248 PROTEIN THERAPY 



is well to give one or two fairly large injections or several smaller 

 ones. Whatever method is used it is well to be cautious, especially 

 when dealing with such toxic substances as vaccines. 



Before applying the treatment to any acute disease it would seem 

 that prudence would demand a thorough familiarity with the range 

 of the reaction and the degree of toxicity of the preparation it is 

 intended to us, by first employing it in some arthritic cases. In 

 arthritis, when we exclude alcoholics and old cardiac cases, the dangers 

 of untoward effects from the reaction are minimal and with reasonable 

 caution nonspecific therapy is not only without risk but indeed fre- 

 quently followed by gratifying clinical improvement. Only in the 

 light of experience so gained would it seem permissible for us to 

 attempt to extend this form of therapy to other acute infections. 



In general it is to be kept in mind that injections must be given 

 early in the course of the disease; that the injections should be given 

 slowly; that relatively small doses should be given the first time and 

 that care must be taken, if intramuscular injections are made, that 

 the injection is not by accident intravenous. 



For intravenous injections the protein split products are, for obvi- 

 ous reasons, more satisfactory than vaccines; if a relatively mild re- 

 action is desired the various serums are very useful. Where a mod- 

 erate reaction (general and focal) is desired, intramuscular injections 

 of boiled market milk are to be considered; if less general but some 

 focal effect is desired, Uddgren believes that milk with a low bacterial 

 count (certified milk) is to be preferred. 



The possibility of a certain degree of selective action of some of the 

 agents is not to be ignored, the use of staphylococcus and pyocyaneus 

 vaccine mixtures in the treatment of neuritis being such a case. In 

 hemorrhagic disease the use of serums and of milk or salt solutions 

 is to be preferred to vaccine or proteose injections, because of more 

 marked effects in hemostasis. 



It should not be necessary to point out that the nonspecific method 

 of treatment should under no circumstances be considered as a rival 

 or a substitute for the proven specific measures that we have at our 

 command. That a nonspecific factor is at times and possibly often 

 associated with the specific reaction may be true, the more reason 

 that both should be studied and both utilized in their proper time 

 and place. From the evidence so far gathered, the use of the spe- 

 cific measures is always in place whenever a true toxin is to be 

 neutralized by an antitoxin; on the other hand, the nonspecific meas- 

 ures find a field of usefulness as adjuvants of drug therapy in the 

 treatment of syphilis, both early and late, with quinin in malaria, 

 with salicylates in arthritis, with luminal in epilepsy, etc. Here the 

 injections serve at least two purposes. They facilitate the diffusion 

 and distribution of the drug and they increase the general resistance 

 of the patient. 



