238 FOIU TASKS OF pyhexia 



treatment for a fortnight ho expressed a wish to leave hospital. He was re-admitted in a 



delirious state twelve days later with a temperature of 105'4 F. Malarial parasites were 



not jiresent in the blood. Blood culture was carried out three days later, and a vaccine 



of the organisms isolated was prepared. Patient's condition steadily became worse. 



About a week afterwards he passed some bright red blood per rectum, and this was 



accounted for by the fact that there was a local surface abrasion in the vicinity of the 



anus. The condition of the patient at this stage was somewhat critical. The morning 



and evening temperatures showed very wide variations. Owing to his weak condition 



it was decided that only small doses of the prepared vaccine ought to be administered, and, 



accordingly, one and a half million of killed organisms was injected. Within 48 hours the 



Minimal temperature reached the lowest recorded since the patient's re-admission to liospital. The 



1)°^'' ° ^txT^t" temperature then began to fall by lysis, and four days afterwards a second injection of the 



great improve- vaccine containing two millions of the killed organisms was given. This was followed by 



"*'"' a slight rise of temperature, but the latter gradually fell by lysis, and in ten days had 



reached normal. The patient made an uninterrupted recovery, and left hospital soon after 



in a convalescent state. 



Dr. Squires stated that the improvement in the jiatient's general condition following 

 the injection of the vaccine was the most striking feature of the whole case, and that 

 there was not the slightest doubt that the dose, small though it was, liad been su£Qcient 

 to turn the scale in the patient's favour, although nothing in the way of a crisis was 

 produced. 



Conclusions 



From the results obtained by the injections of autogenous vaccines in these two 

 Conclusions patients there can be but little doubt as to the efficacy of vaccine-therapy in such cases 

 of septicsemic fever. The successful issue was due to the fact that autogenous vaccines 

 were employed. The extra trouble necessitated in making autogenous vaccines is well 

 repaid in the end by the results achieved, and that has been the experience of the 

 writer, more especially in the vaccine treatment of that somewhat troublesome and 

 resistant condition known as the Nile boil. The question of strength and dosage of the 

 vaccines used is one that cannot be laid down by rule-of-thumb, as the chief guide to 

 these points is to be found in the clinical condition of the patient. Further, in the 

 writer's experience the opsonic index is totally valueless when compared with the clinical 

 progress of the disease as a guide to the frequency of administration of vaccines. 



In Case I., in all probability, too strong a vaccine was employed to produce immediate 

 amelioration of the patient's condition, and one is inclined to agree with the remarks 

 made by Captain Kennedy' in a recent paper that in all cases of acute infection the best 

 results are obtained by tlie administration of a series of small doses of vaccine employed 

 at short intervals. As a further plea in favour of employing autogenous vaccines in fevers 

 of the septicsemic type the procedure involves the withdrawal of at least 5-10 c.c. of blood 

 from a vein. Such a procedure has invariably a beneficial efifect on the patient, and 

 whether it is used as a means of diagnosis or as a method of isolating an organism for 

 vaccine preparation, its practice should be more frequently encouraged. 



It is of interest to note that Statham- in South Africa has isolated oiguinsiiis of the 

 B. cloacte type from the blood of patients suffering from a typhoid-like jiyrexia. 



' Kennedy, J. C. (1910), " Vaccine Treatment of Malta Fever." Journal of Royal Army Medical Corps., 

 September. 



» Statham, J. C. B. (December, 1910), "A Small Outbreak of Fever due to Bacteria having Unusual 

 Cultural Characters." Ihiti. 



