INDICATIONS AND CONTRA-INDICATIONS 249 



Apart from the early use of the nonspecific agents in the hemor- 

 rhagic diseases, their use in methods of desensitization, not only in 

 cases of asthma where we can find no specific cause, but in angioneu- 

 rotic edema, urticaria and certain of the gastro-intestinal conditions 

 to which Danysz has given particular attention, is one of consider- 

 able importance. 



Finally we have to keep before use the therapeutic application of 

 these agents in the focal reaction, where both the sharp effect of in- 

 travenous vaccine injections (as in iritis) and the milder effect of 

 repeated injections of turpentine have found definite spheres of use- 

 fulness. 



CONTRA-INDICATIONS 



The effort has been made throughout this treatise to make it clear 

 that the nonspecific reaction is a diphasic reaction, the first effect be- 

 ing the intensification of the disease manifestation both generally and 

 locally, the second being a constructive phase in which there occurs 

 a general euphoria, a diminution of disease symptoms both generally 

 and locally, with at times complete restitution to the normal. Gen- 

 erally speaking it has been found that the more severe the first phase 

 the greater the clinical benefit. This augmentation of the disease 

 symptoms must be kept firmly in mind. No patient should be sub- 

 jected to an intravenous injection normally followed by a severe 

 reaction (typhoid or colon bacilli, protein split products, etc.) unless 

 there is every evidence that the patient is a good clinical risk and 

 able to bear the additional strain imposed by the injection. If non- 

 specific therapy is desirable in the more uncertain cases some of the 

 less severe methods can be employed with much less danger, such 

 as intramuscular injections of milk, nucleins, turpentine, etc. An- 

 other and equally important deduction can be drawn from the recogni- 

 tion that the reaction is a diphasic one that depends on stimulating 

 the cells. Therapeutic results cannot be expected when the organism 

 is no longer capable of response to stimulation. When complete 

 fatigue has been reached no amount of stimulation will avail and 

 the additional burden imposed by the material injected can only harm 

 the patient. 



One observes not infrequently in the American literature the use of 

 relatively large doses of such agents as typhoid vaccine, colon vaccine 

 and similarly toxic substances. It would appear to be not only neces- 

 sary but quite irresponsible to subject patients to such severe methods. 

 One can usually obtain a very satisfactory reaction with moderate 

 dosage and this without unusual risk or inconvenience to the patient. 



Particular care must be observed to obtain a history of hyper- 

 sensitiveness on the part of the patient serum sickness asthma 

 urticaria angioneurotic edema or of epilepsy or other grave ner- 

 vous instability. In such cases the more active agents must not be used. 



