VACCINATION 605 



fever. The culture is sterilized at 60 C. and centrifuged : part of the supernatant fluid 

 is then decanted until each cubic centimetre contains 0'005 gram of dried organisms. 



[Three inoculations are given. The first, for children of 2-10 years, consists of 0'5 c.c. 

 of the vaccine, the second of O'75-l c.c. and the third of 1*5-2 c.c. 



[Inoculation is followed by a slight local and general reaction : in some cases by a 

 scarlatiniform eruption and sore throat. Gabritchewsky considers that the latter symp- 

 toms prove the specificity of the vaccine. 



[For various reasons, it is hardly likely that this method of vaccinating against scarlet 

 fever will prove to be of any value. ] 



[(5) Vaccines in human streptococcal infections. Autogenous vaccines are 

 now very generally used in the treatment of human streptococcal infections 

 and with much success especially if the vaccine treatment be combined with 

 the ordinary surgical procedures and with the use of a specifically immunized 

 serum. 



[Preparation of the vaccine. Agar tubes are sown with material from the 

 lesion and incubated for 24 hours at 37 C. The growth is then scraped off 

 with a slender glass rod and made into an emulsion with normal saline solu- 

 tion to which 0'5 per cent, carbolic acid has been added. The emulsion is 

 then sterilized either by heating at 60 C. for half an hour or by placing it 

 in the incubator for 24 hours at 37 C. The sterility must be tested by 

 cultivation. 



[Standardization. The emulsion is then standardized either by Wright's 

 method (p. 381) or by means of a Thoma-Zeiss counting chamber. If the 

 latter be employed it will be found convenient to use a dilute solution of 

 Azur II containing 1 per cent, of commercial formalin (to precipitate the 

 organisms) as the diluent the dye stains the organisms and so renders them 

 more distinct. 



[Method of use. The vaccine should be inoculated at the earliest possible 

 moment and while it is being prepared it is recommended that a dose 

 (lOxlO 6 ) of stock vaccine prepared from a mixture of streptococci of the 

 variety which are known commonly to cause the same type of lesion should 

 be administered. The dose (10 to 100 millions) and the intervals between 

 the inoculations will vary according to circumstances " the more acute 

 and the more generalized the lesion the smaller should be the dose intro- 

 duced " (Girling Ball). 



[Sensitized vaccines. Sensitized vaccines prepared according to Besredka's 

 method (p. 382) have recently been introduced for the treatment of human 

 streptococcal lesions with encouraging results. As in the case of non-sensi- 

 tized vaccines an autogenous vaccine, i.e. a vaccine prepared from the lesion 

 to be treated, must be used.] 



5. Serum therapy. 



[The serum therapy of streptococcal infections is highly unsatisfactory. It 

 is now more than 14 years since Marmorek introduced his antistreptococcal 

 serum and though it would appear in some cases that the success following 

 the use of the serum has been very striking, in the vast majority of cases it 

 is far otherwise. 



[The difficulties attending the preparation of an antistreptococcal serum 

 are greatly enhanced by the fact that it is still unknown whether the organisms 

 isolated from streptococcal infections are all identical or whether several 

 different species of streptococci exist. Upon the solution of this question 

 the whole problem of streptococcal serum therapy largely turns. 



[Marmorek regarded all streptococci as identical, and this view was shared 

 by Neufeld, and until recently by Aronson also. These observers therefore 

 prepared a monovalent serum using a single strain of streptococcus artificially 



