Dysentery and Diarrhoea in Wartime SIR,-Sir Philip Manson-Bahr's paper concluded in your issue of Sept. 26 (p. 374) will be helpful to many medical officers in the Services and elsewhere. But in recommending doses of 50 to 80 c.cm. of serum in severe cases of Shiga dysentery he is not, I think, taking into account the remarkable progress achieved during the past few years in refining and standardizing these sera. The product issued to the Army contains 50,000 international units of antitoxin in a volume of less than 10 c.cm.: and 50,000 to 100,000 units is considered sufficient as an initial dose, even in fulminating toxic cases, if given intravenously. Intravenous injection, as Sir Philip will agree, is preferable to intramuscular injection as a means of securing rapid circulation of antitoxin; and, thanks to the use of proteolytic enzymes in preparing the serum, the risk of anaphylaxis to which he refers is now so small that it need no longer deter us from using the most effective route.-I am, etc.
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