TYPHOID AND PARATYPHOID FEVER 161 



In 120 cases so treated the severity of the disease was roughly as fol- 

 lows (50 cases of mild disease were not treated at all) : 



63 moderately severe; typhoid 2 ; Para "A" 35 ; Para "B" 4 ; undetermined 22 



23 severe; " 5; " 11; " 1; " 6 



9 very severe; " 2; " 4; " 1; " 2 



Of the typhoid cases many had had a prophylactic injection shortly 

 before their admission to the ward. (There was probably no vaccination 

 against paratyphoid, although it is not specifically stated in Galambos' 

 paper.) 



The results of the methylene blue therapy was as follows : 



In 13% lysis set in immediately after the treatment. 

 26% lysis somewhat more delayed. 



13% favorably influenced, but not much effect on temperature. 

 44.6% not influenced. 

 3.4% died. 



Compared to the results with the vaccine therapy before used the mor- 

 tality was somewhat less but the general effect on either critical or lytic 

 termination of the disease not so apparent. 



When one comes to study the comparative value of the intravenous 

 method of therapy as contrasted with the subcutaneous injection of 

 vaccine in the treatment of typhoid fever, the statistics of Barrenscheen 

 are of value. 



Barrenscheen treated over 200 cases of typhoid, using Besredka's vaccine 

 intravenously as well as subcutaneously; a small series was also treated 

 with the Vincent vaccine subcutaneously. 



Unfavor- 



Cured ably Infl. Not Infl. Died 

 Besredka Intravenously 



136 cases 87 = 63% 5 = 3.6% 34 = 25% 10 = 7.35% 



Besredka Subcutaneously 



52 cases 26 = 50% 3 = 5.7% 17 = 32% 6 = 11% 



Vincent Subcutaneously 



19 cases 4 = 21% 3 = 15% 12 = 63% = 



The intravenous dose was 100 million (sensitized vaccine) and if the 

 patient was not afebrile after the first injection a second dose was given 

 after two or three days; no more than three doses were given, because 

 Barrenscheen found that if the patient was refractory it was useless to 

 continue. In 30% of the cases a critical termination of the disease was 

 obtained after a single injection. 



For subcutaneous injection he used 500 million organisms, followed 

 two days later by 1,000 million if there had been no effect on the temper- 

 ature. This dose was increased somewhat for the third injection but he 

 never gave more than a total of 9,000 million organisms during the entire 

 course of the treatment. 



As a result of his experience Barrenscheen considers, as other observers 



