18
A few remarks regarding the dosage of the vaccine will be of interest especially as it
was once considered that high doses were not necessary or safe to administer. In the pri
-
mary stages of acute urethritis gonococcus vaccine should be given in very small doses. To
begin with, a dose of 2½ million can be given and followed at intervals of 4 to 7 days by
5 ,
10, 15 and 20 carefully avoididg reactions. In spite of an apparently complete recovery
after a few injections, it is quite a common experience that there is a recurrence of the dis
-
charge after some time either as a result of an indiscretion in diet or physical exertion. A
second course of injections is given wherein a higher dose is usually reached and the dis
-charge is again observed to cease. Third and even fourth relapses are common and nothing is
more annoying to the physician or more disappointing to the patient than such recurrences in
spite of energetic treatment. It is therefore desirable in such cases not to stop the immuni
-
zation until a high dose is reached, say 200 to 500 million, though it might take many weeks
to do so. When the chronic stage of gleet is reached or when a case first presents itself for
treatment in this stage, it is as a rule mere waste of time to administer the smaller doses. In
chronic urethritis, one can safely give a comparatively high dose to start with, say 50 million
and carry the patient on to 500 or even more by injecting at intervals of a week or more.
In gonorrhœal arthritis, tenosynovitis and orchitis, one can start with medium doses as
it is often found that the smaller doses produce little or no impression 10, 20, 50, 100 and 200
million at intervals of 5 to 7 days or more, are found to give the best results.
The following case is an illustration of the inefficacy of small doses in gonorrhœal
arthritis.
A police constable aged 26 years was admitted into hospital for chronic rheumatic pains
in the joints. He had gonorrhœal urethritis a year previously but he had no discharge at the
time of admission. Alteratives and counter irritants gave no appreciable relief. A sub
-
cutaneous injection of 5 million gonococci was given with no benefit. 20 million was next
injected but with no better result. A third injection of 100 million was given and within 72
hours the joint pains vanished.
The following tabular statement shows the result of stock gonococcus vaccine treatment
collected from medical men who indented for gonococcus vaccine from the Institute.
TABLE XII
Giving the results of treatment with stock gonococcus vaccine during 1916.
Nature of genococcal infection
Number of
cases cured.
Number of
cases
improved.
Number of
cases
unaffected.
Total.
Urethritis . . .
4
4
. . .
8
Arthritis . . .
1 6
13
3
32
Ophthalmia, seleritis and iritis . . .
2
2
2
6
Orchitis . . .
2
. . .
. . .
2
C y s t i t i s . . .
2
. . .
2
4
Tot al . . .
26
19
7
52
From the history of the three cases of arthritis, which received no benefit from the treat
-
ment, it was possible to make out that there was no sufficient clinical proof that the infection
was gonorrhœal or the doses of vaccines were not sufficiently pushed.
Tuberculin .—Tuberculin treatment has of late been given up entirely by the Presidency
institutions. It cannot be denied that the use of tuberculin is not suited to every case and
that its employment in certain cases especially of lung infections is not devoid of danger
unless the closest watch is kept over the progress of the case. Whilst afebrile cases are usually
amenable to tuberculin treatment and not febrile ones, occasionally one finds a febrile case
coming down to normal as a result of a few tuberculin injections. In any case it is a safe rule
to restrict the use of tuberculin to afebrile cases.
The value of tuberculin therapy in glandular tuberculosis cannot be questioned and
glands of comparatively large size, which at first sight appear to be fit for no other treatment
but the operative have yielded in a most remarkable way to a course of tuberculin.
The following table gives the result of tuberculin treatment during 1916 by medical men
both in the city and mufassal with tuberculin dilutions supplied from the Institute.