THE NONSPECIFIC REACTION 47 



an urticaria, etc. When he injected it in himself these symptoms were entirely 

 lacking. He gained in weight during the course of the injections. 



This in general has been our experience in normal individuals when we have 

 injected small doses of secondary proteoses intravenously. The reaction on 

 the part of the patient depends to a considerable degree on the amount of 

 bacterial destruction that follows the injection or the amount of necrotic tissue 

 involvement of the patient. 



Just how much of the nonspecific reaction is essential, whether 

 the discomfort of the intravenous bacteriotherapy can be modified by 

 using the protein split products without sacrificing any of the remark- 

 able therapeutic effects that are at times achieved, is not to be de- 

 termined at present but must be the subject of further clinical investi- 

 gation. For purposes of orientation we have in the following pages 

 described the reaction that follows the intravenous injection of typhoid 

 bacilli in moderate dosage 25 to 50 million organisms; not because 

 it may be the ideal form of therapy of this type but because it is 

 the reaction which is most familiar clinically and, because of the 

 availability of the vaccine, the most easily obtained agent for ex- 

 perimentation. 



It is practically impossible to ascertain beforehand, because of 

 the varying individual factors, the degree of the reaction that will 

 be produced. When, however, experience has been gained with a 

 definite preparation and with a certain class of clinical material 

 it is usually possible to gauge the results that are to be expected 

 with some measure of exactitude. Needless to state it is an elemental 

 precaution to begin with a small dose when undertaking a study of 

 the effect on patients. 



The Chill. Usually the first symptom that comes to the attention 

 of the patient following the injection is a chill or rigor. This may set in 

 as early as fifteen minutes after the intravenous injection of typhoid 

 bacilli or a proteose solution, usually within 30 minutes, but may 

 be delayed for several hours. When colon bacilli and some other 

 organisms are used the chill may not be observed for several hours, 

 in one of our cases not until 8 hours after the injection. With intramus- 

 cular milk injections the rigor commences in from two to three hours. 



The degree of the reaction varies there may be merely twitch- 

 ing of the leg or arm muscles, or the chill or rigor may be quite 

 general and severe and last from 20 minutes to an hour. Commonly 

 this phase of the reaction begins to wear off in from one-half to 

 three-quarters of an hour after its inception. 



During this time the patient may complain of actual sensation of 

 chilling and demand extra covering and hot water bottles; in other 

 cases there is merely the muscular twitching and trembling with- 

 out sensory disturbance. In .the acute arthritides this phase of 

 the reaction may be of considerable discomfort to the patient be- 

 cause of the added motion and its resulting pain in the involved joints. 



