THE PROBABLE MECHANISM OF THE REACTION 123 



Now let us observe the effects of the nonspecific reaction in this 

 disease. 



In the case illustrated in Figure 7 the patient was admitted 

 to the hospital on the 5th day of April, 1917, with a history of ill- 

 ness for 5 days previous to admission. The diagnosis on examina- 

 tion was a frank lobar pneumonia of the upper left lobe. Two days 

 after admission he was given a small dose of typhoid vaccine intra- 

 venously (25 million) following which he experienced a slight chill, 

 some rise in temperature and then a fall in the temperature until 

 the next day when it remained normal for several hours in the morn- 

 ing. After this remission it rose again by the evening and then 

 came down by lysis at about the normal time. 



This, it may be as stated, is a typical result, and portrays the 

 experience that we have had when small doses of vaccine are so 

 administered. There are usually a moderate chill (not as severe as 

 in typhoid, for example), a slight rise in temperature, then a critical 

 drop in the temperature and a normal temperature curve for several 

 hours. Usually the former or a temperature slightly lower than that 

 observed preinjectionally is then maintained and the disease continues 

 its unaltered course. Euphoria, a decided clearing of the sensorium, 

 improvement of the pulse and of the vascular tone of the patient are 

 commonly observed after the injection if it has not been too great 

 in dosage. The physical findings of the chest are as a rule not 

 altered. 



Miller summarizes his experience with 15 patients so treated as 

 follows : 



"Fifteen consecutive patients with lobar pneumonia entering Cook 

 County Hospital were treated by a single intravenous injection of typhoid 

 vaccine. The dosage used was 30 millions, the minimum amount required 

 to give a chill. All reacted by a rise in temperature and a leukocytosis. 

 In nine patients the vaccine did not modify the course of the disease. In 

 six, the patient was detoxicated following the injections. The pulse, tem- 

 perature and respiration returned to normal, the cough and pleural pain 

 subsided, and the patient stated that he felt much better. In three of the 

 six cases the improvement was temporary, as after the lapse of from twelve 

 to twenty-four hours the symptoms returned with unmodified severity. 

 In three cases the detoxication was permanent; however, the patients had 

 a moderate temperature for from three to four days, to the time at which 

 the crisis would normally appear. They were, however, entirely free from 

 evidence of intoxication. There was no relation between the severity of 

 the chill, the temperature reaction and degree of increased leukocytosis, 

 and the beneficial results of the vaccine." 



One might characterize the changes as a temporary detoxication 

 that leaves the general course of the disease process unaltered, a 

 result that might be anticipated from the pathology. The biological 

 alterations previously described, i.e., the enzyme mobilization, the 



