770 PASSIVE IMMUNIZATION SERUM THERAPY 



Whenever cultures are used in immunization, the serum should always be cultured 

 carefully and tested by animal inoculation to guard against the possibility of living 

 bacilli being present. 



THE SERUM TREATMENT OF CHOLERA 



In some respects cholera would seem to be due mainly to a toxin 

 elaborated by the bacilli in the intestinal tract of infected persons, 

 similar to the action of the toxin of the Kruse-Shiga type of dysentery 

 bacillus. Various attempts have been made to prepare an efficient 

 anticholera serum, but the only one that has yielded encouraging results 

 in experimental infections as well as in cholera of human beings is that 

 prepared by Kraus. This serum is prepared by immunizing horses 

 with a true toxin derived from a cholera-like vibrio isolated by Gottsch- 

 lich from the intestinal contents of pilgrims dying at El Tor from a dys- 

 entery or cholera-like infection. According to Kraus, this antiserum 

 is largely antitoxic, and serves to neutralize the toxin of true cholera 

 more effectively than does the antiserum resulting from immunization 

 with cholera cultures. A serum that is antitoxic and is obtained by pro- 

 longed immunization of horses by intravenous injections with dead cul- 

 tures of cholera, and later with living cultures, bacterial extracts, and 

 filtrates of old bouillon cultures conjointly, would seem to be a desider- 

 atum. 



Reports from Russia, where Kraus' and Kolle's serums have been 

 employed, indicate that a reduction of about 10 to 20 per cent, in the 

 mortality has been accomplished. JegunofFs method of administering 

 the serum seems quite rational, and consists in making intravenous in- 

 jections of 140 c.c. of serum with 500 to 700 c.c. of sterile salt solution, 

 followed by a similar or slightly lower dosage in from six to twenty-four 

 hours after the first dose. The intravenous administration of salt solu- 

 tion alone has proved of value in the treatment of cholera, and it is 

 reasonable to assume that a potent serum may be of service by neutraliz- 

 ing toxins, destroying the bacilli, and at least furnishing additional 

 fluids for the depleted tissues and circulation. 



There are no available statistics as regards the prophylactic value 

 of anticholera serum, but combined active and passive immunization 

 by means of a subcutaneous injection of from 10 to 20 c.c. of serum, 

 followed by three doses of vaccine, would appear to be a rational pro- 

 cedure in the presence of an epidemic or of a threatened epidemic of 

 cholera. 



