VACCINE-THERAPY 83 



the temperature invariably rises ; and where one is dealing 

 with an acute disease and a high temperature, it is wise to 

 begin with a minimum dose of vaccine. 



When the temperature is very high, and we wish to begin 

 the vaccine treatment, we give a big dose of salicylic acid, 

 wait three to five hours, and then inject. This we find 

 good practice. 



Moreover, it is advisable not to give a second dose of 

 vaccine until the improvement begins to fail. In subacute 

 and chronic cases this varies from five to ten days. The 

 second and succeeding doses should, as a rule, be pro- 

 portionately larger than the first. If one gets no response 

 from the first dose, a second and larger dose can be given 

 almost straight away, and careful notes of the symptoms 

 made. 



The Dose of Vaccine. 



In deciding upon the most suitable dose of vaccine for a 

 patient, one must be guided by circumstances. 



If the disease is an acute one and the temperature high, 

 for reasons already explained, a minimum dose must be 

 administered at the outset; on the contrary, if we are 

 dealing with a chronic condition a full dose is indicated, 

 and is quite safe. Again, certain bacterial vaccines are 

 more potent in their actions than others. For example, a 

 given streptococcal vaccine stimulates the bacteriolytic 

 forces much more effectively than a staphylococcal vaccine 

 of the same strength does. 



In judging as to whether a suitable dose has been given or 

 not, one must take note of every little clinical detail ; but in 

 reading these off one must not rely upon a single condition 

 alone. It is much safer to total them all together, as it 

 were, and strike averages. For example take a case of 

 acute pneumonia: the temperature after an injection may 

 rise, and at first consideration one might suspect a pro- 

 nounced negative phase following upon the vaccine ; but 

 this rise may largely be a coincidence, the primary cause 



