THE COLLECTION AND EXAMINATION OF PUS 151 



falling into unmerited disuse; it often yields extremely good 

 results if used at once, and has the advantage of being imme- 

 diately available. The best plan is to give a large dose (10 to 

 20 c.c.) of polyvalent serum as soon as possible, and to watch 

 the result. If there is an amelioration of the patient's condi- 

 tion, repeat the dose within twenty-four to thirty-six hours, 

 and repeat this as long as it seems to be efficacious or to be 

 necessary, gradually increasing the intervals. If there is a 

 slight rise of temperature after the injection, followed by an 

 improvement, also persevere with the serum. If there is no 

 apparent effect, try a brand from a different source, and you 

 may find that this \v ill give good results when the former has 

 failed. In the meantime, take cultures and commence to pre- 

 pare a vaccine; there is no reason why the two should not be 

 used in conjunction. 



In chronic non-generalized infections, vaccines only are 

 advisable in addition, of course, to general medical and sur- 

 gical treatment. Stock vaccines are almost useless, since 

 cultures of streptococci vary so greatly amongst themselves, 

 and an autogenous vaccine should be prepared in every case. 

 The dose varies greatly with different vaccines and different 

 patients; in general, about 5 millions may be taken as a fair 

 amount to begin with, but it may be necessary to go as high 

 as 250 millions before benefit is gained. Some patients are so 

 sensitive that as small an amount as i million is badly tolerated. 



The pneumococcus often produces suppuration in connec- 

 tion with the respiratory system, especially empyema. It also 

 causes many cases of suppurative otitis media and meningitis. 

 The vaccine treatment of pneumococcic infections has been 

 dealt with already. 



The bacillus of typhoid fever sometimes causes abscesses 

 in connection with the bones after (sometimes long after) 

 typhoid fever. It has been found in other suppurative condi- 

 tions, e.g., empyema. 



The tubercle bacillus gives rise to "cold abscesses," usually 

 in connection with bone. The suppuration which occurs in 

 the walls of phthisical vomicae is due to other bacteria, chiefly 

 streptococci and staphylococci. The pus in true tuberculous 

 abscesses is thin and watery, like milk and water, and often 

 contains small caseous masses. The cells are usually mostly 

 lymphocytes. In most cases it is perfectly easy to find tubercle 



