EMPLOYMENT OF BLOOD SERUM 259 



Gottschliech in 1905 from the intestinal contents of pilgrims who had 

 died at El Tor from dysentery, and is not a true cholera vibrio but 

 very closely related to it. Kraus recommended his antitoxin for the 

 treatment of the cholera. Schurupoff treated one-and-a half to two- 

 day-old cultures of the vibrio with alkali and injected this toxic material 

 into horses at six to ten-day intervals. Under Kolle's direction, Car- 

 riere and Tomarkin injected horses and goats with cholera cultures con- 

 taining also the toxic derivatives and used the mixed sera of these 

 animals. They found that these sera are more valuable against cholera 

 peritonitis of guinea-pigs than any other animal. 



Ketscher and Kernig used Kraus' serum in 119 severe and mod- 

 erately severe cases with a death rate of 58 per cent, in those who 

 received subcutaneous injections, and 50 per cent, when used intrave- 

 nously, while among the non-injected cases the mortality was 63.4 per 

 cent Others have found among the serum-treated cases a mortality of 

 57-5 P 61 " cent, and among the control cases 84.3 per cent. This serum 

 was administered by Jegunoff intravenously together with physiological 

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

 physiological salt solution and subsequently a second injection of 80 to 

 1 20 c.c. of serum within seven and one-half to twenty-three hours after 

 the primary injection. During the Russian epidemics in 1908 and 1909 

 it was shown that large doses of sera did not harm the patients. It 

 was originally believed that large doses of sera lead to quick destruc- 

 tion of the vibrios with subsequent intoxication, but this has not proven 

 to be the case. During these epidemics Salimbeni's and Kraus' sera 

 did not give satisfactory results. Schurupoff's serum was considerably 

 better, and the best results were obtained with the serum prepared 

 according to Carriere and Tomarkin. This serum was given in doses 

 of 50 c.c. to loo c.c. diluted with salt solution subcutaneously and intra- 

 venously and resulted in quick improvement. Von Stiihlern and 

 Tuschinski treated 149 algid cases with fifty-six deaths; twenty-five 

 moderate and thirteen early cases were treated with no deaths. From 

 a total of 187 cases the mortality was 29.9 per cent. The serum should 

 be applied as early as possible. Cholera antisera contain bacteriolytic, 

 agglutinative, probably anti-endotoxic, complement-fixing antibodies, 

 and also tropins. Because of the variety of sera used and the incon- 

 clusive reports given it is exceedingly difficult to reach a definite con- 

 clusion regarding the curative value of anti-cholera sera. It seems to 

 us that Carriere and Tomarkin's serum is the most promising. 



The Use of Anti-anthrax Serum. The treatment of anthrax has 

 consisted mainly in excision of the pustule, application of chemical or 

 thermal cautery, and the injection of germicides as iodine, mercuric 

 chlorid or phenol in the regions of the pustule, but all these methods 

 are objectional because they are likely to produce scars and disfigure- 

 ment. Excision may furthermore increase the danger of systemic 

 infection. Sclavo, Deutsch, Sobernheim and others have produced 

 immune sera by immunization of the sheep, horse and ass with attenu- 

 ated culture of anthrax bacilli. From the work of Marchoux we know 



