194 INFLAMMATION AND SUPPURATION 



and Paine cultivated it from the cerebro- spinal fluid in three 

 cases where chorea was present, and also detected it in the 

 membranes of the brain. They consider that this disease is 

 probably of the nature of a slight meningo-myelitis produced by 

 this organism. The facts already accumulated speak strongly 

 in favour of this organism being causally related to rheumatic 

 fever, though this cannot be considered completely proved. 

 Andrewes finds that the organism has the same cultural characters 

 and fermentative effects as the streptococcus fsecalis, a common 

 inhabitant of the intestine. Even, however, if the two organisms 

 were the same, it might well be possible that rheumatic fever is 

 due to an infection of the tissues by this variety of streptococcus. 

 The clinical data, in fact, rather point to rheumatic fever being 

 due to an infection by some organism frequently present in the 

 body, brought about by some state of predisposition or acquired 

 susceptibility. 



Vaccination Treatment of Infections by the Pyogenic Cocci. 

 From his study of the part played by phagocytosis in the 

 successful combat of the pyogenic bacteria by the body, Wright 

 was led to advocate the treatment of such infections by the 

 origination during their course of an active immunisation by 

 dead cultures of the infecting agent. The treatment is applicable 

 when the infection is practically local as in acne pustules, in boils, 

 etc. (For the theoretical questions raised see Immunity.) It 

 is best to attempt to isolate the causal organism from the lesion 

 and to test the opsoriic index of the patient against it. To 

 prepare the vaccine an agar slope culture is taken and the 

 growth washed off with normal saline. The organism is then 

 killed by steaming for an appropriate time, and the efficacy of 

 the sterilisation tested by inoculating fresh agar tubes. The 

 strength of the emulsion is estimated by the method of counting 

 dead bacteria described on p. 67. The number of bacteria used 

 for an injection is from 250,000,000 to 500,000,000, and in the 

 details of the measurement of this quantity and in its injection 

 every aseptic precaution must, of course, be adopted. If 

 repeated injections are necessary Wright recommends that the 

 opsonic index should be observed every few days and the 

 injections only practised during a positive phase. If it is not 

 practicable to use the infecting strain for the preparation of the 

 vaccine, then laboratory cultures must be used, and in such 

 cases it is well to use a mixture of strains ; in skin infections 

 a mixture of staphylococcus aureus and albus may be employed. 

 Such means have been extensively used in the treatment of 

 acne, boils, sycosis, infections of the genito-urinary tract by the 



