48 PROTEIN THERAPY 



The analgesic effect that follows shortly in the wake of the chill 

 as a rule compensates for this short period of increased pain. 



The Temperature Curve. The temperature reaction of the patient 

 varies greatly with the vaccine or protein used, and even when one ad- 

 heres to a single agent such as typhoid vaccine, differences in the age of 

 the vaccine, the dosage, the strain of bacilli and the method of killing 

 the bacteria when the vaccine is prepared, all have a definite effect on 

 the reaction; and this apart from the individual variation that we meet 

 on the part of the patient variations that depend, as already men- 

 tioned, on the disease, its duration, the previous temperature, previous 

 injections, etc. 



With the subsidence of the chill or during its later stages the 

 temperature of the patient has as a rule commenced to rise. In 

 typical arthritic cases running a febrile course of from 100 F. to 

 101 F. the injection of typhoid vaccine will raise the temperature 

 to about 103 F. or 104 F., the maximum increase being recorded 

 in from three to four hours after the injection. With intramuscular 

 milk injections the temperature maximum may not be reached until 

 six or eight hours after the injection. As a rule the defervescence 

 is more rapid with the intravenous injections, but even in the case 

 of the milk injections the former level is reached within 24 hours. 

 Subcutaneous nuclein injections are followed by a febrile reaction 

 that begins later and recedes more slowly than observed with the 

 other methods. 



Schmidt has classified the reactions following milk injections into 

 5 groups, according to the degree of febrile reaction of the patient 

 following a uniform amount of milk intramuscularly injected. In 

 the first group are the cases that react with 37 C. or under; in the 

 second that react with 37 C. to 38 C. (98.6-100 F.) ; in the third 

 that react with 38 C. to 39 C. (100-102 F.) ; in the fourth that 

 react with 39 C. to 40 C. (102-104 F.) ; in the fifth that react with 

 40 C. to 41 C. (104-106 F.). 



Schmidt and Kaznelson worked chiefly with milk injections, using 

 10 c.c. injected intragluteally. The temperature rise occurred usually in 

 from 6 to 8 hours and was at times accompanied by a chill (rather rare), 

 more often by sweating, and some headache. The blood pressure was not 

 altered. Herpes were seldom noted. The temperature increase at times 

 persisted for from 24 to 48 hours. Among the five groups into which 

 Schmidt and Kaznelson have classified their patients it will be of interest to 

 observe some of the cases in the first three groups. They are as follows : 



Temperature under 37 C., Group I Carcinoma, 4 



(98.6 F.) (Normal) Secondary Anemia, 1 



Myotonia (Thomsen's Disease), 1 

 Diabetes, 2 

 Influenza, 1 



