TYPHOID AND PARATYPHOID FEVER 167 



temperature has been observed, daily remissions in the temperature 

 curve will set in after a single injection; in others the average height 

 of the temperature curve may be altered so that from a continuous 

 temperature of about 102 F. the temperature after the injection 

 will have a level around 100 F., as though the heat regulation had 

 been attuned to a new level. 



The question of the mechanism of recovery brings with it the 

 query, When is the patient cured? Does freedom from symptoms con- 

 stitute cure? It has been pointed out that after the therapeutic crisis 

 a positive blood culture may still be obtained, the spleen may still 

 be palpable for a few days, the roseola remains a short time, the diazo 

 reaction may persist, etc., the while the patient will be free from 

 fever and in excellent condition. As a result of the treatment the 

 body does not react to the typhoid bacteria. It is desensitized, not 

 necessarily free from the infection. Very likely, though, a similar 

 condition obtains frequently during normal recovery from typhoid 

 fever as is evidenced by the persistence of bacteria in the bile tracts, 

 the gastro-intestinal and urinary systems or in the isolated foci that 

 may become manifest weeks after the clinical recovery from the febrile 

 course. As a matter of fact Holler found no cases of carriers in his 

 350 cases of typhoid fever treated with proteoses, and Herz states 

 that typhoid carriers can be freed following protein therapy. Re- 

 lapses occur occasionally, but Liidke observed that these were much 

 milder in character and of shorter duration than in untreated cases. 

 Bresler in his review of modern typhoid treatment brings out the 

 fact that the small number of relapses in cases treated with non- 

 specific injections is quite apparent and he also believes that a dis- 

 tinct improvement of the circulation takes place even when there has 

 been no direct effect on the temperature. 



The observation of Wiesner to the effect that the typhoid ulcers 

 commence healing immediately after the therapeutic injection is of 

 interest in this connection. From the therapeutic standpoint it is 

 naturally important that the patient, even after defervescence, should 

 oe kept quiet in bed for* at least ten days and longer if there is any 

 evidence of myocardial impairment. 



Therapeutic Precautions. There are three chief dangers that must 

 De kept in mind in the treatment of typhoid fever by nonspecific 

 therapy. The first concerns intoxication. When we are dealing with a 

 profoundly toxic patient we must be reasonably certain that he is able 

 to bear the increase in intoxication which seemingly occurs after the 

 nonspecific injection and which is probably due to a rapid destruction 

 of typhoid bacteria. We have observed one such case in a profoundly 

 intoxicated, obese typhoid patient who, despite the gravity of the risk 

 involved, was injected with a small dose of proteoses and died within 



