Financially, the study has been supported by two grants of the Dalton Scholarship at the Massachusetts General Hospital.

the effort has been made, first, by inoculating the horse with typhoid material, to produce a serum which should be of assistance in human typhoid For clinical material I am indebted for all but infection; and in the second place by inoculation two cases to members of the Medical Staff at the of the typhoid patient himself with small doses of same institution, and especially to Drs. Shat- typhoid material to hasten his own immunity and tuck, Cutler and Minot. One case was referred cure. The latter method is, of course, similar to to me by Dr. Arthur Broughton, of Jamaica Plain, and another by Dr. H. V. Reynolds, of Dorchester.

that of specific inoculation introduced recently by Sir A. E. Wright for staphylococcus and other bacterial infections. Thus far no attempt has been made to control treatment by observation of * Read at the Annual Meeting of The Massachusetts Medical the so-called "opsonic index " of the blood.

Society, June 11, 1907.

This study covers observations upon 130 cases cultures through porcelain filters. The age of the of typhoid fever, treated (in addition to the cultures varied from two days to six weeks. The routine hospital treatment) with the following results obtained seemed to be the same, whatever specific fluids: Antityphoid serum was used in the age of the culture. The dose averaged 3 cc. 35 cases, and was produced by inoculating horses daily. over a period of one to two years with gradually

In a third series 21 cases were treated with increasing doses of dead typhoid bouillon cultures. "nontoxic residue" of the typhoid bacillus as The serum of the horses was then given to typhoid prepared by Prof. Victor C. Vaughan, of Ann patients (a) subcutaneously (5 cases in daily doses Arbor, and kindly sent to me by him (daily subof 10 to 100 cc.); (b) by mouth or rectum or both cutaneous dose, 2 to 10 cc.). This residue, though (18 cases dose, 100 to 1,000 cc. daily); (c) in nonpoisonous, contains all the essential immunizpill form with special enteric coating (7 cases); ing portions of the typhoid organism.

- PULSE

creased destruction of the invading germ. This consequent shortening of his disease. That is to destruction follows the interaction of factors much say, we have tried to hasten and strengthen the more complex than those seen in diphtheritic in- active immunity natural to the disease by the fection, and, furthermore, means the setting free introduction into the body of additional small of whatever intracellular toxin those germs con- doses of specific infectious material. tain. Treatment along these lines, therefore, That these inoculations, therefore, should be would not be appropriate for patients already effective and advisable from a therapeutic standseverely intoxicated, but should, on the contrary, point it is essential, first, that the patient be not be inaugurated at the earliest possible stage of the so sick that he cannot react with greater efforts disease. towards destruction of invading germs and, sec

110

100

90

80

༡༠

60

50

145

40

35

30

25

20

• RESPIRATIONS

CHILL

CHART 3.

With our serum, then, we have tried to intro- ond, that he can stand the temporary increased duce into the patient's body specific substances intoxication due to that destruction. destructive to the typhoid bacillus, substances pro- A comparative study of 130 cases of typhoid duced by inoculation in the blood and tissues of fever appears in the following tables, which offer the horse. In other words, any immunity induced many points of interest, but which must be by this treatment is of the passive variety. With scanned very critically lest they convey false the filtrates and residues our object has been to impressions. stimulate the patient's own blood and tissues to greater production of specific antibodies, and the

In the first place the percentage of children in any typhoid series is important because, as is well

by the fact that, even at this stage, a positive diagnosis is often impossible.

coincidence of increased length with increased mildness may be only apparent, but further ex(3) In 204 cases specific treatment could not perience may give it great importance. As to the have been begun immediately in 42 instances, and average stay in the hospital, the cases under the average increased delay from that cause would specific treatment stayed considerably longer, have been five days. Until, therefore, earlier due undoubtedly to the large percentage in those diagnosis becomes available, specific treatment cases of relapses. One serum case, for instance, must be severely handicapped. Table II would went through five relapses and was in the hospital seem to bear out this contention, for in spite of 116 days.