22 PROTEIN THERAPY 



injected subcutaneously in doses of from 5 to 10 c.c. ; later he used 

 intramuscular and intravenous injections. 



Holler has also used ovalbumin. The general reaction is negligible 

 and the therapeutic effect not striking. 



Milk. The intramuscular injection of milk was introduced by 

 Schmidt and by Saxl in 1916 to induce a protein reaction, i. e., the 

 typical rise in temperature observed following other agents. Milk 

 offered the advantage that it would be easily available to the profession. 

 The method is very simple. Ordinary pasteurized (or fresh) milk is 

 boiled for from 5 to 10 minutes and when cooled, from 5 to 10 c.c. are 

 injected intragluteally, or into other muscles arm, back, etc. 



The injection is followed in some instances by a chill (not as se- 

 vere as that following typhoid vaccine), and by a temperature rise 

 that reaches its maximum in from 6 to 8 hours and then subsides within 

 24 hours. A well marked leukocytosis, ranging from 15,000 to 40,000, 

 also results. Milk has a decided styptic effect when so injected and 

 as Doellken has shown is of particular value in diseases associated 

 with hemorrhages. This effect is probably due to its effect on the 

 liver parenchyma, which, together with the bone marrow, seems to 

 be especially stimulated by the milk injections. Thrombokinase and 

 fibrinogen appear in increased amounts in the serum after injec- 

 tion. Locally there may be considerable pain at the site of the in- 

 jection. 



Milk being composed of many and varying elements, efforts have 

 been made to identify those components that might be most effica- 

 cious. The bacterial content in particular has been held responsi- 

 ble for the reaction produced by the milk injection. Indeed Bessau, 

 Decastello and E. F. Mueller believe that the reaction is due wholly 

 to the bacteria that are contained in the milk, and Uddgren found 

 that the reaction following sterile milk injections was relatively mild 

 in character. She has determined that commercial milk, even after 

 boiling for from three to five minutes, may still contain a few viable 

 organisms. Boiled for ten minutes the milk was always found to 

 be sterile. Uddgren believes the reaction of the milk is due to bacterial 

 derivatives or protein split products contained in the milk. 



Ryhmer, who obtained rather unsatisfactory results with milk 

 injections he tried it in diphtheria carriers, in hemorrhage, in 

 anemia, osteomyelitis, sepsis and Barlow's disease also believes 

 that the reaction is due wholly to the bacteria contained in the 

 milk because with fresh sterile milk he obtained practically no re- 

 action. 



When repeated injections of milk are given the reaction of the pa- 

 tient may increase to some extent, differing in this manner from the 

 effect of reinjection when bacteria and proteoses are used. There seems 

 to be relatively little danger of sensitization or of anaphylactic shock 

 following repeated milk injections; many thousand injections have 



