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chronic nature and undoubtedly started by gonoccccal infection, a gonococcus vaccine does
practically no good. In such cases an attempt should be made to treat the secondary infection
with vaccines made from the corresponding organism which, in a large number of cases is a
staphylococcus albus.
Opinions differ a great deal regarding the curative value of gonococcal vaccines. Whilst
the results obtained from the use of these vaccines prepared at the Institute in 1910 were very
promising those obtained in 1911 were quite disappointing. During the year under report a
non-carbolised vaccine prepared from three freshly isolated strains was used and the reports
received from different quarters seem to show that when used in small doses and with judicious
care regarding the interspacing of the doses excellent results were obtained. Thus, the Fourth
Physician, General Hospital, reported a case of multiple gonococcal arthritis of both knees,
elbows and wrists, which resisted treatment with salicylates and iodides but readily yielded to
a series of 4 injections of stock gonococcus vaccine, 3, 4, 6 and 10 million respectively given at
intervals of about 5 days. Another exactly similar case of arthritis was treated with the same
doses with great benefit each successive injection being followed by a fall in the temperature
and subsidence of the joint pains.
The experience of the Station Hospital, at Bangalore, where the vaccine was used on a
fairly large scale, also was that though the vaccine did not benefit acute gonorrhœal urethritis,
it produced very gratifying results in chronic cases especially those accompanied by arthritis.
The results of treatment with gonococcus vaccine at the Jubilee Hospital, Berhampur,
were equally good. Though in many cases a thorough cure did not appear to follow, the
treatment is reported to have " brought about great improvement and all but cure." One case
of acute gonorrhoea was cured in three weeks and another of gonorrhoeal arthritis which
resisted salicylate and iodide was rapidly cured by gonococcus vaccine injections.
Case 165 is instructive as proving the greater efficacy of minute doses than larger ones and
the superiority of autogenous over stock gonococcus vaccines. It was one of combined cystitis
and arthritis in a female. Doses of stock gonococcus vaccine from 10 to 70 million did very
little good. Doses of 1, 2 and 5 million of a vaccine prepared from the strain isolated from the
patient's urine brought about considerable improvement in the condition of the joint, the urine
also clearing up and micturition becoming painless.
It is interesting to note that the results obtained by all the above observers unanimously
prove that gonorrhœal arthritis is more amenable to vaccine treatment than gonorrhœal
infection of the urethra and this agrees with the clinical and bacteriological experience that
cases of urethritis sooner or later end in a mixed infection on account of the facilities for
secondary infection through the urinary meatus, whilst cases of arthritis must, for obvious
anatomical reasons, mostly remain purely gonococcal in nature.
The former class of cases have therefore to be treated with the appropriate bacterial
vaccines corresponding to the secondary infection. Further evidence in favour of this view is
found in the uniformly good results obtained with autogenous coli, streptococcus and
staphylococcus vaccines in cases of cystitis and pyelitis which are in a large percentage of cases
the sequelæ of gonorrhœal infection.
Inflammations of the Naso Pharynx.— W ith the exception of one case of nasopharyngeal
catarrh from which the pneumococcus was isolated and in which autogenous vaccine brought
about great improvement, all the other nine cases, consisting of inflammations of the mouth,
tonsil, pharynx and nose, both acute and chronic, seemed to be of streptococcal origin. The
staphylococcus isolated from case 33 was present in the discharge from the ear and was
presumably a secondary organism. A very interesting morphological characteristic was
noticed in all the strains isolated from the nose and throat in these cases which has not been
observed in streptococci isolated from other sources. When grown on serum agar these strepto-
cocci exhibited a variety of involution forms. These included swollen cocci, oval cocco-bacilli
often in chains, club-shaped bacillary forms, spindles and even apparently typical bacilli of a
diphtheroid shape occurring in irregular clumps. Mixed with these were the regular coccal forms
in pairs and chains of varying length. The varieties of shape were so numerous that it was at
first difficult to believe that the cultures were pure, but the phenomenon was observed even
after careful isolation and sub-cultivation and a transfer to ordinary agar agar at once restored
the typical streptococcal form to the organism. Of five cases treated, in which the after-history
has been reported, two were cured, two greatly improved and one was not benefited by the
treatment.
Case 30 was one of acute tonsillitis with the formation of a patchy membrane over the
tonsils and fauces and attended with fever and malaise. The membrane disappeared within four
days of the first injection of five million of the autogenous streptococcus vaccine. Some pharyn--
gitis which remained gradually yielded to two further injections given at weekly intervals.
Liver abscess.—As during the previous year, the majority of sinuses resulting from opera-
tions for liver abscess gave growths of a type of B. Coli. The infection was presumably
from the adjoining intestinal tract. Pus from two freshly-opened liver abscesses was found to
be bacterially sterile and the pus specimens from which isolations were made were obtained
from the abscess cavities some days after operation, which must mean that all the septic trouble.