232 PROTEIN THERAPY 



less severe reactions could be used over a longer period of time, as 

 suggested by Van Alstyne. 



More recently Klingmueller has reintroduced the injection of 

 turpentine as a method of treatment of skin diseases. Turpentine 

 has, as it will be recalled in connection with the work of the "Fixa- 

 tion abscess," been used before in therapy as a subcutaneous injec- 

 tion. Klingmueller, however, has modified the procedure so that quite 

 minute amounts are injected over a long period of time. By this 

 method 20% turpentine is dissolved in olive oil and injections of 

 about 4 drops (0.01 turpentine) are made at 3-day intervals. Karc 

 and others have improved the method by adding a minute amount 

 of eukupin or novocain to the oil mixture in order to prevent any 

 discomfort to the patient. 



Klingmueller found that the injections were followed by favorable 

 effects not only in trichophyton infections, but in acne, acute derma- 

 titis, eczema, salvarsan dermatitis and strophulus as well. In lupus 

 vulgaris and in tuberculous glands he observed typical focal reactions. 

 There was no evidence of kidney irritation following the injections. 



A number of observers have worked with this method. Thus 

 Holzhauser and Werner reported excellent results in the treatment 

 of leg ulcers and impetiginous skin conditions. Appel, too, has tried 

 it in a series of cases. In all the staphylococcic infections (furuncu- 

 losis, acne-like eruptions and pyodermia, in moist eczema, in pruritus 

 universalis, both essential and symptomatic and in urticaria) Appel 

 reports quite remarkable improvement in most cases. Lupus reacted 

 to the injections just as it does to tuberculin. In the deeper nodules 

 of trichophyton infection a gradual lessening of the infiltration and 

 size of the foci was noted. Gewalt reports the treatment of pemphigus 

 by the same method. 



Lowenfeld and Paulay have made a very careful study of tri- 

 chophyton infection, treating cases with three different methods, one 

 series on a strictly specific basis with trichon, an autolytic product* of 

 the infecting organism; one series with a nonspecific protein tuber- 

 culin; the other with a nonspecific chemical agent turpentine, recog- 

 nizing, of course, that when injecting the turpentine it represented a 

 form of protein therapy, in this case homologous protein from the 

 inflammatory focus produced by the turpentine. There was little or 

 no difference in the therapeutic end result whether the specific or 

 nonspecific methods were used. The deeper nodular infiltrations were 

 gradually absorbed under the course of the injections, the more super- 

 ficial lesions showed less improvement. Lowenfeld and Paulay sug- 

 gest that this result is to be expected in that the more superficial 

 lesions, like those of favus, microsporia, pityriasis versicolor, ery- 

 thrasma, etc., are much less susceptible to the general metabolic 

 change that is brought about either by specific or nonspecific therapy. 



Fischl treated 50 cases of trichophyton infection with turpentine 



