712 ACTIVE IMMUNIZATION 



Chickering 1 have reported upon the treatment of 53 cases of typhoid 

 fever with intravenous injections of TO" to -%% milligram of a sensitized, 

 polyvalent, killed typhoid vaccine sediment prepared after the method 

 of Gay and Claypoole. The mortality was 9 per cent.; in 66 per cent, 

 of the cases a distinct benefit was obtained, as shown by lowered temper- 

 ature, disappearance or amelioration of subjective symptoms, and an 

 apparently accelerated recovery. These effects have been attributed 

 to the production of hyperleukocytosis and various antibodies in the 

 patient's blood. 



In the treatment of complications, as periostitis, glandular suppura- 

 tion, r cholec} r stitis, and similar complications due to localized infections, 

 a typhoid vaccine may be of considerable aid. The vaccine should be 

 autogenous if possible, and mixed if the lesions are open and other bac- 

 teria of probable pathogenic activity are found. Stone 2 has reported 

 favorably upon the treatment of cases of typhoid carriers with the 

 ordinary vaccine, and it would appear that this form of treatment 



is worthy of trial. 



PNEUMONIA 



While pneumococcus vaccine has been employed by a large number 

 of physicians in the treatment of lobar pneumonia, the curative value 

 of Dhis procedure is very doubtful. Stoner,* Allen, 4 Morgan, 5 Harris, 6 

 and others have reported favorably upon the vaccine treatment of pneu- 

 monia as based upon mortality statistics and clinical impressions; 

 Charteris, 7 on the other hand, failed to observe beneficial results. Rose- 

 now and Hektoen 8 have prepared a vaccine of partially autoloyzed 

 pneumococci which they believe proved of value in the treatment of 

 pneumonia. In view of the fact that different types or strains of pneu- 

 mococci may produce the disease, a vaccine if employed at all should be 

 autogenous; if a stock vaccine is employed, it should be polyvalent 

 and contain at least type strains I and II. It is difficult to find support 

 for active immunization in such an acute and relatively brief disease as 

 lobar pneumonia, and if a vaccine is employed it should be given as 

 early as possible. In the treatment of delayed resolution and empyema, 

 autogenous vaccines prepared of cultures secured from the sputum or 

 by puncture may be of considerable value. 



1 Archiv. Int. Med., 1916, xvii, 303. (This paper contains a very good review of 

 the literature upon the treatment of typhoid fever with the intravenous administra- 

 tion of sensitized vaccines.) 



2 Jour. Amer. Med. Assoc., 1910, Iv, 1708; Amer. Jour. Med. Sci., 1912, cxliii, 544_ 

 * 3 Amer. Jour. Med. Sci., 1911, cxli, 186. 



4 Vaccine Therapy and Opsonic Treatment, Blakiston, Philadelphia, 1913. 



5 Proc. Roy. Soc. Med., 1910, iii, Suppl. 65. 6 Brit. Med. Jour., 1909, 1, 1530. 

 7 Glasgow Med. Jour., 1912, Ixxvii, 19. 8 Jour. Amer. Med. Assoc., 1913, Ixi, 2203. 



