666 ACTIVE IMMUNIZATION 



Neufeld for the pneumococcus. In the use of an autogenous vaccine this 

 risk of using an alien species or a different strain is reduced to a minimum. 



In some cases the difficulty of securing and of identifying the in- 

 fective agent may be so great that much time is lost in preparing auto- 

 genous vaccines, as, for instance, in gonorrheal and tuberculous in- 

 fections, and in such cases it may be necessary to use a stock vaccine. 



In protective immunization stock vaccines are used, as, for instance, 

 in the preparation of typhoid vaccine. In certain instances, as in 

 gonococcus and tuberculous infections, stock vaccines possess but 

 slightly inferior therapeutic value as compared with autogenous vaccines, 

 not to mention the delay and difficulty in cultivating and preparing 

 autogenous vaccines. In many other infections, as with the Bacillus 

 coli and gtreptococci, stock vaccines possess little or no value. 



The wholesale manufacture of various bacterial vaccines and their 

 indiscriminate use have brought disappointment to many. Rational 

 and scientific vaccine therapy does not consist in the administration of 

 ready-made, uncertain, and oftentimes hit or miss mixtures, recently 

 so widely exploited. Especially is this true in the use of vaccines for 

 therapeutic purposes. The bacteriotherapeutisjt must possess sufficient 

 skill to enable him to make bacteriologic diagnoses, prepare autogenous 

 vaccines, and skilfully guard their administration. In most instances 

 these requirements are fulfilled by cooperation between the clinician 

 and bacteriologist, or, better, by one who is especially trained in vaccine 

 therapy. 



The Negative Phase. As has been stated in a previous chapter, 

 certain local, constitutional, and focal disturbances may follow the 

 injection of a bacterial vaccine. The first or local symptoms are not in- 

 frequently due to an excess of preservative in the fluid or to the presence 

 of contaminating microorganisms, but abscess formation is distinctly 

 rare. I, in common with others, prefer to find slight focal and con- 

 stitutional symptoms following the first one or two doses of vaccine. 

 In furunculosis, for instance, when the old lesions discharge a little more 

 and one or two others threaten to develop during a day or so following 

 the injection of vaccine, I feel assured that the ultimate result will be 

 good. These reactions are particularly desirable for the non-specific 

 effects of a vaccine. In tuberculin therapy, however, the trend of opinion 

 is very much in favor of administering doses so small that no appreciable 

 focal or constitutional lesions will follow. Both the pathologic a -id the 

 immunologic process concerned in tuberculosis are somewhat different, 

 and in ordinary bacterin therapy a slight focal disturbance is desirable 



