INFECTIOUS DISEASES 189 



"CONCLUSIONS 



t{ I believe I am justified in concluding from these observations that vac- 

 cinotherapy and more especially vaccination intravenously is the most ef- 

 fective therapeutic method in bacillary dysentery in its chronic forms and 

 in the acute forms that show little tendency toward cure. It appears also 

 that the method is more efficacious when it is applied early. The intra- 

 venous route has the advantage that it permits results from doses one- 

 thousandth the size of the subcutaneous doses. Not having had occasion to 

 try this method in cases of Shiga bacillus desentery, it is impossible for me 

 to speak of its utility in this form of dysentery. 



"In acute dysentery, intravenous vaccinotherapy cures quickly in cases 

 exhibiting protracted fever and lasting diarrhea with hemorrhagic and slimy 

 stools, these being the cases that are refractory to other therapeutic meth- 

 ods, including serotherapy." 



Of course, the bacteriotherapy is not a specific procedure ; the same 

 effect can be obtained when the reaction is produced by any of the 

 other agents. 



Milk injections, first used by Adler in dysentery and cholera, 

 were also used by Dollken, who employed them because of the marked 

 styptic effect following intramuscular injections; he did not, how- 

 ever, observe any actual change in the coagulation time of the blood 

 of dysentery patients before and after the treatment. It is to be 

 assumed that in the early stages of dysentery when hyperemia and 

 engorgement of the mucosa are not yet pronounced and where we 

 are dealing merely with small petechial hemorrhages and a hyper- 

 secretion, the injections will be followed with the best clinical result 

 and this is actually found to be the case in clinical practice. 



Dollken injected 5 c.c. of milk intramuscularly (occasionally less). 

 Sometimes after 5 or 6 hours a definite focal reaction was to be 

 observed in the form of increased evacuations containing more blood. 

 The recovery was very prompt after this period. Usually the first 

 day after the injection the blood was considerably less, even absent 

 in some stools. This was observed to continue after the second in- 

 jection. Usually after 5 days blood was no longer present. The 

 spasm of the small bowel was almost always relieved after the first 

 injection; the tenesmus in 4 or 5 hours after the first injection. An 

 interesting fact was noted in regard to those cases that had had al- 

 buminuria. This was invariably gone after the injection. 



Contrary to the experience of Nolf, Dollken did not observe much 

 effect on the temperature curve after the milk injections, although 

 in some cases a defervescence was noticed after the second injection. 

 In cases treated with specific sera and vaccines this same lack of ef- 

 fect on the temperature of course holds true. 



In more advanced cases the ulceration does not yield to treatment 

 so readily. After about 5 days, however, improvement is noted in 



