DYSENTERY 239 



toxin a basic (Grund) immunity is first established by injecting a 

 certain quantity of antiserum together with, or twenty-four hours 

 preceding, the introduction of the toxin, or the toxin cultures, after 

 which the process is continued with these alone. 



Dosage and Uses. The serum which is used for curative purposes 

 in Vienna is of such strength that 0.1 c.c. at most will protect a 

 rabbit weighing 1000 grams against a separate though simultaneous 

 intravenous injection of a single lethal dose of the toxin. The 

 curative dose of such a serum for the human being varies between 

 10 and 20 c.c., which may be repeated several times in severe cases. 

 In extreme cases the French observers have used as much as 80 to 

 100 c.c. on the first day, and have repeated this on the following 

 days. In three instances 240, 380, and 1080 c.c. were injected 

 altogether, i. e., doses which seem unwarrantably and unnecessarily 

 large, if an active serum was really at hand. After the disease 

 comes under control, as is evidenced by a diminution in the number 

 of the stools, smaller doses may be given during the following days. 



For prophylactic purposes the same dosage (10 to 20 c.c.) is 

 recommended, and it is further advised to repeat the injections 

 after two or three weeks, as the protection only lasts a short time. As 

 the different manufacturers do not employ the same standards the 

 practitioner must use the serum in accordance with the printed 

 directions which accompany the individual package. 



Injections. The injections are given subcutaneously in the usual 

 districts. As the Shiga-Kruse strains alone are toxin producers, 

 while the Flexner type does not belong to this order, and as the 

 serum corresponding to the former is markedly specific in its action, 

 it is advisable to ascertain at the time of an epidemic whether the 

 infection is actually of this type. Unless this is done it would not 

 be warrantable to ascribe a lack of action to the serum when no 

 effect is observed. 



Results. Regarding the results which have been obtained with 

 the serum in question, it seems that the treatment is actually quite 

 useful both for prophylactic and curative purposes, though adequate 

 statistics are not yet available. More convincing than mere figures 

 are the observations which have been made at the sickbed, by 

 individual observers, all of whom speak quite enthusiastically of 

 the marked effect of the injections upon the number of the stools, 

 which frequently drops quite suddenly even within the first twenty- 



