188 PROTEIN THERAPY 



slight colic, and at the site of injection a little infiltration with moderate 

 pain. All these sequela soon pass away and, as a rule, disturb the patient 

 but little. 



"VACCINOTHERAPY IN OLD CHRONIC CASES 



"In the winter of 1917-1918, we still were receiving cases of chronic 

 dysentery of which the onset dated back several months or several years. 

 We applied the same treatment, but with this difference, namely, that the 

 initial dose was regularly a million germs, and that the dose was raised 

 progressively up to from 5 to 10 billion. The results obtained continued to 

 be favorable. In every case the general condition was improved, and the 

 intestinal symptoms steadily decreased. In the majority, the cure was com- 

 plete and definite. At times there seemed to be complete cure at the end 

 of the treatment, but at a later period the symptoms returned. In some 

 cases the stools, although regular and only one or two a day and without 

 blood and mucus, yet remained soft, and there persisted a little intestinal 

 instability and discomfort. 



"We should probably have continued the subcutaneous method of ad- 

 ministration of the vaccine, had we not, in other affections, particularly 

 bacteriuria due to the colon bacillus or the staphylococcus, observed that 

 the intravenous method of administration was more efficacious and more 

 rapid in its effects. We therefore began the administration of the vaccine 

 by the intravenous route in bacillary dysentery, 



"THE INTRAVENOUS METHOD IN ACUTE DYSENTERY 



"We applied the treatment not only to those with confirmed ulcerative 

 dysentery, but also to all those in whom the course of the disease made 

 one fear the development of the ulcerative form, that is to say, in every 

 case in which, after one week, a dietetic and drug treatment had not 

 brought about a cure, or at least promise of a speedy cure. 



"The doses were given at four-day intervals, the initial dose being regu- 

 larly 10,000 germs, then 30,000, then 50,000, then 1,000,000, etc. In general, 

 the betterment of the patient did not long delay. The fever dropped by 

 lysis, with some recrudescences more or less marked on the days of the 

 vaccine therapy and the next day; and the intestinal symptoms improved 

 coincidently. In many cases of moderate intensity a complete cure was 

 effected when the dose of 500,000 was reached. In the more refractory 

 cases, it was necessary to push the vaccine up to about 10 million. 



"In fifty-two cases treated in this way, we had only two deaths. All the 

 other patients left the hospital cured, except two whom military necessity 

 forced us to send away too soon. We have no doubt that in these two 

 cases also the continuation of the treatment would have resulted in a 

 cure in a relatively short time. By vaccinotherapy we were thus able to 

 avoid the dangerous tendency toward chronicity which in 1917 was pro- 

 duced in a considerable number of our patients. This last result we 

 considered particularly gratifying. 



"The complete record of the epidemic of bacillary dysentery of 1918 shows 

 a complete cure, at the latest in a few weeks' time, in 500 cases except only 

 two patients who died, and two who had left before the cure was complete. 



