656 ACTIVE IMMUNIZATION 



It may be stated in general that: 



1. Vaccine therapy has a special field of usefulness in the treatment 

 of chronic infections. 



2. Autogenous vaccines are to be preferred to stock vaccines, and in 

 some infections the former must be used. 



3. It is not advisable to continue the use of the same vaccine for 

 more than several doses if no reaction and no improvement are noted. 

 New cultures should be made to determine if the right organism is 

 being used, or if reinfection with another organism has occurred. 



4. It is essential that the vaccine be properly prepared and not over- 

 heated. 



5. It is highly important that the usual forms of treatment be employed 

 in conjunction with the vaccine therapy. Thus abscesses should be 

 incised; proper drainage of a discharging wound afforded; discharging 

 ears cleansed, etc. 



6. While the dose should not be too large, neither should it be too 

 small, nor too far apart. There is a proper dose for each patient, and 

 this may be determined by starting with a small dose and gradually 

 increasing it until some reaction is secured. An efficient dose must 

 necessarily produce some reaction, and increased doses are contra- 

 indicated so long as any sign of general or focal reaction is produced and 

 so long as steady progress is maintained. 



DISEASES OF THE SKIN 



Furunculosis. Furuncles are usually caused by some member of the 

 group of staphylococci, and frequently the most rational and successful 

 form of therapy is by means of bacterial vaccines. A stock vaccine of 

 Staphylococcus aureus may prove satisfactory, and should be used while 

 an autogenous vaccine is being prepared. For adults the initial dose 

 may be 100,000,000 cocci, succeeding doses gradually increasing until 

 1,000,000,000 are given at one time. The injections may be given at 

 intervals of from five to seven days. Following the first few doses, a 

 slight focal and some constitutional reaction should be secured. After 

 all the lesions have disappeared, one or two full doses at intervals of 

 several months will continue to fortify the patient against a recurrence. 



Carbuncles. These are invariably caused by the Staphylococcus 

 aureus, and exceptionally by a streptococcus. The urine should be 

 examined for sugar, and even if the patient is diabetic, small doses of 

 vaccine may be of value when used in conjunction with the customary 

 treatment. 



