THE COLLECTION AND EXAMINATION OF PUS I23 



— in addition, of course, to general medical and surgical 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 pnemiiococcus often produces suppuration in connection 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 con- 

 nection with the bones after (sometimes long after) typhoid fever. 

 It has been found in other suppurative conditions, 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 vomicee 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 bacilli in this pus if it is 

 examined when the abscess is first opened, whereas afterwards 

 none may be found after a very long and painstaking search. 



The bacillus of glanders only causes suppuration in the specific 

 lesipns of the disease when these run an acute course. 



The B. coli communis is the chief cause of suppuration occurring 

 in connection with the abdominal viscera, especially of peritonitis 

 due to perforation of the intestine and appendicitis. It frequently 

 attacks the urinary passages, causing cystitis, etc. 



Vaccine Treatment. — See p. 138. 



The B. pyocyaneus causes blue pus, usually in connection with 

 the skin or subcutaneous tissues. 



The fungus of actinomycosis has been dealt with already. 



