ACTIVE IMMUNIZATION FOR THERAPEUTIC PURPOSES 711 



Otitis Media. Autogenous vaccines prepared from carefully made 

 cultures of the diseased tissues, secured with the aid of an ear speculum, 

 may prove of some value in the treatment of subacute and chronic 

 suppurative otitis media. Coates has reported very good results. 

 Additional treatment may be carefully given, but not infrequently 

 more harm than good is done by careless flushing and cleansing of the 

 auditory canal, whereby deeper and healthy tissues become infected. 

 Free drainage should be afforded, and in chronic otitis media necrosed 

 ossicles and granulations may require surgical removal. Injections 

 may be given every five to seven days. A slight increase in discharge 

 after the first one or two doses is of good import, and indicates a slight 

 focal reaction. With Weston, J have treated a large number of cases of 

 suppurative otitis media following scarlet fever, and while the results 

 were seldom brilliant, in general, the duration and severity of the infec- 

 tions were favorably influenced. 



TYPHOID FEVER 



While killed preparations of the typhoid bacillus have been injected 

 subcutaneously as a method of treatment in typhoid fever since the 

 work of Fraenkel 1 in 1913, the subject is still in the experimental stage. 

 An analysis of the literature upon this subject by Callison, 2 Watters, 3 

 and Krumbhaar and Richardson 4 show that at best the ordinary type 

 of heat-killed vaccine administered subcutaneously does no harm and 

 may shorten the course of the disease, prevent fever relapses and compli- 

 cations and yield a slightly lower mortality. The treatment should be 

 given early if at all, while the resistance and general condition of the 

 patient is good. The injections are given subcutaneously and the doses 

 should be modified in individual cases in order to avoid severe reactions. 

 The initial dose may be 100,000,000 bacilli; three days later 250,000,000 or 

 500,000,000 may be injected, followed by three or four similar doses at 

 intervals of five days. During convalescence two or more additional 

 doses may be given in an effort to prevent relapses. Garbat 5 has found 

 the subcutaneous administration of sensitized typhoid bacilli or sero- 

 bacterin superior to the non-sensitized vaccine. 



More striking results have been reported by Ichikawa, 6 Kraus, 7 and 

 others from intravenous injections of sensitized vaccine. Gay and 



1 Deutsch. Med. Wchnschr., 1893, xix, 985. 



2 Amer. Jour. Med. Sci., 1912, cxliv, 350. 3 Med. Rec., 1913, Ixxxiv, 518. 



4 Amer. Jour. Med. Sci., 1915, cxlix, 406. 



5 Jour. Amer. Med. Assoc., 1915, 64, 489. 



6 Ztsch. f. Immunitatsf., orig., 1914, xxiii, 32. 



7 Wien. klin. Wchnschr., 1914, xxvii, 1443. 



