TYPHOID AND PARATYPHOID FEVER 155 



cured. Kraus suggested the extension of the method of treatment 

 to a number of diseases such as scarlet fever, plague, septicemia, etc. 

 Other reports were soon published dealing with nonspecific therapy 

 in typhoid fever; most of the observers first used typhoid vaccine. 

 Thus Rhein tried it in 33 cases. He prepared his vaccine as follows: 

 To 5 c.c. of Halle typhoid vaccine and 0.5 gm. pure phenol, physio- 

 logical salt solution was added to a volume of 100 c.c. Of this prepa- 

 ration he employed 0.6 to 1.4 c.c. diluted with 8 c.c. physiological 

 salt solution for intravenous injection. Within one to two and a 

 half hours a rise in temperature and a chill of varying severity and 

 duration (five to thirty minutes) occurred in 94 per cent, of the 

 cases. Injections were made only in patients in whom the diagnosis 

 was clear clinically or bacteriologically. Three of the patients treated 

 showed paratyphoid bacilli A in the blood. Patients exhibiting the 

 steplike curve of defervescence were excluded, as were also those 

 suffering with complications such as pneumonia, pleurisy, nephritis, 

 or myocarditis. Status typhosus, with delirium and bronchitis, but 

 with good pulse, was not looked upon as contra-indication for injec- 

 tion of vaccine. Thirty -three patients received the injections and 

 6 of these had a second injection. In 9 cases there was a critical 

 fall of temperature within one day after the first injection and in 

 1 case after the second. In 13 cases a favorable effect on the tem- 

 perature curve was noted after the first injection and in 3 cases after 

 the second injection. In 8 patients there was no effort whatever on 

 the temperature curve, and in 2 of these a second injection was also 

 without visible effect. On the other hand, 3 patients who were un- 

 affected by the first injection reacted favorably after the second. 

 In the 3 cases of paratyphoid fever a critical fall of temperature was 

 not observed, but there was a gradual lowering in the fever. Of 

 the patients injected, 3 died; in none could the death be attributed 

 to the injection. Of all the patients treated, only 1 suffered from 

 intestinal hemorrhage, which occurred six days after the injection. 

 Other complications were not observed in the injected patients. No 

 evidence of collapse even in patients with weak pulse was seen. The 

 reaction of the patient to the injection was studied with relation to 

 the following clinical signs or symptoms: Bronchitis, palpable spleen, 

 roseola, diazo-reaction, leukocyte count, eosinophil count, and bac- 

 teriemia. A favorable response to the injection could not be corre- 

 lated with any of these. However, after crisis, comparatively many 

 eosinophils (100 to 200 per c.mm.) appeared in the blood in twenty- 

 four hours in spite of the leukopenia, and the diazo test remained 

 positive as long as three days after the temperature was normal. It 

 was noticeable that with larger dosage (4 c.c.) the crisis was of 

 shorter duration. Since no ill effects followed the injection, and, on 

 the contrary, in 48 per cent, of the cases the fever was shortened 

 and in 30 per cent, cure followed within two days, Rhein believed 



