198 ACTIVE IMMUNIZATION 



Staphylococcus aureus 50,000,000 to .500,000,000 (or more) 



Staphylococcus albus and citreus . . 100,000,000 to 1,000,000,000 (or more) 



Streptococcus pyogenes 5,000,000 to 100,000,000 (or more) 



Gonococcus 5,000,000 to 100,000,000 (or more) 



Friedlander's bacillus 10,000,000 to 100,000,000 (or more) 



Colon bacillus 10,000,000 to 100,000,000 (or more) 



Of the tubercle vaccine it is recommended to begin with very 

 small doses, i. e., TTUTTO to irH o" of a milligram, and to continue 

 the same dose or gradually increase it, according to the indications 

 of the individual case (see Tuberculosis). 



Indications for the Use of Bacterial Vaccines. As I have already 

 indicated in a general way, bacterial vaccines may be employed in 

 practically any infection which has a tendency to a certain degree 

 of chronicity. It has been recommended in the various chronic 

 infections of the bones and joints (tuberculosis, osteomyelitis, gonor- 

 rheal arthritis) in the early stages of pulmonary tuberculosis, in 

 chronic gonorrheal infections of the peritoneum, in the colon bacillus 

 infections of the urinary tract, in tubercular cystitis, in the chronic 

 Staphylococcus infections of the skin (lupus, scrofuloderma, tuber- 

 culides), chronic gonorrheal urethritis, with its local complications, 

 in chronic inflammation of the middle ear, the antrum, the frontal 

 sinus; also in endocarditis, as a postoperative measure in connection 

 with empyema, etc. 



While acute infections have generally been regarded as contraindi- 

 cating the use of vaccines, this has largely been on theoretical grounds. 

 Personally, I have gained the impression that vaccination, even in 

 such cases, could do some good. However, it is just in such cases 

 that correct judgment is frequently fallacious and difficult. 



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 

 where 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 contraindicated 

 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 I have said that we know too 

 little as yet of what vaccination can accomplish in the chronic 

 bacterial infections to warrant any dogmatic statements. The 



