240 PASSIVE IMMUNIZATION 



four hours; then upon the pain and upon the general condition of 

 the patient. Even in chronic cases much benefit may be expected. 

 Veillard and Dopter thus mention a case which had lasted five 

 months, in spite of the most varied treatment, where recovery 

 occurred after three injections of serum. 



If we bear in mind that, next to typhoid fever, bacillary dys- 

 entery is probably the most formidable common disease with which 

 military surgeons have to deal, it would suggest itself that in times of 

 war, or when large bodies of men are concentrated within a narrow 

 compass and are obliged to drink water of unknown quality, pro- 

 phylactic treatment with antidysentery serum might prove of signal 

 benefit. 



CHOLERA 



Although a number of different attempts have been made to pro- 

 duce an active antiserum for the treatment of Asiatic cholera, 

 nothing of real value has as yet been accomplished. This is probably 

 owing to the fact that while the symptom complex of cholera is 

 evidently largely the result of an intoxication, the toxins in question 

 are probably only in small part true toxins, but essentially endotoxins 

 against which antitoxins are produced only to a slight extent, if 

 at all. 



The only preparation of this order which deserves any considera- 

 tion, is the antiserum of Kraus, in the production of which the El 

 Tor vibrio was used as antigen. This organism, it may be recalled, 

 was obtained by Gottschlich in 1905 from the intestinal contents of 

 pilgrims who had died at El Tor from dysentery, and is not identical 

 with the true cholera vibrio, but evidently very closely related to 

 it. But unlike the cholera vibrio, the El Tor furnishes a true toxin 

 in fairly large amount, against which an active antitoxin can be 

 obtained. This latter, according to Kraus, neutralizes the toxin 

 of true cholera as well, and more efficiently than the antitoxin 

 resulting from immunization with the latter. He has therefore 

 recommended it for the treatment of Asiatic cholera. From the 

 reports which have thus far been obtained it is, however, scarcely 

 possible to reach a definite conclusion regarding its value. Ketscher 

 and Kernig used the serum in 119 severe and moderately severe cases, 

 with a death-rate of 58 per cent, in those who had received subcu- 



