Xi
together and produced an itching sensation. Three inoculations of the autogenous streptococcus
vaccine (5—20 millions) at intervals of about a week ended in complete recovery, the scabs
falling off and the skin resuming its normal appearance.
Case 31.-This is one of the most interesting cases treated during the year. Patient, a
young man of about 22 years, was of a strumous constitution. His complaint began as a
whitlow on the right ring-finger which was treated by a local medical practitioner without
any benefit and as caries of the phalanx was suspected, the latter had to be amputated. The
operation wound only healed after considerable delay and difficulty. The patient having
responded to the ophthalmic and cutaneous tuberculin tests, the complaint was considered by
his medical attendant to be entirely tuberculur in nature. Abo ut 6 months from the commence--
ment of the complaint he had a large crop of vesicles, bulk æ , pustules and whitlows on the
legs, feet and toes, which refused to yield to the ordinary local remedies. His resistance to the
infection was so low that mere scratching of the skin used to produce tracks of pus which were
slow to heal up. Another interesting fact recorded was that at the punctures of the first two
inoculations with the autogenous vaccine, i.e., before immunity was definitely established the
patient developed a minute point of pus about 48 hours after the injection. After four inocu-
-lations of the vaccine made from the organism (streptococcus longus) isolated in pure culture
from the bullæ and administered at intervals of a week the patient completely recovered.
When seen a month and a half after the last inoculation be was in good health.
Case 35.—A child of seven years who came under observation covered with multiple boils
and abscesses. One of these was evidently a deep one over the sacro iliac joint and was consi-
dered to be due to suppuration of the underlying joint. Cultures made from the pus of this
abscess gave a pure growth of a streptococcus brevis. The child was inoculated with three doses
of the autogenous vaccine (5—20 millions) at intervals of four days. The temperature which had
run high for not less than a week gradually went down, and abscesses threatening to break out
in the vicinity of the old ones subsided. The child when admitted into the hospital was in an
emaciated condition, but picked up wonderfully and was finally discharged, cured in six weeks
from the date of admission and the day after a third inoculation with the antogenous vaccine
had been given.
Case 36.—A case of extensive suppurative cellulities of the leg, supposed to have commenced
as a guinea-worm abscess. The local condition was so severe that at one time it was considered
that amputation was the only chance of saving the patient. Under a course of autogenous
streptococcus vaccine the patient has made considerable improvement, being thus saved from a
severe surgical operation involving the loss of a limb. The case continues to be made under
vaccine treatment.
Case 41.—A cooly 40 years of age with a discharging sinus two weeks after operation for
liver abscess. Temperature came down to normal after the first inoculation with autogenons
colic vaccine and continued normal. The discharge steadily diminished, until, after five injec-
tions of autogenous vaccine in the course of two weeks, the patient was discharged cured.
St aphyl ococcus vacci nes. — T h e
m o s t g r a t i f y i n g r e s u l t s w e r e o b t a i n e d b y t h e u s e o f t h e s e
vaccines. Staphylococci were isolated from a variety of conditions including furunculosis,
sycosis, deep multiple abscesses resembling pyæmia and liver abscess sinuses. As remarked
in last year's report different strains of st. anreus were observed to produce different shades of
yellow when grown on agar, the typical orange yellow colour being comparatively rare. Some
of the strains were slow in developing the color looking almost like st. albums in 24 hours
whilst others produced more or less translucent colonies resembling B. coli. The routine doses
were 50, 100 and 200 millions, higher doses being rarely employed except in one or two obdurate
cases. A polyvalent staphylococcal vaccine made from not less than fifteen different strains
was used on a large scale by the hospitals in Madras City with apparently satisfactory results.
Streptococcus vaccines .—Streptococci were isolated from cases of puerperal sepsis, from boils,
abscesses, sinuses in muscles, bone and joints, from suppurative cellulitis, tonsillitis, alveolar
pyorrhoea and a variety of cutaneous affections including conditions clinically diagnosed as
pemphigus, eczema and impetigo contagiosa. With the exception of the case of alveolar
pyorrhœ a the results obtained in all these different injections were very satisfactory.
Pneumococcus vaccines.—Of the four cases of chronic bronchitis placed under autogenous
vaccine treatment during the year, one recovered, but it is doubtful whether the recovery was a
result of the vaccine one continues under treatment, one was improved and the result in the
remaining case is not known. The organisms isolated in these cases belonged to the pneu-
- m o c o c c u s g r o u p , a n d w e r e o b t a i n e d e i t h e r b y d i r e c t c u l t u r e o f t h e s p u t u m o r b y s u b c u t a n e o u s
passage through the rabbit. The organisms varied a good deal in their degree of virulence,
some of them being non-pathogenic to the rabbit and others killing the animal in one to three
days. Cultures made from the heart blood of the rabbit showed the morphological and cultural
characters of the pneumecoccus, but cultures obtained from the first passage through the rabbit
sometimes proved nonpathogenic when tried a second time.
Considerable difficulties are associated with the isolation of the causal germ in cases of
bronchitis. The condition may be due to one of several organisms and it is not easy to deter--
mine which. Almost invariably a pure culture of pneumecoccus can be obtained by inoculating
a rabbit with the expectoration but the same is true of normal saliva. The catarrhalis group