VACCINE THERAPY IN THEORY AND PRACTICE 609 



after operations, exercise, after deep breathing in the case of 

 lung disease, and after reading aloud in the case of disease of 

 the larynx. 



This discovery of the possibility of inducing auto-inoculation 

 in cases of local disease has proved to be of the greatest 

 importance in vaccine therapy for several purposes. It can be 

 employed as a crucial test in diagnosis, it offers a most valuable 

 means of treatment in certain cases, and it is necessary to bear 

 it in mind in order to devise correct treatment for patients 

 suffering from constitutional disturbance. For the purpose of 

 diagnosis of an obscure lesion, in a site such as a joint, the 

 patient's blood is drawn after a period of rest, and the joint is 

 then subjected to some treatment which induces hyperaemia, 

 such as massage or exercise, and the blood is drawn again at 

 varying periods afterwards. If after this treatment a definite 

 variation is found in the opsonic index to any organism, in 

 either direction, that is strong presumptive evidence of infection 

 by that organism — it is indeed evidence which is the next best 

 thing to the actual demonstration of the microbes in the lesion. 

 It is of especial value in making a differential diagnosis between 

 two possible infections — as, for instance, gonococcus and tubercle. 

 If hyperaemia produces evidence of auto-inoculation with one, 

 and no alteration with the other, the experiment may be con- 

 sidered to afford conclusive proof. This is no matter of theory — 

 it is a practical method in constant use ; and several charts have 

 been published which bring out the points in cases which 

 afterwards improved when treated with the vaccine thereby 

 indicated. 



Some recent work in the use ot auto-inoculation will be 

 referred to later, but some points that require consideration 

 in the choice between auto-inoculation and vaccine treatment 

 may be discussed here. In any given case auto-inoculation 

 insures the use of the correct organism, the physician is not 

 limited by his facilities for cultivating the microbe, and treat- 

 ment may be begun at once without preliminary study. But 

 there are certain disadvantages in its use. The organisms thus 

 introduced into the blood are living, and capable of spreading 

 infection ; they are introduced in unmeasured doses, the 

 lesions may not be conveniently situated for the application 

 of the necessary stimulus, and it is generally found that the 

 patient undergoes a maximum of intoxication for a minimum 



