, dysphagia, and 

 paralysis of the intestinal tract appear, antitoxin should be admin- 

 istered as soon as possible, and should be given in large doses 

 intravenously. Dickson also advises the use of antitoxin to all 

 persons who have eaten fowl that have suffered from limberneck. 

 Of importance is the use of polyvalent sera because of the discovery 

 of Leuchs that two strains, the one of Van Ermengem and a 

 Darmstadt strain, were distinct, that the toxin of one was not 

 affected by the specific antitoxin of the other, and vice versa. As 

 for the effect of botulinus antitoxin in man, little is known, as it 

 has been used only in isolated instances. Dickson and Howitt, in 

 1918, gave 85 c.c. of immune goat serum (i c.c. equivalent to 3000 

 M.L.D. for a guinea-pig) to each of two patients at Madera, Cali- 

 fornia. Both patients recovered, but as the antitoxin was given very 

 late, in fact, after all the more seriously poisoned patients had 

 succumbed, there is no definite evidence that the course of the ill- 

 ness was favorably influenced by the antitoxin, although it was 

 later shown that the toxin of the strain recovered from the food was 

 Type A. McCaskey used small doses of antitoxin in three patients 

 (5 to 10 c.c.). One died and two recovered and this author there- 

 fore thinks the serum to be of some aid. Nonnenbruch obtained 

 rapid improvement in his case after the use of antitoxin. His pa- 

 tient became poisoned after eating sausage. Jennings, Haas and 

 Jennings in the recent Detroit outbreak used Graham's serum in a 

 dose of 42 c.c. intravenously in one case without apparent effect, and 

 20 c.c. in two injections to another patient, who recovered, and state 

 that the latter case was not of mild type. Dickson and Howitt 

 found that of all the outbreaks in which the serum had been used, 

 with the exception of the cases of McCaskey, the toxin was that of 

 Type A, and consequently when Type B serum was used it could 

 not be expected to give any satisfactory results. As it is impos- 



