TYPHOID AND PARATYPHOID FEVER 165 



the patient. The agglutinin titer, which has been most often studied, 

 is normally found to be rather high after the early stage of typhoid 

 fever is passed and after nonspecific injections it is at times increased, 

 at other times diminished. Nor does the increase or decrease bear any 

 relation to the therapeutic result. Thus Rohonyi found that in some 

 of his patients who had recovered after a single injection by a critical 

 drop in temperature, there was no increase in the agglutinins, in 

 opsonins or in bacteriolysin; indeed in some cases he was able to 

 get a positive blood culture two days after the patient was clinically 

 free from every evidence of active disease an observation which 

 Decastello has not been able to confirm. Llidke was not able to de- 

 termine any constant increase in the amount of agglutinins or of 

 opsinins after his deutero-albumose injections. Baluit observed no 

 change in the agglutinins or the bacteriocidal antibodies, but obtained 

 some evidence that the opsonins were increased. Svestka and Marek 

 found no increase in agglutinins. Flechseder on the other hand claims 

 to have observed an increase in agglutinins after albumose injections 

 in typhoid fever. 



While it is apparent that the inconstant results exclude the anti- 

 bodies as sole factors in the recovery, the possibility that their sud- 

 den flooding of the lymph spaces after the permeability of the 

 capillaries is increased following the protein shock may be a vital 

 factor in overcoming the infection. 



Whether or not cell receptors (sessile antibodies that may have 

 increased in amount following immunization or infection without their 

 being cast off into the general circulation) are under shock conditions 

 mobilized and in this way increase the titer after nonspecific therapy 

 is here a point at issue. That rabbits immunized to some specific 

 bacterial or other protein may, on nonspecific stimulation, respond by 

 the "shedding" of the specific antibody is an old observation. Dieu- 

 donne observed that rabbits immunized with typhoid bacilli and 

 then injected with "Hetol" responded by an increase in the antibody 

 production. Solomonsen and Madsen found the same true of diph- 

 theria horses after pilocarpin injection, and Obermeier and Pick found 

 that an injection of 5% or 10% peptone increased the agglutinin 

 titer of rabbits immunized more than 3 months previously. Kutcher 

 has observed that patients immunized to typhoid and cholera will 

 show an increase in the agglutinins for dysentery (paraspecific ag- 

 glutinins) and the mass immunization of large bodies of men with 

 typhoid vaccine gave opportunity during the course of the war to 

 observe that many varieties of shock (acute infectious diseases of 

 various kinds, etc.) were followed by a flooding of the serum of such 

 individuals with large amounts of agglutinins. Conradi and Bieling 

 and also Johnson made experimental observations along the same 



