166 CLINICAL BACTERIOLOGY AND 



Wynn describes the first case so treated in the British 

 Medical Journal of March 7, 1908, thus : 



" The infection dates back at least twelve months, and 

 six months prior to admission to hospital extension seems 

 to have occurred from the bronchi to the lung tissue, and 

 much sputum with a f esculent odour was expectorated. 

 Subsequent formation of an empyema required operation, 

 and from the pus a pure culture of streptothrix was 

 isolated, and a vaccine prepared from a forty-eight-hour- 

 old agar culture. The dose employed for each inoculation 

 represented O001 milligramme of bacterial substance. 

 Attempts were made to estimate the index, which was 

 approximately 03 on January 3, and 0-5 on January 7 ; 

 on January 8 the first inoculation of O001 milligramme 

 was given. Twenty-four hours later the negative phase 

 was apparently over, as the index had risen to 07, and by 

 January 16 was 1'2. In a few days the cough became 

 less troublesome, and the sputum and discharge of pus 

 diminished in a remarkable way. The temperature dropped 

 from over 100° F. to normal, and remained normal for three 

 days. Four days after injection the discharge had so 

 diminished that the drainage-tube was removed. A slight 

 rise of temperature resulted, and on the 18th instant a 

 second inoculation of O'OOl milligramme was given. Three 

 days later temperature was again normal, and remained so. 

 Subsequent injections were given on February 11 and 25, 

 and March 11 and 27, each of 0*001 milligramme. Th 

 patient gained 1 stone 6 pounds in weight, and the con- 

 dition on discharge was a thickened pleura, with a large, 

 dry cavity in the lung. There was no sputum, and only 

 occasionally a dry cough. The patient has continued 

 well." 



When local growths are operated upon, there is the 

 possible chance of a recurrence. We venture to think a 

 course of vaccine might do good in cases of this kind, but 

 of this we have no experience. 



