704 ACTIVE IMMUNIZATION 



FOCAL INFECTIONS 



As discussed on page 94, recent investigations have shown that 

 various bacteria and particularly strains of streptococci may gain 

 entrance to the blood and lymph circulations through foci of infection, 

 particularly at the roots of teeth and in the tonsils. Various lesions 

 and particularly arthritis and endocarditis have been attributed to 

 this mode of infection. In treatment particular attention should be 

 given to the detection and removal of these foci, and autogenous vaccines 

 prepared of cultures from the infected tissues may be of aid. 



DISEASES OF THE SKIN 



Furunculosis ; Abscesses. Furuncles are usually caused by some 

 member of the group of staphylococci, and frequently the most rational 

 and successful form of therapy is by means of bacterial vaccines. A 

 stock vaccine of Staphylococcus aureus may prove satisfactory, and 

 should be used while an autogenous vaccine is being prepared. For 

 adults the initial dose may be 100,000,000 cocci, succeeding doses 

 gradually increasing until 1,000,000,000 are given at one time. The 

 injections may be given at intervals of from five to seven days. Follow- 

 ing the first few doses a slight focal and some constitutional reaction 

 should be secured. After all the lesions have disappeared, one or two 

 full doses at intervals of several months will continue to fortify the 

 patient against a recurrence. 



Carbuncles. These are invariably caused by the Staphylococcus 

 aureus, and exceptionally by a streptococcus. The .urine should be 

 examined for sugar, and even if the patient is diabetic, small doses of 

 vaccine may be of value when used in conjunction with the customary 

 treatment. 



Sycosis. Sycosis vulgaris is usually caused by the Staphylococcus 

 aureus and albus, and such patients are frequently very rebellious to the 

 ordinary treatment. An autogenous vaccine is very helpful in some 

 cases. Due care should be exercised in making cultures to secure pus 

 from a well-developed lesion. Relatively large doses of vaccine are 

 necessary, and treatment is usually prolonged, at least 12 injections being 

 necessary before the conclusion is reached that the vaccines are of no 

 service. As a rule, the condition will improve under vaccine therapy, 

 but only in exceptional cases does a complete cure result. 



Acne. Acne is frequently caused by two microorganisms a Staphy- 

 lococcus and the acne bacillus. In cases showing pustulation a Staphy- 

 lococcus is invariably present, and exceptionally the bacillus may be 

 found alone in comedones. Cultures should be made from several 



