INOCULATION OF BACTERIAL VACCINES. 425 



the bacterial diseases is the inoculation of an appropriate dose of the 

 proper strain of vaccine; just as the only absolutely essential step in the 

 treatment of a case of diphtheria is the injection of an appropriate dose 

 of antitoxin that has been prepared by some other person who has proper 

 facilities for such preparation. 



This is especially true in the treatment of gonorrhoeal arthritis and 

 epididymitis. Here the vaccine must be prepared from a gonococcus 

 obtained elsewhere than from the patient, as it is impossible to secure 

 a pure culture of this organism from him under these conditions. So 

 the vaccine can be prepared by some one having proper facilities ten or 

 ten thousand miles away. It is necessary to mix the three or four strains 

 of gonococcus known in opsonic work, standardize the vaccine, and send 

 it to the man who is to treat the case. He injects the vaccine and 

 determines the result. If considered necessary from the clinical condi- 

 tion, the dose can be repeated at intervals of seven to ten days with 

 the assurance that it can do nothing but good. Two to five doses are 

 generally sufficient for the most intractable cases of gonorrhceal arthritis 

 and often the result at the end of 24 hours after the first injection is 

 little short of marvelous. 



My experience with epididymitis and urethritis is of too short duration 

 to warrant any statement at present, although I have seen cases of 

 epididymitis clear up in twenty-four hours, and one para-urethral abscess 

 which I observed disappeared almost entirely in 36 hours. Ohlmacher 

 has reported good results in two cases of epididymitis. 



The condition in urethritis is more complicated, as here we usually 

 have a mixed infection, and it is known that inoculation against one 

 organism in a mixed infection may actually give the other organism a 

 chance to thrive. Some apparent success, however, in urethritis en- 

 courages me to continue my work. 



Chart I is taken from a case of furunculosis which shows the negative 

 and positive phases in the opsonic index as well as the subsequent decline 

 of the curve toward normal. Clinically, all furuncles began to heal and 

 no new ones appeared after twenty-four hours following the first inocula- 

 tion. 



Chart II is compiled from a case of gonorrhoeal arthritis. It shows 

 a prompt and marked increase in the opsonic index for the gonoccoccus, 

 and clinically twenty-four hours after injection the man was free from 

 pain and tenderness in a joint that had been extremely painful and 

 tender for nearly four months. Some stiffness and enlargement remained 

 as a result of the prolonged inflammation, but these conditions rapidly 

 subsided and the man expressed himself as able to do his duty in less 

 than one week after his first injection. He was kept in the hospital 

 another week to observe his index and the practical result of the treat- 

 ment. He was allowed to go on duty two weeks after his first injection, 

 as he was entirely well. 



