212 
Autogenous  Vaccines. 
Am.  Jour.  Pharm. 
May,  1914. 
or  of  a  polyvalent  single  organism  type  have  their  place,  and  a  very 
important  place  of  usefulness,  in  the  48-96  hour  interval  that  is 
often  necessary  to  prepare  the  autogenous  vaccine,  after  the  bac- 
terial identification  in  the  specific  case  has  been  established,  and  I 
almost  uniformly  use  this  period  to  give  one  and  sometimes  two 
injections  of  the  appropriate  stock  culture.  Appropriate  stock 
cultures  may  often  be  used  with  value  in  association  with  autogenous 
vaccines  in  selected  cases. 
A  word  or  two  now  to  ensure  success  in  getting  the  proper 
bacterial  results  in  culture  taking.  The  first  principle  is  to  obtain 
your  material  free  from  contamination,  and  this  requires  the  observ- 
ance of  special  precautions  according  to  the  kind  of  material  that 
is  to  be  cultured. 
Urine:  Should  always  be  obtained  by  sterile  catheter,  after  the 
external  meatus  has  been  appropriately  cleansed,  and  drawn  off  into 
a  sterilized  flask  or  bottle,  to  which  no  preservative  should  be  added. 
It  is  better  to  catheterize  the  day  specimen  into  one  receptacle  and 
the  night  urine  into  a  separate  one. 
Feces:  Should  be  obtained,  urine- free,  and  specimens  from  first 
and  last  portion  of  the  stool  obtained  and  studied. 
Sputum:  Should  be  obtained  with  greatest  care,  because  for 
practical  purposes  no  mouth  is  germ-free,  and  alveolar  pyorrhoea, 
infected  tonsils,  and  the  like  are  so  common.  Before  retiring,  the 
mouth  should  be  carefully  rinsed  with  sterile  water  and  the  teeth 
brushed  with  sterile  toothbrush,  and  a  closed  vessel  containing 
sterile  water  placed  at  the  bedside.  In  the  morning  the  mouth 
should  again  be  rinsed  thoroughly  with  the  sterile  water,  gargled, 
and  with  the  brush  re-sterilized,  by  dipping  in  boiling  water,  the 
teeth  should  be  thoroughly  brushed  and  then  a  few  mouthfuls  of 
clean  sterile  water  should  be  swallowed.  After  this  the  sputum 
should  be  expelled  by  coughing  and  caught  in  serial  sterilized  wide- 
mouth  bottles  (with  sterile  corks),  and  it  is  best  that  only  one  or 
two  masses  of  sputum  should  be  expelled  into  any  one  bottle  and 
the  bottles  labelled  and  sent  at  once  to  the  bacteriologist  for  im- 
mediate examination.  The  sputum  should,  after  direct  examination 
of  stained  specimens  to  determine  morphologically  the  different 
types  that  may  be  present,  be  then  "  whipped  "  through  several 
Petri  dishes  containing  sterile  water  to  further  free  the  bacteria 
from  surface  contamination,  and  the  final  washed  specimen  planted 
upon  the  different  culture  media  that  will  appear  best  suited  for 
