156 NINTH REPORT. 



girl was eating splendidly, and had gained in flesh and strength, and with 

 no pain or fever. That gain has been uninterrupted imtil the present time, 

 a month since the treatment. In other words, a perfect recovery of a sac- 

 culated empyema was effected in seven days by small pvmcture, evacuation 

 of the bulk of pus, small drainage, and artificial auto-inoculation. 



Another example of unhealed empyema has more recently been brought 

 under my care by Dr. George W. Moran, who had operated on the patient, 

 a six-year-old lad, eight weeks before. When I first saw this patient six to 

 eight ounces of this greenish yellow pus was escaping daily from the opening 

 in the chest. This amount of pus had drained for several weeks. The 

 boy was weak, thin and haggard, and had the usuahfluctuating temperature 

 of extensive chronic suppuration. Among the bacterial flora of the pus 

 was a streptococcus which I isolated and converted into an opsonogen. On 

 Feb. 22, the first inoculation of 10 millions of these streptococci was made. 

 In two days a pronounced fall in the febrile curve was noted and thereafter 

 the temperature did not exceed 100 F. The amount of pus rapidly diminished 

 until only a tablespoonful escaped in the 24 hours at the end of a week, when 

 the second injection of 10 millions autogenous streptococci was performed. 

 Ten days after the first inoculation the boy was allowed out-of-doors. He 

 had gained very decidedly in flesh. His appetite was splendid. The drain- 

 age tube had been forced by the expanding lung out of the opening in the 

 chest wall and not enough discharge to wet the dressing escaped in 24 hours. 

 By the end of the second week full healing of the wound had occurred, ami 

 following this the boy passed through an attack of mumps with no further 

 evidence of his thoracic disease. 



Postoperative Fistulas. — A patient who had been oj^erated for breast 

 tumor with total extirpation of that organ and of the axillary glands, de- 

 veloped an, infection of the wound followed by profuse suppuration and 

 acute septic symptoms. After the acute manifestations had been controlled 

 a sluggish unhealing state followed leaving a large denuded area, a deep 

 fissure and a subcutaneous sac. Four months after all attempt to remedy 

 this had failed and after a consultation between Dr. H. C. Walker and Theo. 

 McGraw, I was invited to see the case. Mixed with several organisms from 

 the pus was a streptococcus which I used as a source of an autogenous opson- 

 ogen. Inoculations with the streptococcos in average doses of 10 millions 

 have been practiced at intervals of 7 to 10 da,ys. The sluggish condition 

 has mended, clean pus-free healing of the denuded area and of the fissure 

 in the breast has gone on to practical completion. Only a portion of the 

 arm wound which was covered with thin, poorly nourished skin now remains 

 to heal. 



In a patient with two persistent discharging abdominal fistulas following 

 a cholecystotomy and appendectomy in Dr. McGraw's service in St. Mary's 

 Hospital, a single injection of the autogenous streptococcus, in ten days 

 brought complete cessation of suppuration and complete healing, so that 

 the patient, whom I found bed-fast, was able to leave the hospital fourteen 

 days after the first inoculation was performed. 



BACTERIAL THERAPY OF GONORRHCEA. 



My first essay in the bacterial therapy of gonorrhoea was made early last 

 summer in a case of halanoposthitis and gonorrheal urethritis of eight month's 

 duration, with the usual picture of an immensely swollen and phimosed 

 foreskin and a thick scar-like preputial orifice. An injection of gonococcus 



