METHODS OF EXAMINATION 223 



successful combat of the pyogenic bacteria by the body, Wright 

 was led to advocate the treatment of such infections during their 

 course by active immunisation by means of dead cultures of the 

 infecting agent (for methods of preparation, see p. 130). The 

 treatment is applicable when the infection is practically local, 

 as in acne pustules, in boils, etc., but has also been applied in 

 more acute conditions. (For the theoretical questions raised, 

 see Immunity.) For an isolated furuncle, Wright recommends 

 a dose of 50 to 100 million staphylococci to be followed three or 

 four days later by the injection of 250 to 300 millions, and for 

 an incipient streptococcic lymphangitis a dose of 500,000 to 

 2,000,000 streptococci. In chronic staphylococcal infections the 

 number of bacteria used for an injection is from 250,000,000 to 

 500,000,000, but a smaller number may give a good result, and 

 the general principle to be adopted is to use the smallest dose 

 necessary for a therapeutic effect. If it is not practicable to use 

 the strain derived from the lesion fqr the preparation of an 

 " autogenous " vaccine, then laboratory cultures or the stock 

 vaccines which are now in the market may be used ; in such 

 cases it is well to use a " polyvalent " vaccine made from a 

 mixture of strains ; in skin infections a mixture of staphylococcus 

 aureus and albus may be employed. The treatment of various 

 staphylococcus infections, such as pustular acne, boils, and 

 chronic abscesses, by vaccines, has been carried out very ex- 

 tensively, in many cases with good result, and a similar state- 

 ment is true of some streptococcic infections. Vaccine 

 therapy has also been used in inflammatory and suppurative 

 conditions due to other organisms, for example, infections of the 

 genito-urinary tract with b. coli, where an autogenous vaccine 

 with initial doses of from 10,000,000 to 50,000,000 may be 

 employed; gonococcal arthritis, where the initial dose is from 

 1,000,000 to 5,000,000 organisms; chronic respiratory catarrh. 

 The case of the last can usually only be met by mixed vaccines 

 on account of the presence of different species of bacteria, several 

 of which may be potentially pathogenic ; in these circumstances 

 the use of a mixed vaccine is purely empirical. 



The treatment has also been applied in acute streptococcic 

 infections, e.g., with the pyogenic cocci, b. coli, etc., very small 

 doses— e.g., from 200,000 to 5,000,000 being given— but the 

 method has not been attended by striking success. It is stated 

 that better results have been obtained by the use of sensitised 

 vaccines (q.v.), very small doses being here again employed. 



Methods of Examination in Inflammatory and Suppurative 

 Conditions. — These are usually of a comparatively simple nature, 



