222 INFLAMMATION AND SUPPURATION 



body, brought about by some state of predisposition or acquired 

 susceptibility. 



Vaccination Treatment of Infections by the Pyogenic Cocci. 

 From his study of the part played by phagocytosis in the 

 successful combat of the pyogenic bacteria by the body, Wright 

 was led to advocate the treatment of such infections during their 

 course by active immunisation by means of dead cultures of the 

 infecting agent (for methods of preparation see p. 133). The 

 treatment is applicable when the infection is practically local, 

 as in acne pustules, in boils, etc. (For the theoretical questions 

 raised, see Immunity.) For an isolated faruncle, Wright recom- 

 mends a dose of 100 million staphylococci to be followed three or 

 four days later by the injection of 250 to 300 millions, and for an 

 incipient streptococcic lymphangitis a dose of 2,000,000 strepto- 

 cocci. In chronic infections the number of bacteria used for an 

 injection is from 250,000,000 to 500,000,000, but a smaller 

 number may give a good result, and the general principle to be 

 adopted is to use the smallest dose necessary for a therapeutic 

 effect. If repeated injections are necessary, Wright recommends 

 that the opsonic index should be observed every few days and 

 the injections only practised during a positive phase. If it is 

 not practicable to use the strain derived from the lesion for 

 the preparation of the vaccine, then laboratory cultures or the 

 stock vaccines which are now in the market may be used ; in 

 such cases it is well to use a vaccine made from a mixture of 

 strains ; in skin infections a mixture of staphylococcus aureus 

 and albus may be employed. Such means have been extensively 

 used in the treatment of acne, boils, sycosis, infections of the 

 genito-urinary tract by the b. coli, infections of joints by the 

 gonococcus, and in many cases considerable success has followed 

 the treatment. Sometimes acute affections, e.g. puerperal 

 septicaemia, have been treated by vaccines. It is difficult here 

 to judge of the results which have been attained, but in any 

 case only very small doses of the vaccine should at first, at any 

 rate, be administered. 



Methods of Examination in Inflammatory and Suppurative 

 Conditions. These are usually of a comparatively simple nature, 

 and include (1) microscopic examination, (2) the making of 

 cultures. 



(1) The pus or other fluids should be examined microscopic- 

 ally, first of all by means of film preparations in order to 

 determine the characters of the organisms present. The films 

 should be stained (a) by one of the ordinary solutions, such 

 as carbol-thionin-blue (p. 105), or a saturated watery solution of 



