TYPHOID AND PARATYPHOID FEVER 157 



three hours after the injection. An autopsy was performed which 

 revealed typical typhoid lesions in the small intestine, pneumonia, and 

 myocarditis. The patient had been brought to the hospital uncon- 

 scious and desperately ill, and a poor risk. Paltauf, at whose re- 

 quest Biedl and Eggreth had reported their experiences from the 

 military hospitals, uttered a word of warning, as he had heard of 

 a few instances of collapse following the intravenous use of Bes- 

 redka's vaccine. 



In the earlier experience collapse and even death after the intra- 

 venous injection of relatively large doses of typhoid and other toxic 

 vaccines was not uncommon (Kraus and Mazza, Boral, v. Reuss) and 

 the caution expressed by Paltauf is more than justified. The early 

 doses were tremendous and would put even a healthy individual to 

 considerable strain; that patients severely ill would occasionally suc- 

 cumb to the treatment was therefore not unexpected. 



At a meeting of the Gesellschaft fur Aerzte in Wien (June 18, 

 1915) a number of clinical reports were presented which are of in- 

 terest. Nobel treated 14 cases of typhoid with intravenous typhoid 

 vaccine injections. Of these 11 were cured after one injection, 3 

 died. Zupnik, who used typhoid, meningococcus and albumose in- 

 jections, brought out the fact that small doses were much prefer- 

 able to the larger ones heretofore used, because the therapeutic re- 

 sult was just as good and the danger to the patient much less. Fleck- 

 seder treated 41 cases of typhoid with intravenous injections of Bes- 

 redka vaccine. Of these 21 cases proved refractory. In 20 cases 

 the temperature came down after several injections. He used fairly 

 large doses and saw several cases of vasomotor collapse. In two 

 cases a hemorrhagic nephritis developed. He therefore considered the 

 treatment of doubtful value, particularly in severe cases. Stoerk 

 used albumoses and obtained results that were similar to those ob- 

 tained with typhoid vaccine. 



Meyer reported a series of cases treated with typhoid vaccine 

 with typical results but in a later discussion is rather inclined to think 

 that the intravenous injection of typhoid vaccine is too strenuous. 

 He has come to the conclusion that some of the milder agents will be 

 found much more satisfactory for general use. Lucksch has reached 

 the same conclusion. Other earlier reports are those of v. Czylharz, 

 v. Czylharz and Neustadtl, Neustadtl, Reibmayr and Decastello, 

 Sladek and Kotlowsky. 



Reibmayr and also Decastello reported on a series of cases 

 treated with cholera and colon vaccines. In Decastello's cases he 

 injected 30 million organisms (colon) which gave a sharp reaction. 

 In 10 cases of typhoid fever 4 responded by defervescence by crisis, 

 1 by lysis after the first injection. Three more cases became normal 

 by lysis after the third injection; in two cases there was no effect 



