SERUM TREATMENT OF DYSENTERY 783 



For prophylactic purposes, usually from 10 to 20 c.c. are recommended, 

 and it is further advised to repeat the injection after two or three weeks, 

 as the protection lasts only a short time. 



For curative purposes, Shiga has advised 10 c.c. for mild cases and 

 from 20 to 60 c.c. for severer cases. It may be necessary to repeat the 

 injections several times. Vaillard and Doyle have given as much as 

 from 80 to 100 c.c., and have repeated this dose on the following days. 

 When the serum is being used during an epidemic, it is advisable to as- 

 certain beforehand the nature of the infection, as the antiserum for the Shiga 

 bacillus is highly specific and is not likely to prove of value in the treatment 

 of infections caused by the Flexner type of bacillus. Otherwise a poly- 

 valent serum should be used. 



The injections have usually been given subcutaneously. Better 

 results would, no doubt, be obtained in the treatment of severe infec- 

 tions by administering large doses of serum intravenously. 



Results. Adequate statistics regarding the value of the serum in 

 the prophylaxis and treatment of dysentery are not yet available. From 

 the prophylactic standpoint, encouraging results have been reported by 

 Kruse, Shiga, Vaillard and Dopter, Rosculet, and others, and it would 

 appear that passive immunization is of value in combating localized 

 outbreaks, such as occur in institutions and armies. 



From the curative standpoint, most observers agree that the use of a 

 potent serum will reduce the mortality of acute cases at least from 30 

 to 50 per cent. Shiga reports a drop in the mortality in Japan of from 

 22 to 26 per cent, to 9 to 12 per cent. ; Kruse obtained a reduction in 

 mortality of about 10 per cent. Vaillard and Dopter 1 treated 96 cases, 

 with but 1 death; Rosenthal 2 treated 157 cases with 7 deaths, a mor- 

 tality of 4.5 per cent, as compared with that of 10 to 11 per cent, oc- 

 curring in other German hospitals. Coyne and Auche 3 treated 11 cases 

 due to the Flexner type of bacillus and report good results. Ruffer 

 and Willmore, 4 Violle, 5 Rogers, 6 Brau 7 and Bahr 8 have also reported 

 favorably upon the use of the serum. A highly potent and polyvalent 

 serum should be in readiness during war, and particularly in camps 

 and hospitals. In a thorough investigation made in the United States in 

 1903 by the Rockefeller Institute, under the direction of Flexner, it was 



1 Ann. Inst. Past., 1906, xx, 321; 1907, xxi, 241. 

 ^Deut. med. Wchnschr., 1904, xxx, No. 19. 



3 Compt. rend. Soc. Biol., 1906, Ix, No. 26. 



4 Brit. Med. Jour., 1908, 11, 1176; ibid., 1909, ii, 462. 



5 Arch. med. et pharm. nav., 1912, xcviii, 61. 



6 Dysenteries, Their Differentiation and Treatment, London, 1913, 290. 



7 Ann. d. hyg. et meU, 1913, xvi, 710. 8 Brit. Med. Jour., 1914. 



