124 CLINICAL BACTERIOLOGY 



Having ascertained what bacteria are present, the im- 

 munizer should forthwith make an autogenous vaccine. 



In our experience the B. coli groups are the most common 

 offenders, and they sometimes take on a very virulent form. 

 After injecting the vaccine, a careful note of the clinical 

 symptoms should be made. A slight rise of temperature 

 may take place, and an increase of the uterine discharge 

 is to be expected. After forty- eight hours this should 

 become gradually less, the patient will look brighter, the 

 temperature falls; and this will go on for a few days, 

 after which another injection should be given. 



Locally, of course, much can be done to assist the 

 vaccines. 



The womb should be irrigated with a very dilute boric 

 acid solution, to which is added citrate of soda in weak 

 solution. 



The temperature of the douche should be about 40° C, 

 and gradually increased to 45° C. The therapeutic value 

 of this is apparent. The womb is a highly vascular organ. 

 By applying heat, and gradually increasing that heat, 

 dilatation of the bloodvessels takes place, more blood 

 reaches the organ, increased osmosis follows, and so long 

 as the blood in such a state can be kept fluid, as it can be 

 with the soda citrate in solution, so long will an increased 

 flow of bacteriolytic and bacteriotropic essentials reach the 

 death-producing bacteria, to the benefit of the patient. 



Needless to say, these uterine douches should be repeated 

 at intervals, and the fluid should not remain in the womb 

 longer than a few minutes, it being either pumped or siphoned 

 off if the contractile powers of the womb itself are in 

 abeyance, or the patient is too weak to make an effort. 



When streptococci are present, a streptococcal serum 

 should also be used, 20 c.c. being injected daily for several 

 days with increasing doses; but note should be made 

 of the fact that sera only obtained from a bovine animal 

 should be used, such animal having been immunized by the 

 uterine streptococcus for preference. 



