160 PROTEIN THERAPY 



and gonococcus organisms were injected, 250 million of the staphylo- 

 coccus, in order to obtain a satisfactory reaction. 



When 100 c.c. of physiological salt solution was injected a defer- 

 vescence was obtained in 70% of the cases. 



In the total series the mortality was 6% and the results can be 

 summarized as follows: 



Critical defervescence 22% 



Prompt lysis 22% 



Marked improvement 18% 



Moderate improvement 9% 



No effect 28% 



As a result of his investigation Galambos inclined to the treat- 

 ment with protein split products. 



The treatment by salt solution injections was first reported by 

 Englander. Englander while treating a bleeding typhoid case injected 

 about 300 c.c. of salt solution intravenously and found that this was 

 followed by a typical chill and a defervescence the following day. 

 Mitlander later reported on the same method. 



Comparative Results. Galambos who studied the intravenous 

 therapy of typhoid and paratyphoid fevers with Besredka's vaccine and 

 with albumose, hetero vaccines and salt solution, as just mentioned 

 reported later on the treatment of 120 cases with methylene blue. 



He considers intravenous treatment limited in its application for sev- 

 eral reasons: it requires a certain degree of skill and experience on the 

 part of the physician, who must rule out contra-indicated cases myo- 

 carditis, pneumonic complications, etc.; there are associated with the in- 

 jections certain dangers of hemorrhage and of collapse (from 1% to 2%) ; 

 the substances used are not chemically defined and experience must be 

 gained with the dosage before one can be fairly safe in using the method. 

 This came to Galambos' attention when he reviewed his earlier and his 

 later results with nonspecific therapy. In his last 50 cases where he used 

 only a small dose of Besredka vaccine intravenously (}4 c.c.) he had no 

 hemorrhage or collapse at all, and he likewise had no ill effects in his 

 series of 60 cases treated with albumoses. The intravenous injection of 

 larger amounts of salt solution was found too cumbersome for routine 

 use. 



To overcome some of these practical objections he began the use of 

 methylene blue, which, being a chemically defined substance, could be 

 standardized, and while, being a protoplasmic stimulant as the others, could 

 be given by mouth without a marked reaction. He gave 1.2 gm. per day 

 in doses of 20 cgm. every 4 hours. The effect on the temperature was 

 usually apparent in a few days, usually declining by lysis. The euphoria 

 so commonly observed in nonspecific therapy was apparent in most in- 

 stances. The medication was continued some days after the temperature 

 reached normal. If discontinued too early an occasional recrudescence 

 was noted. 



