122 CLINICAL BACTERIOLOGY AND HJEMATOLOGY 



interest than of practical importance. It is the situation of the 

 collection of pus rather than the bacteria causing it which 

 influences treatment and prognosis. A list of the more important 

 results which are produced by the chief pyogenic bacteria may be 

 of interest. 



Staphylococci are the chief producers of localized suppuration, 

 in the skin^ — such, for instance, as that which occurs in boils, 

 carbuncles, impetigo, folliculitis, etc. They may cause abscesses 

 in any part of the body, and may also give rise to general infec- 

 tions, ulcerative endocarditis, etc., though this is rare. 



It is in the localized skin affections of staphylococcic origin 

 especially that good results are obtainable by specific vaccination, 

 and a cure may often be obtained in cases which are very intract- 

 able by other methods. The doses required are larger than in 

 the case of most bacteria, the best results being obtained when 

 I, coo to 2,000 millions are given. As these doses sometimes cause 

 severe reactions, it is, however, advisable not to give more than 

 250 to 500 millions to commence with. 



Streptococci usually cause spreading inflammation of the type of 

 erysipelas or cellulitis. They are common causes of osteomyelitis 

 and suppurative and septicsemic or pyaemic processes connected 

 with the puerperium. 



Treatment of Streptococcic Infections. — In acute diseases due to 

 streptococci (septicaemia, erysipelas, puerperal fever, etc.), two 

 specific therapeutic agents are available — antistreptococcic serum 

 and vaccines. In my opinion the former is falling into unmerited 

 disuse ; it often yields extremely good results if used at once, and 

 has the advantage of being immediately 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 condition, 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 in- 

 jection, 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 will give good results when 

 the former has failed. In the meantime, take cultures and com- 

 mence to prepare a vaccine ; there is no reason why the two 

 should not be used in conjunction. 



In chronic non-generalized infections, vaccines only are advisable 



