ACTIVE IMMUNIZATION FOR THERAPEUTIC PURPOSES 707 



aseptic conditions and preferably with a catheter. Stock vaccines of Ba- 

 cillus coli and vaccines prepared of Bacillus coli isolated from the urine 

 collected under ordinary conditions, and therefore likely to be other 

 than that strain causing the infection, are of little value. Children 

 usually bear the vaccine very well; I usually administer 50,000,000 to 

 100,000,000 bacilli every five to seven days. 



Urethritis. There is a considerable difference of opinion as regards 

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

 thritis of gonorrhea! 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 

 urethra and general therapeutic measures should be employed. It may 

 be stated that vaccines should be used routinely in all cases, as under 

 any condition the infection is likely to be prolonged and tedious. In the 

 acute stages the doses should be relatively small, about 10,000,000 cocci 

 being given every three to five days. In the subacute stages from 

 50,000,000 to 100,000,000 may be given at intervals of from five to ten 

 days. 



