660 ACTIVE IMMUNIZATION 



sis. Several investigators who have used a stock vaccine of the per- 

 tussis bacillus claim that, used in small and appropriate doses, the 

 severity of the paroxysms of coughing is lessened, and the whole course 

 of the infection shortened; besides this, they assert, it decreases the 

 danger of a complicating bronchopneumonia. When the disease is 

 unusually severe and the prognosis is bad, a vaccine may be administered 

 in doses of 25,000,000 if the patient is over four years of age. The 

 pneumococcus and Bacillus influenzse are frequently associated, and a 

 mixed vaccine of these microorganisms may be of special aid in the later 

 stages of the disease. The usual remedial measures should be employed 

 while vaccines are being tried. A stock vaccine has been advocated for 

 purposes of prophylactic immunization, especially in institutions, where 

 pertussis among children claims a high mortality. 



Otitis Media. Autogenous vaccines prepared from carefully made 

 cultures of the diseased tissues, secured with the aid of an ear speculum, 

 may prove of some value in the treatment of subacute and chronic 

 suppurative otitis media. Additional treatment may be carefully 

 given, but not infrequently more harm than good is done by careless 

 flushing and cleansing of the auditory canal, whereby deeper and healthy 

 tissues become infected. Free drainage should be afforded, and in 

 chronic otitis media necrosed ossicles and granulations may require 

 surgical removal. Injections may be given every five to seven days. 

 A slight increase in discharge after the first one or two doses is- of good 

 import, and indicates a slight focal reaction. With Weston, I have 

 treated a large number of cases of suppurative otitis media following 

 scarlet fever, and while the results were seldom brilliant, in general the 

 duration and severity of the infections were favorably influenced. 



ACUTE GENERAL INFECTIONS 



Vaccines have been advocated in the treatment of typhoid fever and 

 pneumonia. In the former an autogenous vaccine may be prepared 

 if a blood culture is made early in the infection. Otherwise a stock 

 vaccine prepared of a strain of known immunizing power may be used. 

 The doses should be small, and may be given at short intervals. The 

 object is to stimulate the body-cells to further effort in the production 

 of antibodies. On the whole, I am not in favor of giving vaccines in 

 typhoid fever, especially if the infection is severe or the general vitality 

 of the patient is low, because of the danger of doing actual harm at a 

 critical period. If vaccines are used, however, the initial dose should 

 be less than 100,000,000 bacilli, and their effect must be very carefully 

 observed. 



