ARTHRITIS 151 



it must be said that at the time of leaving the hospital none of them 

 showed any serious cardiac damage. We endeavored to keep all 

 rheumatic patients in bed for three weeks after the temperature 

 reached normal and succeeded in most cases in doing so. 



Any measure that will protect against carditis will be of tremendous 

 importance and while in this case we may be merely clutching at 

 a straw the subject should be studied carefully. It is recognized that 

 infection is prone to implant itself upon the heart in which there has 

 been tissue damage and it is more than possible that endocardial 

 damage results first as a toxic expression, as it may in the joints, and 

 that the liability of a permanent infection may be reduced by the 

 detoxicating action of the allergic response. The writer's feeling is 

 that serious cardiac trouble is less apt to develop when this form of 

 therapy is used. Realizing the risk attendant on its use he is still 

 i Alined to try it on young and vigorous individuals where the 

 myocardium is not greatly damaged." 



This conservative resume of Torrey's is quoted in full because 

 of its dispassionate and critical perspective and because it emphasizes 

 several points that should be kept in mind whether it is a dangerous 

 method of therapy; if not, is it a better method than our present 

 one, and finally, does it prevent cardiac complications? 



While we by no means believe that the goal in therapy has been 

 reached when we inject typhoid vaccine intravenously other agents 

 may be much better and may be much less uncomfortable for the pa- 

 tient yet we have never seen any ill effects from moderate doses 

 of typhoid vaccine injected intravenously when reasonable care was 

 exercised to exclude alcoholics and severe heart cases. It is considered 

 safe enough to enable one hospital to make the injection a routine 

 procedure for all rheumatic cases entering the service. 



Our present expectant therapy or salicylate therapy fails in a 

 definite percentage of cases. In a good number it is temporarily ef- 

 fective and is followed by a relapse. In others cardiac complications 

 are superimposed even during the course of the salicylate treatment. 

 It is furthermore a protracted therapy and therefore an expensive 

 one. 



Nonspecific therapy does frequently effect improvement and cure 

 of the disease where salicylates have been used without avail. 

 Usually one or two injections will disclose whether or not we can ex- 

 pect much relief by the nonspecific agent and when it is effective, it 

 is rapidly so. My own impression is that it materially lessens the 

 number of cardiac complications, although I cannot present definite 

 statistics to that end. And in terminating the disease abruptly we 

 lessen the number of chronic arthritic cases, which, once established, 

 are so intractable to treatment. 



To the clinician who is satisfied with his present method of treat- 



