19
the bronchial tubes and during the course of the affection the weakened mucus membrane
becomes infected with the same micro-organisms as cause the pathological changes of chroni
bronchitis. It is therefore evident that vaccine treatment cannot cure true spasmodic asthma
and all that it will do is to relieve the inflammatory condition and catarrh set up in the mucous
membrane by the organisms that have invaded it and thereby lessen the irritation which is so
apt to light up the mechanism which causes the bronchial spasm True bronchitis however
stands on a quite different footing and there is no reason why, with an appropriate vaccine
sufficiently persevered with, an ultimate cure should not be effected. The following is the
bacteriological analysis of the 34 cases of asthma and chronic bronchitis that came under vaccine
treatment during the year :—
Cases.
Pneumococcus only isolated . . .
9
streptococcus only isolated . . .
10
Micrococcus paratetragenus only isolated . . .
3
Micrococcus catarrhalis only . . .
1
The pneumococcus and micrococcus paratetragenus . . .
2
The pneumococcus and streptococcus . . .
3
The pneumococcus and micrococcus catarrhalis . . .
2
The streptococcus and micrococcus catarrhalis . . .
1
The streptococcus and micrococcus paratetragenus . . .
2
A diphtheroid bacillus . . .
1
It will be seen from the above that the pneumococcus was present in 16 cases either alone
or in association with other organisms and the streptococcus similarly in 16 cases. In this
connection it must be mentioned that it is by no means an easy matter when examining cultiva--
tions of sputum in which more than one kind of organism grows to apportion to each of the
organisms the relative part they play in the causation of the diseased condition. In the first
place, it is not unlikely that in the chronic inflammatory condition of the bronchi, the upper part
of the respiratory passages may harbour adventitious organisms, mostly streptococci which have
absolutely nothing to do with the true catarrhal changes going on in the smaller bronchioles.
These adventitious organisms will no doubt grow in the cultures in greater or less numbers
along with the true pathogenic organisms and it will be practically impossible to distinguish the
two from each other, especially as they happen to be identical in microscopic and cultural
characteristics It is thus quite possible that in some of the cases where streptococci only have
been isolated from the catarrhal discharge, the true causative organism if present has been
missed and the adventitious organism has been isolated and made into a vaccine. All due
precautions were however taken to exclude the adventitious organisms. Thus the patients were
in many cases asked to come to the laboratory, the discharge collected in sterile dishes, the -
inoculation of the media made immediately after collection of the sputum, the latter being
mechanically freed from saliva or glairy mucoid fluid which was likely to have come from the
trachea, throat and mouth. When streptococci were observed to grow on the media only such
of them as were found in predominant numbers were isolated, and sub-cultivated for prepara--
tion of the vaccine. It was frequently noted that the microscopic examination of the smear of
sputum was not in conformity with the cultural result. A sputum may show microscopically a
large number of what look like pneumococci but the cultivations may show just the reverse, a
proponderating growth of streptococci with very few pneumococci and vice versa. In all such
cases a mixed vaccine was made and the relative proportion of the organisms in the mixture
was fixed without regard to their apparent ratio in the microscopic orcultural examination.
Thus in all mixed infections with the pneumococcus and streptococcus, whatever their relative
numbers in the sputum or cultures, a mixed vaccine of the pneumococcus and the streptococcus
was given, the initial dose of each in the mixture being about 10 million (i.e.) the same as
would be given in a single infection with either organism.
As regards the results obtained by vaccine treatment it can be said that they were not so
disappointing as in previous years. They could be followed in only 19 out of the 34 cases.
The rest were either not treated or the results were not reported. Twelve improved, four of them
showing marked improvement and in seven the vaccine was of no avail. In very few of the
cases was the treatment continued beyond a few injections, about half a dozen or so. With a
more prolonged course of injections and with some further improvement in the methods of
collection and cultivation of sputum and preparation of the autogenous vaccine, it will not be
too much to expect more satisfactory results in a number of cases of this most obstinate and
harassing complaint which is so well known to baffle all medicinal treatment.
Considering that the bacteriology of the condition varies with each case, it is not likely that
a stock vaccine made from any one class of respiratory organisms will do good in every case.
A stock polyvalent pneumococcus vaccine made from a number of strains of this organism
isolated from cases of bronchitis and asthma was issued to a few medical officers and the results
reported by them seem to be encouraging. The Surgeon, First District, Madras, tried it on two
cases, and the results in both were as good as could be desired, the patients being quite relieved
of the distressing symptoms at least for the time being. Dr. A. Y. Narayanayya, Tinnevelly,
reports the case of a girl of twenty years, an asthmatic since her infancy, who was completely