298 THE PRINCIPLES OF IMMUNOLOGY 



Pyelitis and Suppurative 'Nephritis. In pyelitis the causative or- 

 ganism should be discovered before vaccine treatment is considered. 

 If due to the bacillus coli communis, autogenous vaccines in doses of 

 from 50 million to 100 million organisms given at weekly intervals 

 often yield good results. Suppurative nephritis occasionally is improved 

 by vaccination with the causative organism, but the danger of wide- 

 spread infection as a result of the disease is so great that in our opinion 

 surgical measures are of more immediate importance unless the general 

 condition of the patient contraindicates operation. 



DISEASES OF THE SKIN 



Many of the diseases of the skin and of the subcutaneous tissues 

 depend upon the local action of bacteria ; a considerable number of these 

 is susceptible to vaccine treatment. A greater number of skin diseases 

 is the result of more deep seated disorders and under these circumstances 

 it is essential that the cause be corrected; in these instances vaccine 

 treatment is of little avail unless the primary disease is one susceptible to 

 that mode of treatment. 



Furunculosis. Furuncles are usually caused by some variety of the 

 staphylococcus, most frequently the staphylococcus pyogenes aureus. 

 Occasionally, furuncles may be the result of streptococcus infections 

 or of mixed infections. The single furuncle usually heals after the 

 pus is discharged, either naturally or surgically, and may clear up with- 

 out any interference whatever. Patients are seen, however, in whom 

 furuncles appear repeatedly. In some of these cases the underlying 

 cause is diabetes mellitus and in others it is apparently due to a pro- 

 longed decrease in the number of circulating leucocytes. Vaccination 

 in cases in which the boils are persistent and frequent is usually effec- 

 tive. Stock vaccines are frequently employed, but in this condition, as 

 in others, autogenous vaccines are to be preferred. Stock vaccines have 

 frequently failed because of failure to identify the exact organism 

 causing the condition. For example, staphylococcus aureus stock vac- 

 cines are employed on the assumption that the boils are due to this 

 organism, whereas if cultures were made from the boil another organism 

 might be isolated. It is generally recommended that the vaccine be 

 composed of 2000 million organisms per cubic centimeter. It is im- 

 portant that the first dose be relatively small and the increase in doses 

 gradual. At the first dose o.i c.c. is given and at the second dose 0.2 

 c.c. is given and the doses increase by gradations of o.i c.c. until the 

 maximum dose o>f i.o c.c. is reached, It is often recommended that 

 the doses be given eight days apart, but this period may be reduced 

 with advantage to three or four days. In case of diabetes the vac- 

 cination should proceed more slowly and with somewhat smaller 

 doses than in other cases. With the dosage recommended, local 

 reactions are slight and general reactions very rarely appear. Vac- 

 cination in furunculosis usually gives excellent results and is to be 

 highly recommended. 



Carbuncles. These are also benefited in certain instances by vac- 



