TYPHOID AND PARATYPHOID FEVER 169 



consequent danger of hemorrhage and perforation by using opiates be- 

 forehand. There seemed to be little control, however, of the in- 

 crease in peristalsis. Zupink, Miiller and Leiner, Matko and Holler 

 stimulated their cases with caffein given before the injections. 



If the pulse is over 100 and there are evidences of vasomotor 

 instability, if the patient is profoundly toxic or cachectic, if there 

 has been any bleeding epistaxis, gastro-intestinal, etc., if cyanosis 

 is present, if the disease has continued for several weeks before treat- 

 ment is commenced, or if there is any evidence of pneumonic compli- 

 cations, it is not advisable to try nonspecific therapy. If given under 

 such conditions the clinician must consider the dangers involved 

 and seriously weigh the chances for collapse or hemorrhage or per- 

 foration and determine whether or not they are overbalanced by 

 possible advantages, 



PARATYPHOID FEVER 



It will be recalled that Ichikawa treated a number of paratyphoid 

 cases with typhoid vaccine with good results. 



Holler in his series of infectious diseases treated 140 cases of 

 paratyphoid fever with small daily injections of deutero-albumoses. 

 There were 7 deaths in this series. 



The indications and contra-indications are those that have been 

 discussed under the subject of typhoid fever. 



