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Case 1.—Puerperal
Sepsis—The patient, aged 25, had more or less continuous fever ! for
about 25 days The lochia were purulent and pus cells and phosphates were present in the
urine. An examination of the blood for malaria and Widal's 'reaction for enteric proved
negative. Curetting of the uterus and swabbing with Izal produced no improvement. A
streptococcus was isolated from the urine. After 4 injections of autogenous vaccine beginning
with 4 millions and ending with 20 millions in the course of two weeks, the patient made a
favourable recovery.
Case 2—Is dealt with in a separate note by Assistant Surgeon T. Seethapathi Aiyar.
Cases 3,12 and 16.—Emphasize the necessity for speed in preparing these vaccines.
Unfortunately it must always be a matter of days unless the organism can be isolated in a pure
state from the blood. In the future it may be possible to gain a little time by the routine use of
polyvalent stock vaccines and thus tide the patient over the interval till the autogenous vaccine
is ready.
Case 5.—The treatment of Pyorrhoea alveolaris offers many difficulties, as it is never
possible to be sure that we are really dealing with the organism causing the condition, if indeed
there be any one such organism. A case of failure such as this ought not to discourage us from
further attempts.
Case 6.—A case of abortion at three months followed by a continued rise of temperature
lasting for about 6 weeks. Clinically the symptoms were similar to those of case 1, the lochia
being purulent and a large amount of pus being present in the urine. After three inoculations
of streptococcus vaccine (5 millions, 7 millions, and 10 millions respectively) recovery resulted.
Case 10.—After an operation for ankylosis of the jaw, the operation wound suppurated.
Cultures from the pus showed a growth of a diphtheroids organism, producing large round
creamy white colonies on serum agar and fine transparent colonies on ordinary agar. The
organism was positive to Gram's stain but did not show metachromatic granules by Neisser's
method. A strong norphological resemblance to the bacillus of diphtheria was displayed in the
production of involution forms, such as clubs and irregular shapes when the organism Was
grown on agar agar. It differed from the B. Diphtheri æ in being shorter, in rarely consist-
- i n g o f m o r e t h a n t w o s e g m e n t s a n d i n b e i n g n o n - p a t h o g e n i c t o t h e g u i n e a p i g . I t f e r m e n t e d
glucose, galactose and say charose but not lactose, maltose, mannite, raffinose or inulin. Treat-
ment with a vaccine made from the organism resulted in a rapid healing of the suppurating
wound.
Case 18.—A case of sycosis of six months' duration. The usual local remedies were tried
without effect. The patient then had a series of injections with a stock vaccine of mixed
staphylococcus aureas and albus, the doses ranging from 100 millions to 1,200 millions continued
over a period of 12 weeks. As there was no marked improvement, an autogenons St. aureus
vaccine was prepared and inoculated. The case progressed favourably, the pustules diminishing
in number and healing rapidly.
Case 22—was one of very chronic cystitis which had lasted for months and resisted all
treatment. The urine always showed a heavy sediment with organisms. Antiseptic irrigation
of the bladder was without effect. B. coli (Sch æfferi) was isolated from the urine and an
autogenous vaccine was prepared. Three inoculations (10 millions, 25 millions and 50 millions)
at intervals of a week resulted in complete recovery. Writing two months later the patient
said there was no return of symptoms.
Case 23.-Contrasts unfavourably with cases 24 and 27. Probably the organism isolated,
Staphylococcus Pyogenes albums, was purely adventitious.
Case 24.-This patient suffered from high septic fever after operation for liver abscess, which
did not yield to local antiseptic treatment and continued for four months, St. aureus was
isolated from the discharge. Five injections of the autogenous vaccine (100—200 millions)
were given at intervals of a week. The patient's general condition steadily improved, the
discharge lessened and the sinus healed completely about three weeks after the final injection.
Case 27.—A patient suffering from hectic fever two weeks after operation for amoebic liver
abscess. With four inoculations of autogenous St. aureus vaccine in doses of 50—200 millions
administered at intervals of 3 to 4 days the case made steady progress both in the general and local
condition and was discharged cured in 3 weeks from the commencement of vaccine treatment.
Case 28—was one of sub-gluteal hydatid cyst of two years' duration which suppurated and
burst, leaving a sinus which kept on discharging for six months. After two injections of the
autogenous streptococcus vaccine the discharge stopped and the sinus filled up. It must be
mentioned in this case that local antiseptic surgical treatment was simultaneously adopted the
sinus having been scraped and drained through a free, incision. The patient's condition was a
very serious one with great emaciation, hectic fever and with albumen in the urine.
Case 30—showed an acute pustular eruption affecting the great toe and the instep and
producing general constitutional symptoms with feverishness and malaise. The pustules, some
of which were in the vicinity of the nail, were very painful and on discharging left scabs,
some of which, especially those on the instep, were thin and scaly, adhered to the skin for days