PRACTICAL APPLICATIONS 367 



the patient's own culture was employed that improvement began. 

 It is in general advisable to treat the case with a stock vaccine, 

 and to commence to prepare a special one if this should fail. In 

 prolonged cases it is sometimes of benefit to prepare a fresh 

 vaccine after a time, in order to counteract any possible change of 

 type of the organism in the body. 



As a rule, the first dose should not exceed 50 millions for an 

 adult and 10 millions for an infant, and, if the disease is febrile 

 and the symptoms acute, may be decidedly less. Subsequent 

 doses may be larger, but as a rule it is not necessary to exceed 

 200 or 250 millions. Probably the opsonic control is of more 

 value here than in most diseases, but in the absence of this doses 

 may be given every week or ten days. The opsonic control, it 

 may be noted, is of more value in acute cases than in chronic 

 ones, since in the latter the index may be persistently normal or 

 high, and yet the disease yields readily to treatment. Thus a case 

 of pneumococcic empyema of the frontal sinus of four years' 

 duration, which had been twice submitted to operation, had an 

 index well above normal, and was completely and permanently 

 cured by four injections of a homologous vaccine at intervals of a 

 fortnight. As a general rule, for the treatment of a small lesion 

 in an adult, such as an unhealed sinus from an empyema, the 

 injections may be 25, 50, 100, and 200 millions, with an interval 

 of a week between the first two and ten days between the 

 remainder, of course subject to any indications which may be 

 derived from clinical observation. It need scarcely be pointed 

 out that but little benefit can be expected in cases in which there 

 is a mechanical obstacle to the escape of pus or the closure of an 

 abscess. A case of very chronic pulmonary abscess, due to 

 pneumococci, in which the X rays showed a considerable amount 

 of thickening, derived no benefit from a long and careful course 

 of vaccine treatment, with and without opsonic control. 



Vaccine treatment has been used in acute pneumonia (according 

 to Allen, routine injections of 25 millions may be given), and is of 

 especial value in unresolved consolidation, which often clears up 

 after its use in a most satisfactory manner, the moist sounds 

 clearing up in a very short time, and the general condition 

 improving rapidly. 



Space forbids mention of all the conditions in which the 

 pneumococcus, perhaps the most protean of all bacteria in its 

 pathogenic effects, has been combated by vaccine - therapy. 



