ACTIVE IMMUNIZATION FOR THERAPEUTIC PURPOSES 205 



where it is possible to draw so many erroneous conclusions regarding 

 the value of a therapeutic agent as in the domain of vaccinotherapy 

 in its application to chronic infections. Much good can unquestion- 

 ably be accomplished, but we must be careful not to attribute all 

 improvement to our immunizing efforts. 



Standard Doses. As standard doses of the different vaccines, or 

 bacterins, as bacterial vaccines are now termed, the following may be 

 recommended, bearing in mind what has been said in the foregoing 

 lines : 



Staphylococcus aureus 50,000,000 to 500,000,000 (or more) 



Staphylococcus albus and citreus . . 100,000,000 to 1,000,000,000 (or more) 



Streptococcus pyogenes 5,000,000 to 100,000,000 (or more) 



Gonococcus 5,000,000 to 100,000,000 (or more) 



Friedlander's bacillus 10,000,000 to 100,000,000 (or more) 



Colon bacillus ....... 10,000,000 to 100,000,000 (or more) 



Of the tubercle vaccine it is recommended to begin with very 

 small doses, i. e., -g^-JinF * TSlhnr of a milligram, and to continue 

 the same dose or gradually increase it, according to the indications 

 of the individual case (see Tuberculosis). 



Indications for the Use of Bacterial Vaccines. As I have already 

 indicated in a general way, bacterial vaccines may be employed in 

 practically any infection which has a tendency to a certain degree 

 of chronicity. It has been recommended in the various chronic 

 infections of the bones and joints (tuberculosis, osteomyelitis, gonor- 

 rheal arthritis) in the early stages of pulmonary tuberculosis, in 

 chronic gonorrheal infections, in the colon bacillus infections of the 

 urinary tract, in tubercular cystitis, in the chronic Staphylococcus 

 infections of the skin (lupus, scrofuloderma, tuberculides), in chronic 

 inflammation of the middle ear, the antrum, the frontal sinus; also 

 in endocarditis, as a postoperative measure in connection with 

 empyema, etc. 



While acute infections have generally been regarded as contra-indi- 

 cating the use of vaccines, this has largely been on theoretical grounds. 

 Personally, I have gained the impression that vaccination, even in 

 such cases, could do some good. However, it is just in such cases 

 that correct judgment is frequently fallacious and difficult. 



To what extent vaccination may be serviceable as a protective 

 measure before certain operations is difficult to say. Generally 

 speaking, one should expect that it might be of use in those cases 



