202 PROTEIN THERAPY 



With typhoid vaccine and old tuberculin a similar reaction and ef- 

 fect was obtained, just as one finds that as a result of intercurrent 

 infections, pneumonia, etc., the symptomatology of the trench fever 

 may almost completely disappear. The nonspecific injections, accord- 

 ing to Jungmann, had no direct effect on the course of the disease 

 other than described. 



Kirchberg, on the other hand, who used collargol intravenously, 

 states that during the time that the patients were under observation 

 there was no return of the fever after the injections, and the anemia 

 was also markedly improved. Richter, too, found that collargol in- 

 jections were followed by satisfactory results. 



TUBERCULOSIS 



In the discussion of the focal reaction and the relation of the 

 skin reactions to nonspecific factors, evidence has been presented that 

 tuberculins are active as non-specific agents and it should be kept 

 in mind that their therapeutic effect can be accounted for largely 

 on such a basis. In a general way the experience with tuberculins 

 has been the following: Large doses in active cases cause a 

 rapid progression of the disease, with cavity formation, increased 

 tendency to hemorrhage, etc. Even small doses in active cases are 

 not without some danger. In the inactive cases large doses may acti- 

 vate the focus ; moderate doses may be followed by an improvement, or 

 no apparent effect on the focus. In incipient cases large doses may 

 occasionally be followed by complete and rapid recovery; more often 

 though the effect is a harmful one. 



Keeping in mind the fact that resistance to tuberculosis is largely 

 cellular and that the effect of nonspecific stimulation is always at 

 first associated with increased digestive phenomena, we might antici- 

 pate these effects. An active process will be made more active, an 

 inactive one may be activated; on the other hand, a small incipient 

 lesion may, by activation, digestion, etc., occasionally be rapidly 

 healed. 



In a general way this agrees with the experience that has been 

 gained with protein therapy in the treatment of pulmonary tuberculosis. 



Holler found that while early cases may react well and there may 

 be an increase in the general resistance, advanced cases may give 

 noticeable evidence of autolysis and extended cavity formation. 

 Mueller found that if he treated cases with slight apical lesions 

 and only moderate evidence of activity, the entire process might be 

 cleared up after a few injections of milk. Naturally in such cases 

 we bring about a decided focal reaction and the organism must be in 

 physical condition to withstand and detoxicate all the necrotic ma- 

 terial that is liberated by the digestion at the point of infection and 

 to destroy bacilli that are freed in the process. If it cannot do this 

 we will merely spread the infection. 



