96 CLINICAL BACTERIOLOGY AND 



We have given up to, as a dose, 10,000,000,000 

 devitalized bacteria, after a decided toleration has been 

 established. If streptococci are present, a vaccine from 

 this microbe should be made, and the initial dose should 

 be not more than 100,000,000. One has to be more careful 

 with a vaccine from this bacterium than with staphy- 

 lococci. In five to seven days repeat the dose, giving 

 200,000,000. As a maximum dose, after several adminis- 

 trations, we have never given more than 1,000,000,000, 

 preferring to combine the vaccine with antistreptococcal 

 serum, if the case requires it. 



The writer has had one troublesome case which was a 

 mixed infection in a fistulous withers patient. 



The wound was freed of staphylococci, and then the case 

 came to a standstill, the obstinate bacterium being a specially 

 long-chained streptococcus. The vaccine failed to get rid 

 of it by itself, but after combining' it with streptococcal 

 serum the patient made good progress, and recovered. 



Clinical Phenomena after Injection. 



In these cases of poll-evil or fistula, one has the advan- 

 tage of watching local conditions which, if properly inter- 

 preted, are of singular value to the clinician. 



There may be a slight constitutional disturbance ; this is 

 salutary. Invariably, if the vaccine causes a response, 

 the local swelling increases during the first twenty-four 

 hours ; if discharging, the discharge also increases, contain- 

 ing more lymph and looking more healthy. In the case of 

 poll-evil the head is carried more stiffly, and the nose more 

 protruded. 



The pus should be carefully noted. The writer has 

 found, in those cases where the opsonic power is low and 

 the bacterial invasion virulent, the purulent elements are 

 of a greyish-yellow colour, thin and watery in consistence, 

 and possessing little or no viscosity. The clinician may 

 safely interpret this condition to mean the lymphoid 

 elements of the blood are either very defective in them- 



