22
products, producing the symptoms of hectic so well marked in cases of cavities. In all these
cases, the rational treatment by way of vaccines would be to combine the secondary vaccine with
tuberculin or else to precede tuberculin treatment with an autogenous vaccine made from the
secondary organisms, Five cases of pulmonary tuberculosis were treated with such secondary
vaccines of the pneumococcus and streptococcus, with improvement in three cases.
Case 17.—Tubercular infection of the right lung with a history of cough for six months
previous to admission. The cough was particularly severe at night and was attended with a fair
amount of expectoration, occasionally blood tinged. Under the microscope streptococci could
be seen in large numbers, along with a few diplococci and staphylococci. Cultures gave a
predominant growth of streptococcus longus from which an autogenous vaccine was prepared.
Two doses (6 and 20 million) of the vaccine were injected with an interval of five days. There
was a mild reaction within 24 hours of each injection with a rise of temperature by 0.4°F.
The quantity of expectoration diminished in quantity after the second injection and the number
of streptococci as seen in microscopic preparations was found considerably decreased. The
patient was then put on tuberculin treatment.
Case 68.—Male aged. 36. Admitted in a state of emaciation, cough, hectic and night
sweats. Both lungs were involved, the left more advanced than the right. A streptococcus was
cultivated from the sputum and a vaccine prepared from it. Only two injections were given,
namely, 5 and 10 million with an interval of eight days. There was a distinct reaction after each
injection, the temperature rising next morning and the cough and expectoration increasing for
24 hours. The expectoration rapidly diminished after the second dose and the lung became
practically free of moist rales.
TABLE XVII.
S e r i a l
n u m b e r .
Case
number.
Medical officer.
Disease.
Vaccine made.
Result.
1
17
Second
Physician,
General
Hospital, Madras.
Tuberculosis of lungs.
Streptococcus longus.
Improved.
2
50
Dr. T. V. Subba Rao, Tripli-
cane.
Do.
Pneumococcus . . .
No effect.
3
68
Second Physician,
General
Hospital, Madras.
Do.
Streptococci . . .
Improved.
4
175
First Physician, General
Hospital, Madras.
Do.
Pneumococcus . . .
Not used.
5
203
Fourth Physician, General
Hospital, Madras.
Do.
Streptococcus . . .
Decidedly improved.
Tuberculin was issued in three different forms. Old tuberculin, bovine, human and mixed
was sent out undiluted in capillary pipettes for Von Pirquet's reaction; and in different dilu
-
tions containing 1/10 mgr. up to 10 mgr. per c.c. for the subcutaneous tuberculin test. The
bacillary emulsion obtained from German makers in the strength of 5 mgr. to the c.c. was
diluted and supplied in capsules containing 1/50,000 mgr. to the c.c. and upwards. It was
used by the different medical men to whom it was supplied in a variety of medical and surgical
tubercular affections. The results obtained by them will be of some interest especially at a time
when opinions on the subject of tuberculin treatment are so conflicting. It will be observed
from the synopsis of tuberculin therapy obtained from different medical officers as set out in the
three tables, that the results have varied not only in different kinds of tubercular disease but
with the different medical officers themselves. Some have used tuberculin in lung disease with
apparently marked. benefit whilst others have found it to be of no avail. The general impres
-
sion produced by the results as set forth in Table XVIII is that when used sufficiently early in
the disease or when used with judicious care even in the later stages where the general condi
-
tion of the patient as personally studied. by the medical man in charge is such that he will not
react too violently to the vaccine, tuberculin is a very efficacious adjunct to drugs and general
hygienic and nutritive measures. Opinion seems to be almost unanimous as regards the efficacy
of tuberculin therapy in tubercular gland disease, but in the implication of bones and joints
experience has again varied with the men using this vaccine. As has already been explained
before such conditions especially in the later stages are complicated by secondary infections
and there is little doubt that in many, if not all, the unsuccessful cases, the failure could be
traced to the secondary infection not having been first dealt with.