./ 



212 ACTIVE IMMUNIZATION 



pneumococci in the treatment of pneumonia, on the basis that the viru- 

 lent organisms contain a soluble "virulin" which interferes with 

 the formation of antibodies following injections of the non-toxic 

 insoluble remnants. These virulins pass into solution when virulent 

 pneumococci are kept for from forty-eight to seventy-two hours in 

 sodium chloride solution (until they have become Gram-negative), 

 and may then be removed by centrifugation. The remaining cocci 

 are brought into suspension arid are then used as a vaccine, from 

 10,000,000,000 to 15,000,000,000 being injected subcutaneously, 

 daily, until the temperature reaches normal. 



Rosenow concludes as follows: In view of the fact that the mor- 

 tality is consistently lower in the injected case, that the average time 

 of the injection was late and that the type of cases treated was of the 

 worst kind, the conclusion that this method of treatment is of value 

 seems warranted. The results obtained in the series outside of the 

 hospital, in which the injections were begun earlier, indicate that by 

 the early administration of the antigen better results can be secured. 

 In a foot-note Rosenow adds that the vaccine is kept on hand, and 

 will be sent free on application to physicians who are willing to send 

 him records of their cases. 



To what extent vaccination may be serviceable as a protective 

 measure before certain operations is difficult to say. Generally 

 speaking, one should expect that it might be of use in those cases 

 in which there is danger of infection, and in which enough time is 

 given before operations to attempt the patient's immunization, while 

 in urgent operations the measure would seem to be contra-indicated 

 as possibly favoring infection, i. e., as causing an immediate, though 

 temporary, drop in the body's content of protective substances. 



Results. It is evident from what has been said that we know 

 too little as yet of what vaccination can accomplish in the chronic 

 bacterial infections to warrant any dogmatic statements. The 

 amount of clinical material that has been satisfactorily studied is 

 entirely too small as yet, and it seems to me that we are really not 

 entitled to say more than that vaccination may do good and should 

 be tried. But we can neither state in what percentage of cases it 

 will be helpful or effect a cure, nor can we predict in an individual 

 case what the result will be. I have seen excellent results, and no 

 results, in apparently similar cases, and I feel that every unbiased 

 observer has similar experiences to record. It would after all be 



