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c o n s e n t s b e c a m e c o n v e r t e d i n t o a m a t e r i a l h a v i n g t h e c o n s i s t e n c y o f h a r d . c h e e s e . T h e
individual bullæ varied in size from that of a two-anna piece to a rupee or even larger. They
involved chiefly the face, round the eyes and mouth and disfigured the features beyond
recognition. There was also a number of similar bullæ on the fore-arms and hands. All these
patches were very painful and tender and the skin immediately surrounding them was inflamed,
red and angry-looking. A dose of stock pemphigus streptococcus vaccine, l million, was given
and within 24 hours a marked improvement in the condition was noticeable. Cultures made
from the eruption gave an almost pure growth of what looked at first like a diplococcus, but
proved during sub-cultivation to be a streptococcus brevis not unlike that isolated from the
ordinary cases of streptococcal pemphigus. Treatment with the autogenous vaccine accelerated
the recovery and after four injections the patient was completely cured of the severe skin
affection, which otherwise would probably have terminated fatally. This case is of peculiar
interest in that it not only proved the causal relationship between the disease and the organism
isolated from it, but it established as well the practical identity of the organisms isolated from
different cases of varying degrees of virulence, as shown by the immediate relief afforded by the
initial dose of stock vaccine. Case 21 was a peculiar staphylococcic infection of the mucous
membrane of the alæ and septum of the nose of about 4½ years' duration associated with
a hypertrophic inflammation of the inferior turbinated bones. Medication, cauterization, etc.,
were tried, but to no effect. Successive crops of tiny pustules formed, burst, and left small
punched out ulcers with red bases, sometimes causing epistaxis. A series of injections with the
a n t o g e n o u s s t a p h y l o c o c c u s a u r e u s v a c c i n e c a u s e d a d e c i d e d i m p r o v e m e n t i n t h e c o n d i t i o n b u t
not a cure.
Acne.— Nine cases of acne were treated with autogenous vaccine. The acne bacillus was
isolated from two of these cases. In the other seven, failure to isolate the acne bacillus was due
to the fact that the cultures were made outside the laboratory and incubated ærobically. The
technique employed in the cultivation of the bacillus of acne, a strictly anærobic organism, was
briefly as follows. One or more comedones were squeezed out of the acne pimples, crushed in
a sterile watch glass and the pulped comedy substance was used. for making either surface or
stab cultures in glucose agar which was then incubated anærobically. Two weeks or more
usually elapsed before a good growth was obtained, the stab cultures producing an earlier and
more exuberant growth. Of the seven oases from which the acne bacillus was not cultivated, the
staphylococcus albus only was isolated in five and the staphylococcus aureus only in two. It is
interesting to see that cases have been reported as cured, practically cured and improved even
when the acne bacillus was not isolated, indicating the important role played by staphylococci
in the secondary infection of acne.
Abscesses and suppurative cellulitis. —Staphylococci and streptococci were the usual cause
of these inflammations. In diabetic carbuncle the organism was always the staphylococcus
aureus but in one case (125), both staphylococci and streptococci were present. When the
suppuration was near the anus or in the abdominal wall a bacillus of the colic group was often
found associated with the pyogenic cocci (cases 26, 28 and 31), pointing to a secondary infection
from the adjoining intestinal tract. A diphtheroids bacillus was isolated from a case of pelvic
abscess in a female (case 59). Case 26 was one of a chronic sinus of the scrotum which refused
to heal after thorough scraping for over two months. With three doses of autogenous
streptococcus and coli vaccine the sinus healed completely in less than two weeks. The remark
-able rapidity with which this obstinate sinus healed under vaccine treatment is sufficient proof
that the coliform organism and the streptococcus were the direct cause of the sinus cavity not
filling up.
Pyœmia, septicaemia and septic infections. —Streptococci were isolated from all the four
cases (52, 133, 154 and 176). The most interesting of these was case 154, one of septic infec-
tion of the hand which was accidentally cut during an operation. There were severe constitu-
tional symptoms and. prostration. Treatment with stock streptococcus vaccine did not do any
good. Pending the preparation of an autogenous vaccine antistreptococcus serum was used,
which checked the farther progress of the septic condition. Subsequently three doses of the
autogenous streptococcal vaccine were used and the patient made a remarkably rapid recovery.
In septic inflammations of the synovial membranes of joints and the meninges the
pathogenic organism isolated was a streptococcus.
Puerperal sepsis.—A puerperal streptococcus was isolated from three cases of puerperal
sepsis (119, 136 and 183) and one of infection from a puerperal sepsis case (133). On account
of the rapid course of these puerperal infections the autogenous vaccines could not be prepared
in time to be of any use for two of the cases. The organisms isolated were therefore used for
the preparation of a polyvalent puerperal streptococcus vaccine. A very successful case (case
183) was that of a puerperal woman who bad been bad y handled by Indian barber midwives.
Following instrumental delivery she developed pelvic peritonitis and her condition was
considered to be so grave that permission was given to her relatives to get her removed from
hospital. The relatives did not turn up in time and the patient was treated as a last resource
with antistreptococcus vaccine, five dases of which, from 2·5 to 20 million were injected in the
course of 72 hours. The patient made a rapid recovery. The Superintendent of the Govern-
ment Matrnity Hospital, in whose wards the case was treated, affirms that the cure was