250 PROTEIN THERAPY 



Alcoholism, of the type that one encounters not infrequently in 

 charity hospitals, is an absolute contra-indication. We have records 

 of several patients who developed delirium tremens after nonspecific 

 injections, one ending fatally. 



Pregnancy must be similarly regarded as an absolute contra- 

 indication. 



In the various cardiac lesions great caution must be observed. 

 We would include not only severe valvular injuries but cases with 

 high blood pressure, with arteriosclerosis, myocarditis, or with evi- 

 dences of vasomotor instability. In typhoid we have found it a good 

 rule to exclude all cases with a pulse rate over 100; indeed, every 

 case of acute infectious disease should be carefully gone over for evi- 

 dence of myocardial impairment before injections are made. In well 

 compensated valvular lesions we have injected typhoid vaccine with 

 relatively severe general reactions without ill effects. The left heart 

 border may be observed to extend outward for a centimeter or so, 

 but as a rule there are no evidences of decompensation, v. Groer 

 has fortified patients that were not in exceptionally good vascular 

 tone by giving small doses of digitalis for about two days before 

 injections were made. 



Diabetes is considered a contra-indication by Lindig who was of 

 the impression that because of the vascular changes often associated 

 with the diabetic condition the diabetic should be excluded. Uddgren 

 also excludes the diabetic. 



In typhoid we have excluded the older cases (third week) from 

 treatment, as well as cases that were septic or had evidence of septic 

 or pulmonary complications. Naturally any evidence of bleeding 

 either from the nose, stomach or bowel would exclude nonspecific 

 therapy. The earlier workers observed several deaths from epistaxis 

 following intravenous typhoid injections when these precautions were 

 not observed. 



Neither old age nor infancy is considered a contra-indication by 

 Uddgren. 



The patient does not become sensitive to the injection of hetero- 

 vaccines or of proteoses; on the contrary, with succeeding doses there 

 is increased tolerance until several multiples of the original dose must 

 be injected to elicit the proper reaction. Sensitization to serum is 

 not only possible but occurs not infrequently, usually not to any 

 degree that need cause alarm. Smith has made use of this increased 

 sensitization to serum to obtain shock reactions and therapeutic re- 

 sults therefrom. With milk the conditions are somewhat different. 

 Some observers, including Bessau, Decastello and Mueller, consider 

 the milk injection and its effect as due practically to the bacterial 

 content, i.e., a heterobacteriotherapy. Considering the popularity of 

 the milk injections in Europe, there have been relatively few reports 



