6l2 SCIENCE PROGRESS 



the ear, and there was a large gland in the axilla. Inoculation 

 treatment was then undertaken with new tuberculin and a 

 staphylococcus vaccine, and the local application of formalin 

 and gelatine. In eleven months the whole skin was com- 

 pletely healed except one area the size of a threepenny-piece. 

 Six months later further glands became enlarged and broke 

 down, treatment was resumed, and the lesions completely healed. 

 From that date to the present time the patient has kept in very 

 fair health, and though not a strong man he is able to be con- 

 stantly at work, and is now employed in the laboratory. 1 



The limitations of vaccine therapy are at once evident from 

 a consideration of the mechanism of immunisation. It is not a 

 remedy which is being applied, but a stimulus to the body to 

 form its own remedies. On any given occasion the body may 

 fail to respond to this stimulus, and if this occurs, immunisa- 

 tion does not result. Further, the protective substances may 

 disappear from the blood, or the results of a therapeutic dose 

 may be upset by auto-inoculation. Lastly, the physician may fail 

 to determine a flow of lymph to the focus of infection ; this is 

 the reason of the lack of complete success in the treatment of 

 lupus. It is very difficult to maintain an adequate blood supply 

 to the outer layers of the skin, which explains the difficulty 

 constantly experienced in treating superficial skin infections. 



It is clear that in vaccine therapy the physician has in his 

 hands a powerful weapon for good or ill, so powerful that 

 its use can hardly be wisely undertaken without some accurate 

 means of gauging the results of an inoculation. This may be 

 done in various ways: by elaborate experiments on animals with 

 living cultures, by observation ol the toxic effects on patients, 

 by observation of the clinical symptoms, and by measurement 

 of the anti-bacterial substances in the blood. 



Experiments on animals may be left out ol account as 

 impracticable, and toxic effects are often imperceptible, and 

 cannot be expressed in any accurate terms. The choice lies 

 between observation of the clinical symptoms and estimation 

 of the anti-bacterial substances in the blood. 



In some infections, such as those due to staphylococcus, 



the conditions are very easily gauged from the clinical picture. 



If a patient has a boil, and is inoculated with staphylococcus, 



and next day the boil is gone, it is clear that the dose received 



1 Wright, Trans. Roy. Med.-Chi. Soc, 1906. 



