148 PROTEIN THERAPY 



action is followed by the best clinical results. Of course, efforts have 

 been made to inject substances that would give the same therapeutic 

 effect without the severe reaction. Brooks and Stanton have, for 

 instance, used the lower fractions of digestion products obtained 

 from ox fibrin for injections in arthritis. With this product they 

 claim to have obtained satisfactory clinical results with practically 

 no unpleasant systemic reaction on the part of the patient. The 

 dosage of these lower split products was about 12 milligrams for 

 intramuscular injection, while one-fourth or one-third of this dose 

 was given for intravenous injection. They observed improvement 

 in all of the 8 cases of arthritis treated with this preparation. 



Their experience differs from that of the majority of the clinical 

 observers in their ability to obtain therapeutic results without marked 

 general reaction. It has been our experience in treating arthritis 

 that unless a sharp reaction was elicited at the first injection, subse- 

 quent injections would as a rule be followed by little or no clinical 

 improvement. We have felt that arthritis was one of the diseases 

 where such a sharp reaction was justified and where typhoid vaccine, 

 toxic though it is, seems to give the most brilliant results. Usually 

 the arthritic patient is an excellent risk, is not very toxic, and has few 

 centra-indications, so that a more or less heroic method of therapy is 

 entailed with less danger than in other forms of disease. 



Apart from the immediate cure of the disease another factor of im- 

 portance enters into consideration when we deal with arthritis, namely 

 the carditis that so often complicates the picture. Nonspecific therapy 

 seems to have little or no influence on an endocarditic process once 

 it is established unless small doses are given over a long period of 

 time; even then its absolute value is not certain. Single large 

 doses may at times influence the temperature of such cases for a day 

 or two, but not, as a rule, over a longer period of time (Kinsella). 

 It is probable, however, that the early termination of the arthritic 

 process by nonspecific therapy does prevent the establishment of 

 endocarditis in a definite number of cases and in the prevention, 

 rather than the cure of endocarditis, this form of therapy perhaps 

 offers a valuable aid. 



From the point of view of the hospital management of arthritic 

 cases another factor of importance must be emphasized, namely, the 

 relative cost of maintenance of the arthritic case. If by any form 

 of therapy the period of hospitalization can be shortened from the 

 average of 5 or 6 weeks to a period of a week or two, its usefulness 

 from an economic standpoint will be apparent. 



Possibly an unbiased review of the subject, such as that recently 

 published by Torrey, will be of greater value than my personal im- 

 pression, which perhaps may be prejudiced in favor of this form of 

 treatment. 



