THE NONSPECIFIC REACTION 51 



went on to a complete recovery from his typhoid in two days. 

 Cyanosis is but infrequently noted in the literature. Gow has re- 

 cently studied the pulse rate in patients receiving peptone injec- 

 tions intravenously. He finds that the higher the leukocytosis, the 

 greater the rise in pulse frequency after injections. The increase in 

 pulse rate in his cases varied from 5 to 20 beats per quarter minute. 

 The pulse frequency returned to normal in from 3 to 5 minutes after 

 the injections. With vaccines these effects are of course greatly delayed. 



The character of the pulse and its rate is of decided importance in de- 

 termining which cases are suitable for injection. In typhoid a rapid pulse 

 rate (over 100) is a contraindication to nonspecific therapy. Experimen- 

 tally it has been shown that small doses of proteoses stimulate the heart 

 muscle, the amplitude and the force of the beat being increased (Weichardt). 

 In several cases of long-standing heart lesions associated with arthritis 

 we have watched the size of the heart after nonspecific injections both 

 during the acute reaction and the defervescence. In these cases the left 

 border went out about 1 cm. and returned to the preinjection size in from 

 24 to 48 hours. The patients showed no evidences whatever of any cardiac 

 decompensation. Naturally only cardiac patients that were in good con- 

 dition were selected for the injections. 



The Blood Pressure. Scully was one of the first to undertake sys- 

 tematic studies on the blood pressure of patients after typhoid vaccine 

 injections. It is of course quite difficult to obtain an accurate reading 

 during the time that the patient has a chill, but enough observations 

 have been recorded to indicate that there is a slight increase in blood 

 pressure during this time. When the chill has subsided and the period 

 of perspiration sets in, the blood pressure shows a progressive decline 

 of from 10 to 25 mm., reaching a maximum in from 6 to 8 hours, 

 and returning to the normal pressure within 24 hours. Considerable 

 variation is noted, however, in individual cases, depending on the 

 dosage, the agent used and the infection of the patient. . 



When injections are given to a typhoid patient in the later stages 

 of the illness, where evidence of an unstable vasomotor system fol- 

 lowing the long continued toxemia is apparent, we have observed a 

 vasomotor paralysis extending over a period of 48 hours and very 

 refractory to stimulation. In one such case the systolic pressure 

 sank to 55 mm. and remained very low for 24 hours. This patient 

 had been running a very high typhoid temperature for 4 weeks with- 

 out any evidence of improvement. Following the recovery from the 

 injection his temperature remained normal and the patient made a 

 complete recovery. 



A number of factors enter into the effect on the blood pressure. 

 It has been noted for instance that the subcutaneous injection of 

 relatively large doses of typhoid vaccine Besredka or Vincent 

 during typhoid fever, while it has a much less apparent effect on 

 ftie patient in ftie form of chill, fever and sweating, seems to be 



