258 APPLIED IMMUNOLOGY 



Many failures in therapeutic inoculation result 

 from improper administration of the bacterin. The 

 doses given are either too large or too small, more 

 frequently the former, and the intervals carelessly 

 spaced. This is partially accounted for by the fact 

 that some physicians are gifted with superior judg- 

 ment and possess keen powers of observation, while 

 others are below par, yet overworked and indifferent, 

 or overenthusiastic or prejudiced. Another impor- 

 tant cause of failure in biological therapeusis is dis- 

 regard of associated conditions. These are both 

 general and local. The general comprise diabetes, in- 

 testinal stasis, constipation and toxicosis. In these 

 states phagocytosis is markedly handicapped or im- 

 possible. The local causes responsible for failure 

 include marked suppurative foci, caries, sequestra and 

 other conditions demanding primary surgical interven- 

 tion. Again, owing to the anatomy of the part, as in 

 chronic otitis media, also on account of the pathology 

 as observed in sinuses, fistula and old abscess cavities, 

 where, due to coagulated fibrin and old inflammatory 

 exudate and cicatrization, the diseased area becomes 

 walled off, it is impossible for the systemic blood- 

 serum, even though highly opsonized, to bathe the 

 affected part, hence exert a healing influence. Here 

 the rational employment of hyperemia, by massage, 

 rubefacients, heat and Bier's methods, flushing sinuses, 



