A New Method of Dealing with the Peripheral Branches of the Fifth Cranial Nerve in Tic Douloureux

BENJAMIN BRABSON CATES
1913 Boston Medical and Surgical Journal  
toxin and smallpox vaccine.3 It should be borne in mind that after typhoid inoculation the Widal reaction is positive, and an absolute diagnosis of typhoid fever can be made only by means of a blood culture. Russell, in the paper referred to above, says, "It is proven that the prophylactic treatment (of typhoid fever) is without danger (and) that the protection is almost absolute even under conditions of unusual exposure." The treatment of typhoid fever by vaccines is still in the experimental
more » ... n the experimental stage. Different authors recommend doses from one million to one billion, with varying intervals between doses. The sum of opinion of these men, however, is unquestionably favorable. They claim that the fever period is shortened, and that complications, relapses and mortality are markedly reduced; while the use of the vaccine is attended with no bad results and in no way increases the patient's discomfort. Callison4 has recently collected from the literature 475 cases of typhoid fever treated with vaccines. Omitting 52 cases in which the dose was one or two millions, unquestionably a dose too small to have any effect, the mortality in the remaining 423 cases was 5.4%, with relapses in 6.5%. Callison recommends that vaccine treatment should be instituted as early as it is possible to make a diagnosis. His initial dose is 500 million bacilli ; the inoculation is repeated at four-day intervals as long as required, increasing the dose 100 million each time. In his last series of fourteen cases, no patient received more than six, with an average of three to four inoculations. Although 475 cases is too small a number from which to draw conclusions, especially in so protean a disease as typhoid fever, the results obtained are encouraging. While medical literature contains numerous reports of chronic typhoid carriers, there is but little discussion of the treatment of these patients. Brem and Watson,5 reviewing the literature in November, 1911, found, including one case of their own, only 12 recoveries of typhoid carriers. Three chronic intestinal carriers recovered after operations on the gallbladder, one during the administration of B. bulgaricus in large doses, one after repeated exposure of the gall-bladder to x-rays, and one urinary carrier after the administration of hexamethylenamin in combination with boric acid. One intestinal, three urinary and two carriers discharging bacilli from bone lesions were cured with autogenous vaccines. Cummins, Fawcus and Kennedy6 treated 7 typhoid carriers by various methods and were sure of the recovery of only one patient, an intestinal carrier treated with lactic acid bacilli. Vaccine treatment failed in the three cases in which it was tried, one intestinal and two urinary carriers. Since the publication of Brem and Watson 's paper, six cases, one urinary and five intestinal carriers, treated with vaccines have been reported. Two intestinal carriers, one with an acute cholecystitis that recovered without operation,7 and a bacilluria of twelve years' duration10 were cured. Two intestinal carriers have remained free from typhoid bacilli for three and one-half8 and six months.9 The sixth case, a chronic suppurative cholecystitis, was drained and the discharge gave a pure culture of B. typhosus. The sinus gave no evidence of healing until a vaccine was given.10 In the treatment of typhoid carriers Meader9 recommends an initial dose of 100 million bacilli repeated at intervals of two weeks, increasing the dose 200 million each time. To summarize: (1) Typhoid vaccine as a prophylactic provides almost certain protection from typhoid fever. (2) Typhoid vaccine as a therapeutic agent in active typhoid is still in the experimental stage. A sufficient number of cases have not been studied to enable one to draw definite conclusions. The results so far obtained, however, are favorable. (3) Typhoid vaccine as a therapeutic agent in chronic typhoid carriers, while it does not offer certain cure, is the method of treatment that has given the best results.
doi:10.1056/nejm191303131681105 fatcat:7m3mq2d6and4jiyjfs2ya5ww7i