782 PASSIVE IMMUNIZATION SERUM THERAPY 



SERUM TREATMENT OF DYSENTERY 



Soon after the discovery of a bacillus of dysentery by Shiga in 1892 

 the treatment of bacillary dysentery by the use of immune serums was 

 undertaken. Following the discovery of the etiologic importance of 

 Shiga's bacillus in the dysenteries of Asiatic countries, similar investiga- 

 tions were made in various parts of the world and various bacilli were 

 isolated. At first these microorganisms were all regarded as being iden- 

 tical, but further investigation has shown that marked differences are 

 apparent, and two main types are now recognized: one type (Shiga) 

 does not ferment mannite and produces a soluble or extracellular toxin, 

 and a second type (Flexner-Harris, Hissy, etc.) ferments mannite and 

 does not produce an extracellular toxin. A further discussion of these 

 bacilli will be found in Chapter VII. 



Dysentery caused by the bacilli of the Kruse-Shiga type may be re- 

 garded as a form of intoxication analogous to the intoxication of diph- 

 theria. The intestine, where the bacilli lodge, corresponds to the throat, 

 which is the site of infection in diphtheria; here the bacilli develop and 

 produce their toxins, and these toxins, when absorbed into the circula- 

 tion, in turn produce the symptoms of the disease. 



Antitoxin has been prepared for the bacilli of the Kruse-Shiga type, 

 and these have yielded fairly satisfactory results in the prophylaxis and 

 cure of this variety of bacillary dysentery. Antiserums for the mannite- 

 fermenting group of bacilli (Flexner, Harris, Hess, Duval, etc.) have not 

 proved of much value in the treatment of these infections. Bacilli 

 of the latter group are largely responsible for the dysenteries in this 

 country, and also for a percentage of cases of ileocolitis of infancy. 

 Since the antiserum of the Shiga bacillus is of practically no value in the 

 treatment of infections caused by bacilli of other groups, the serum 

 treatment of dysentery is employed mainly in European and Asiatic 

 countries, where infections with this group are common. After fairly 

 extensive trials in this country the serum treatment of infantile diarrheas 

 and true dysenteries has proved disappointing. 



The preparation and standardization of dysentery antitoxin is de- 

 scribed in Chapter XIV. 



Administration and Uses. Dysentery antitoxin has been used both 

 in the prophylaxis and in the cure of this infection. The doses of serum 

 advised by various observers vary considerably, owing to the marked 

 differences that exist in the potency of these serums. Since the various 

 manufacturers do not employ the same standards, the physician should 

 use the serum in accordance with the printed directions that accom- 

 pany each package. 



