TWO CASES OP VELDT SORE TBEATED BY AUTOGENOUS VACCINES 215 



never seen ulcers of this kind heal up so well or so quickly, and the patient's astonishment 

 and pleasure were very gratifying. 



Films made from the ulcers in Case II. showed diplococci and diphtheroid bacilli 

 (Figs. 57 and 58), the former being the more numerous. The cocci yielded an orange growth 

 on agar and proved to be <S'. ■pi/or/enes anreun, which, however, is probably only a variant 

 of aUiiiis and citreus, all being forms of S. fi/ogciiei;. 



G. BCCHAK&X 





Pi^. &7. — Cas- , sbowin^ diplococcy ■S''^ Pig. 59, — C.is^ II. film [.r,wine diphtbeioid biicilh 



A staphylococcic vaccine was first prepared, and on February 20 he was given 

 250,000,000 with the same local treatment. Inipi-overnent was slower in starting in 

 this case, but had commenced by February 24. 



On February 24, the ulcer on the left forearm was found to be still undermined at the 

 edges but to be clean and dry. The other two sores were still flat and crusted as was 

 the ulcer on the chest from w^hich yellow pus was exuding. Its periphery was angry 

 and inflamed. Both diplococcic and diphtheroid bacilli still persisted in the discharge. 



In consequence, the bacilli w^ere isolated, cultivated, and a vaccine prepared from 

 them in the usual way. 



On March 1, doses of 500,000,000 staphylococci and 10,000,000 bacilli were issued Use of a 

 and administered by hypodermic injection on March 3. 



By March 8, a very notable change had occurred, apparently as a direct result of 

 the double inoculation. The large ulcer on the forearm was quite clean and nearly 

 healed, though slightly sodden in appearance. It was no longer undermined at the 

 edges and the discharge had practically ceased. The two small ulcers had completely 

 healed up. The large sore on the chest was healed throughout three-quarters of its 

 area, a white scaly scar having formed. The remaining quarter was covered with a 

 thin skin or film which was of a yellowish-green colour, probably as a result of a thin 

 layer of dried pus underneath it. Its edges were puckering and healing and the inflamed 

 areola was much less marked. The discharge had ceased. 



A few days thereafter, scars had taken the place of all the ulcers, and shortly afterwards 

 the patient was discharged well, and returned to duty. 



The two cases present an interesting contrast, as, for the first, a single vaccine 

 sufiiced, while for the second, a double one was required. 



I am indebted to Captains Mackenzie and Cassidy, of the Egyptian Medical Service, 

 for carrying out the special treatment and furnishing me with material and notes. 



