150 PROTEIN THERAPY 



As Miller states, it is necessary always to start with a minimum dose 

 of vaccine until its toxic index has been gauged. The writer has 

 heard of a fatality resulting from the intravenous use of typhoid 

 bacilli. The reaction is so severe that it would, offhand, appear that 

 the margin of safety was a narrow one. On the other hand long 

 series of cases so treated have been reported by Miller and Lusk, by 

 Cecil and other American observers. 



As for the use of unknown quantities of mixed organisms with 

 no means of duplicating surely the strains used, it would seem ex- 

 tremely hazardous to use such products intravenously ; and where such 

 severe reactions are concerned, very difficult in any event to judge 

 dosage. 



It would appear safer to use a definite compound as suggested 

 by Jobling (proteoses) where the dose can be accurately determined 

 by weight and where stability can be assured. 



The writer has used formaldehyd intravenously to accomplish 

 the same reaction. The toxic agent introduced here is probably 

 a combination of formaldehyd and serum protein. The systemic re- 

 sults are similar to those accomplished by the bacterial injection. 

 Two years ago the writer with his resident physicians at the Phila- 

 delphia General Hospital treated 29 cases of acute and chronic ar- 

 thritis by this method. In these cases careful search was made for 

 signs of renal changes, blood breakdown or other signs of renal 

 damage but we could find no evident bad effects. 



It might be said that while bad results have not been shown to 

 follow careful intravenous therapeutic measures we are dealing with 

 a most potent agent and the safety of this procedure has not been as- 

 sured. It is probably not justifiable to employ this method of treatment 

 routinely unless more is to be accomplished than simple relief of the 

 arthritis. In most cases salicylates and good nursing will accom- 

 plish this result in a few days' time. 



(b) As regards the second query, Is the development of carditis 

 prevented or favorably influenced by this form of treatment? a 

 much larger collection of cases will be necessary before this question 

 can be answered. It is said that established active endocarditis is not 

 eradicated; further, that when endocarditis is present arthritis tends 

 to recurr after intravenous treatment, showing that the infection re- 

 mains. 



The writer has not used intravenous therapy in cases with severe 

 endocarditis or in those showing evidence of severe myocardial de- 

 generation. The patients were selected as a rule among younger 

 adults either refractory to salicylates or showing a very severe degree 

 of arthritis, or those who, having observed results in other patients, 

 requested this form of treatment. These patients were usually la- 

 borers from railroad construction gangs or workers in munition plants 

 and it has been impossible to follow up these cases properly, but 



