•214 



TWO CASES OK VKLnX SOKE TREATED BY AUTOGENOUS VACCINES 



Successful 

 treatment !iy 

 autogenous 



Previous (7/««'^^(!<?^•.■--None. General condition. — Satisfactory. 



Preeent difi'tise. — Two months ago two small papules appeared on his right wrist. 

 A week later, another couple appeared on his left clieek. All began to enlarge and redden, 

 and, within a month, presented the appearance of large pustules. Crusts formed upon them 

 which the patient picked off and a purulent discharge was established. They were treated 

 by washing witli sublimate solution and by tlie application of silver nitrate, but witiiout 

 any beneficial result. 



CASK II. — Nafar No. 4841. Moh.Hussien Eid.Siid Batt. Egyptian cavalry. Age 21years. 



Fiiinily liistiinj of no special importance. 



Previous illnesses — not stated. 



General condition — satisfactory, a healthy man of good physique. 



Present disease — Began three months ago at Shendi. Small pimples, about the size of 

 peas, appeared on Itis left forearm. These were at first red in colour, but afterwards 

 became reddish-grey and scaly. They were itchy. After a few weeks, more spots made 

 their appearance on his forearm, lower lip, iiuck and chest. These enlarged, indurated 

 and fissured. Some broke down and discharged. Men in the same l)arrack-room 

 were similarly affected. 



On seeing these sores I recognised the condition as being, in all probability, one 

 with which I used to be very familiar in Soutli .\frica — namely, veldt sores. The fact that 

 the men, primarily affected, wei-e associated with horses, tends to confirm this supposition. 

 In both cases (Figs. 53, 54, 55, 56) the ulcers were of the same type, with indurated, inflamed, 

 undermined edges, and flat, dense and fissured crusts. The pus was thick and yellow or 

 greenish-yellow, but not offensive. 



The oflicer (Eigs. 53, 54) was in a state of considerable mental distress owing to the 

 chronicity of his disorder and its disfiguring effect. 



The discharge from the sores in Case I. contained almost no organisms but diplococci, 

 which were present in great numbers. On culture, the organism proved to be Staphijlococcus 

 pi/oijenes albtis. 



I prepared a vaccine, and, on February 12, a dose of 250,000,000 staphylococci was 

 given, the only other treatment being the local lavage and dressing recommended by 

 MacWatters,' namely, frequent bathings with a lotion containing sodium citrate, 1-5 per 

 cent., with common salt, 20 per cent.; together with small dressings of lint soaked in the 

 same lotion during the night. This is said to prevent clotting of the exuding lymph and 

 to promote by osmosis a flow of the highly opsonised lymph through the infected tissues. 



There was an almost immediate improvement which was rapid and progressive. By 

 February 24, the ulcers presented the appearance of healthy healing sores. The crusts 

 were gone, the surfaces healthy and granulating, the edges were softer and had become 

 shelving, while a bluish-wliite film of young epithelium everywhere surrounded the healing 

 wounds. The opsonic index was not determined, partly because I was much too busy 

 to attempt it and partly because it appeared unnecessary. 



On February 26, a second dose of 500,000,000 was given, and, by March 1, the sores 

 had completely healed, local induration being the only sign remaining. 



On March 5, the patient was discharged from hospital and returned to duty. 



It is true that the early treatment had neither been very extensive nor very thorough, 

 but when one remembers how obstinate cases of veldt sore used to be and the extensive 

 pathological changes in the case in question, one can only conclude that the rapid and 

 complete cure was due in very large measure to the vaccine-therapy. Certainly I have 



' loe. cU. 



