394 BACILLUS COLI 



The main difference, pathologically, between the two organisms 

 is that, whereas the disease due to the typhoid bacillus is usually 

 a septicaemia, localized infections (typhoid osteitis, etc.) only 

 occur as sequelae, the diseases due to B. coli are almost in- 

 variably local inflammations, blood infections, except, perhaps, as 

 mere terminal phenomena, being rare in the extreme. These 

 inflammatory lesions are extremely common and important, and 

 of most diverse nature. The majority are in connection with 

 the urinary (cystitis, pyelitis, etc.) and alimentary systems 

 (cholangitis, cholecystitis, appendicitis, etc.). It also causes 

 acute peritonitis, but usually in association with other bacteria. 

 It may affect almost any part of the body, causing broncho- 

 pneumonia, otitis media, endometritis, metritis, and a host of 

 other diseases. 



The only specific treatment of any avail is the use of a vaccine. 

 A serum has been prepared, but appears to be quite useless. 

 The vaccine should always be prepared, if possible, from the 

 patient's own culture, since various strains classified as B. coli 

 differ slightly the one from the other. In addition to this, there 

 are very marked differences in virulence, cultures isolated from 

 the stools being in general less virulent than those derived from 

 the diseased tissues. In cases in which treatment has to be pro- 

 longed it is sometimes an advantage to prepare fresh vaccines 

 from time to time, since the organism may change its type to 

 accommodate itself to the immune substances produced. 



The initial doses should be small (10 to 40 millions), and it will 

 be rarely found advisable to exceed 250 millions. Too large an 

 initial dose may be badly tolerated, causing rise of temperature 

 and a good deal of local reaction, but no permanent bad results 

 seem to have been observed. On the other hand, it may some- 

 times be noted that in severe febrile cases the vaccine acts more 

 like an antitoxin, causing a sudden drop in the temperature and 

 a rapid amelioration of the symptoms, which may or may not be 

 associated with a great improvement in the local lesion. This is 

 shown in the accompanying chart, from a severe case of cystitis 

 under the care of Mr. Burghard at King's College Hospital. As 

 far as his general condition was concerned, he was practically well 

 within ten days of the commencement of the treatment. The 

 amount of pus in the urine fell to less than an eighth of its 

 original volume, but had not disappeared entirely when he was 

 discharged. This has been my usual experience of cystitis due 



