20 FOREWORD 



feature of the Proteal response is a mononucleosis, and in par- 

 ticular a large monocytosis. 



A pronounced anaphylactic reaction has not been observed in 

 the use of the Proteals prepared by the newer method. The rea- 

 son may be that the proteins in the Proteals as now prepared 

 are partially hydrolyzed, appearing as proteoses, and perhaps in 

 small part as peptones. The earlier Proteals, comprising saline 

 and alcoholic extracts, contained the unbroken protein molecule, 

 and their use in repeated and maximum dosage was attended 

 with more or less marked anaphylactic reactions. Indeed, it was 

 my custom to force the dosage until a marked systemic reaction 

 was produced. The absence of this reaction makes the newer 

 Proteals far pleasanter to administer, and far more acceptable to 

 the patient, but leaves us without a clinical guide to maximum 

 dosage in intractable cases. 



It may fairly be said that no one at present knows what is the 

 maximum permissible dose with any Proteal. Even with the 

 old form of Proteal, containing the unbroken protein molecule, 

 the dose was sometimes advanced (gradually) to forty, fifty, 

 sixty, and even to ninety minims; and, although a severe sys- 

 temic reaction was expected and even desired, no untoward result 

 was ever observed. I have repeatedly given to guinea pigs day 

 after day doses of proteins that, weight for weight, were equiva- 

 lent to fifty or one hundred times the maximum dose adminis- 

 tered therapeutically ; and the animals thrive under the experi- 

 ment. 



Notwithstanding the relative non-toxicity of the Proteals, I 

 regard it as desirable to administer the smallest doses that will 

 produce results. If a dosage of six or eight minims will keep 

 the blood conditions as I like to see them, with corresponding 

 clinical improvement, I hold to such dosage. If it is necessary 

 to go to a dosage of fifteen or twenty minims, there should be 

 no hesitancy in doing so, but beyond this it is usually better to 

 shorten the interval between administrations rather than to give 

 inordinate single doses. These are matters, however, regarding 

 which individual cases differ, as do also the preferences of dif- 

 ferent physicians. The experienced practitioner, guided by per- 

 sonal observations, will develop his own technique in the use 

 of the Proteals as with other lines of treatment. 



DEVELOPMENT OF THE PROTEAL METHOD 



The theory of action of Proteals and other non-specific pro- 

 teins, which originated .with the present writer (so far as I am 

 aware, no other has been suggested), is based on my inter- 

 pretation of the mechanism of immunization as first published 



