ACTIVE IMMUNIZATION FOR THERAPEUTIC PURPOSES 703 



diverse infections. It may be stated that in many infections the vac- 

 cines may be beneficial, but they should be used only under proper 

 conditions, as was indicated in the first portion of this chapter. 

 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. 



INFECTED WOUNDS 



In the treatment of infected wounds and sinuses autogenous vac- 

 cines are frequently of considerable value in those infections due 

 to staphylococci and streptococci. In chronic suppurations pseu- 

 dodiphtheria bacilli and Bacillus pyocyaneus are commonly found, 

 but these microorganisms are likely to be secondary invaders. While 

 bacterial vaccines are being employed the usual surgical treatment should 

 be given, and it is particularly important to afford adequate drainage and 

 remove foreign bodies, as sutures and bits of necrotic bone. Great care 

 must be exercised in preparing the cultures in order that the infecting 

 bacteria may be secured for the vaccine. In wounds likely to be infected 

 with staphylococci or streptococci, it would be good practice to admin- 

 ister one or two doses of a stock vaccine in an effort to protect against 

 infection. 



