2IO CLINICAL BACTERIOLOGY AND H^MATOLOGY 



in a test-tube, which is drawn out and sealed in a blow-pipe 

 flame and completely immersed in a water-bath at 60. After 

 one hour it is removed, and a small amount placed on a suit- 

 able culture medium and incubated (in order to ascertain its 

 sterility), and the tube resealed.* If sterile, it is now 7 to be 

 diluted with a 0-25 per cent, solution of lysol or carbolic acid 

 in sterile normal saline solution to such an extent that the 

 dose required is made i c.c. Thus an emulsion of staphylo- 

 cocci was found to contain 2,500,000,000 cocci per c.c. The 

 dose required was 500,000,000, so that i part of the emulsion 

 was diluted with four of 0*25 per cent, lysol in normal saline. 

 Lastly, it is pipetted off with a i c.c. pipette or hypodermic 

 needle (of course, sterile) into i c.c. ampoules, previously steri- 

 lized by heat. 



The doses appropriate for the various organisms have 

 been given under the appropriate headings, but a few more 

 notes may be useful. In acute cases small amounts given 

 frequently are advisable, the effect, if any, on the temperature 

 and other symptoms being watched with great care. If 

 none are produced, an increased dose may be given after 

 twenty-four to forty-eight hours, whilst if there is any bene- 

 ficial effect the next injection should not be given until this 

 has shown some sig'ns of passing off; or, if the patient con- 

 tinues to improve, in four or five days. It should be borne 

 in mind that in acute infections, especially if severe, a dose 

 of vaccine, if too large, may make the patient worse; the 

 first dose, therefore, should be small, and more or less tenta- 

 tive, whereas the second may probably be larger, some 

 information having been obtained by the patient's response 

 to the first. In chronic cases the doses may be larger, and 

 as a rule I think there will be no great amount of benefit 

 unless the amount is sufficient to cause a reaction, a rise of 

 temperature, a swelling at the site of injection, or a slight 

 exacerbation of the lesion. The doses should be gradually 

 increased, if necessary, until the maximum is reached, and 

 the intervals between each should be usually seven to ten 

 days. 



[Since the last edition of this book was published our 



views on the opsonic index have changed considerably. It 



* It is best to add a little carbolic acid or lysol at this stage, to prevent 



the growth of air-borne organisms which may get in whilst the tube is open. 



