658 ACTIVE IMMUNIZATION 



a member of the group of colon bacilli. It is highly essential, in order 

 to attain success with vaccine therapy, that urine be collected aseptically 

 and the causative microorganism secured and used in the preparation 

 of a vaccine, as stock vaccines are of little or no value. Exceptionally 

 the infection may be due to another microorganism, either alone or in 

 conjunction with Bacillus coli. Treatment with an autogenous vaccine 

 may be of distinct aid in lessening the symptoms and in reducing the 

 amount of pus. The initial adult dose of Bacillus coli vaccine should 

 be about from 50,000,000 to 100,000,000 bacilli. In subacute cystitis 

 of the male, due to stricture of the urethra or enlarged prostate, or in the 

 female, due to perineal injuries, not much benefit follows its use until 

 the underlying cause is corrected or removed. 



Urethritis. There is a considerable difference of opinion as regards 

 the efficacy of vaccines in the treatment of acute and chronic ure- 

 thritis of .gonorrheal origin. A polyvalent stock vaccine of gonococci of 

 proved immunizing powers may be even more efficient than an auto- 

 genous one, especially if the latter must be prepared from a strain that 

 has been repeatedly subcultured in order to obtain the vaccine in a pure 

 state, or from one that has lost its virulence from long residence in the 

 infected urethra. Owing, therefore, to the difficulty of isolating and 

 cultivating gonococci, stock vaccines have been generally employed. 

 In subacute urethritis the initial dose may be 25,000,000; if complica- 

 tions threaten, less than this, and if no local reaction has followed more 

 than this, is given, the object being to secure a slight increase of the 

 secretion, which should become more purulent, and a little constitu- 

 tional disturbance, followed by lessening of local pain and tenderness. 



In chronic urethritis the primary infection is gonococcal, although 

 other organisms, such as the Micrococcus catarrhalis, staphylococci, and 

 diphtheria bacilli may have some relation to the process. A stock 

 gonococcal vaccine may be used in sufficient dosage to evoke 'a reaction; 

 not infrequently, however, a stock and an autogenous vaccine or vac- 

 cines combined yield better results. Cultures of the urethra should 

 be made only after thorough cleansing of the meatus and flushing of the 

 urethra with sterile salt solution and massage of the prostate, cultures 

 being made direct from the prostatic secretion or from the crypts through 

 the urethroscope. In any case expert local treatment should be given 

 while vaccines are being used. 



Gonorrheal Arthritis. Polyvalent stock vaccines of gonococci have 

 generally been found to be of distinct value in the treatment of this 

 troublesome and oftentimes chronic infection. Local treatment of the 



