162 PROTEIN THERAPY 



also do, that the first week or ten days of the illness offers the best time 

 for treatment; after the third week he considers it not only valueless but 

 dangerous (because of the danger of hemorrhage or perforation). 



He does not give it in any cases where the pulse is over 100, where 

 there is any evidence of lung complication or where a tendency to hemor- 

 rhage is present nose-bleeding, blood in stool, etc. If these conditions 

 are observed the mortality would be even lower than that obtained in his 

 series, for many of his results that were unsatisfactory were the result of 

 his earlier efforts when he was not sufficiently experienced. In only one 

 case did he find that death was due to a complication resulting directly 

 from the injection. This was a perforation that came to notice immediately 

 after the injection. 



In four cases a rather widespread roseola was observed shortly after 

 the injection. It had no further significance but might disturb an inex- 

 perienced clinician. 



The intravenous injection seemed much superior to the subcutaneous, 

 not only apparent in the statistical result but because of the prompt bet- 

 tering of the general condition of the patient. Headache and insomnia 

 disappeared, the appetite improved and the mental conditions always cleared 

 up. On the other hand this effect was never so apparent after the subcu- 

 taneous injections and there seemed no doubt in his mind that the effect 

 of the subcutaneous dosage was bad on the pulse. Both after the Besredka, 

 more frequently after the Vincent vaccine the ill effect on the pulse was 

 observed and in some instances stimulants had to be generously used before 

 the equilibrium was restored. 



Following the intravenous injections the usual reaction was observed, 

 with temperature reactions from 40 to 41 C. (104 to 105.8 F.), in one 

 instance to 41.9 C. (106.3 F.). The pulse never went over 120 and 

 always remained of good quality and the patient without evidence of cardiac 

 impairment there was no dyspnea, cyanosis, etc. After the second injec- 

 tion the temperature response was not as high as with the first, nor was 

 the leukocyte count altered as much. 



During convalescence the patient should be kept rigidly in bed, at least 

 for a week after the temperature has been normal, and careful attention 

 given the diet and the bowels. In several cases where the patient became 

 constipated a temperature reaction was observed which lasted several days. 

 Occasionally a pronounced bradycardia was found during convalescence. 

 Pulse counts as low as 36 to 50 were not uncommon in these cases, while 

 an arrhythmia was at times present. Barrenscheen is under the impression 

 that no myocarditis was present in his cases, but the fact that he lost two 

 cases who got up and walked around two days after their recovery by crisis 

 might lead one to think otherwise. 



Grote treated 24 cases of typhoid with milk injections with good 

 results but came to the conclusion that the injections must be given 

 early if they are to be effective. 



Mark White has reported on the treatment with normal horse 

 serum; E. F. Muller on the use of casein injections, both with favor- 

 able results. Ullmann treated typhoid with "Dispargin," a silver 

 colloid; Salomon has reported favorable results in 141 cases treated 



