568 WHITMORE. 



of mention. In the more acute conditions it is not advisable or pos- 

 sible to give as large doses of vaccine as when the condition has be- 

 come more chronic. Thus, a chronic gonorrhceal arthritis will stand 

 without any reaction a dose of gonococcus vaccine that will cause fever 

 and marked discomfort in a case of epididymitis or acute urethritis. 

 It is advisable in acute conditions to give small doses at shorter intervals 

 and thus assist the body cells in walling off a process that threatens to be- 

 come general; for instance, small injections of a personal vaccine in a case 

 of cellulitis will localize the condition so that we have an abscess to open 

 instead of a case of septicaemia to treat. 



It is important to inject near the seat of the infection and in such 

 a position that the lymph flows from the site of injection through 

 the area of infection. A case of gonorrhceal arthritis of the right knee 

 had received two injections of gonococcus vaccine in the buttock with- 

 out any apparent effect on the lesion. The patient was then given an 

 injection of gonococcus vaccine into the right leg about six inches 

 below the knee. On the next day the relief from the pain was marked, 

 progress toward recovery was rapid, and the patient walked out of 

 the hospital in two weeks after the injection. 



It sometimes happens that a case does not respond to injection with 

 a personal vaccine, or else the response is satisfactory for the first in- 

 jection or two and then the patient remains stationary or gets worse. 

 In such instances a new vaccine should be prepared from fresh cultures, 

 and this vaccine will often give satisf actory results. 



It is important to continue the use of other accepted methods of 

 treatment in a case that is receiving bacterial inoculations, and the 

 production of local hyperaernia is always to be combined with bacterial 

 inoculation wherever it is possible to do so. 



In conclusion^ I would say that bacterial vaccination is to be con- 

 sidered as an important method of treatment for certain diseases ; in fact, 

 there are a few conditions in which the results are far better than 

 from other methods of treatment that we now have, but it is not in 

 any sense a "cure all." In some conditions it does no good, in others 

 it is of relatively slight value, while even in the diseases where the 

 results are the most satisfactory there are individual instances where there 

 is little or no impovement. Possibly, with increasing knowledge and 

 experience we may learn the reason for some of our failures, and with 

 this may come the ability to use the method with even better results 

 than we are obtaining at present. 



