6
Vaccine Therapy.—A very great increase in this branch of the work has occurred,
during the year, the number of doses sent out having risen from 3,004 to 7,087
Autogenous vaccines were prepared for 230 cases against 189 last year.
It is very difficult to arrive at definite conclusions with regard to the benefit
derived from vaccine treatment even when the conditions are favourable. When they
are highly unfavourable, as matters are at present, little can be said.
A s regards stock vaccines this institute functions merely as a store : supplies
are sent to practitioners on indent, the latter employ them just as they would any
drug and nothing further is heard. It rests then with medical practitioners who have
a large experience of these remedies to note carefully the purposes for which they are
administered, the dosage, the intervals, the re-actions and the final effect, and to publish
their observations in tabulated form. As regards autogenous vaccines, really to
understand what he is about, the bacteriologist ought to follow up the case from the
very beginning, to collect the morbid material with his own hands, so that he may
know precisely its source and the general condition of the patient, and to watch the
effects of each dose. If he does not do this he cannot be certain that he is not pre-
paring a vaccine from the wrong microbe : he may even be misled in this direction
if he collects his own material. If he does not witness the effect of the injections
he is not in a position to regulate dosage on that and other occasions, nor is he able
to recognise when a mixed infection has to be dealt with. It is counselling perfec-
tion to urge that the bacteriologist should see every case he deals with, that admittedly
is not practicable ; but he ought to be in much more intimate relation with his cases
than is now possible. No one would suggest that we have to deal with a well-tried
specific remedy which requires no art or modification in its application, yet the bac-
teriologist here is much in the position of the manufacturer of drugs whose aim is to
make the best article he can from the raw materials at his disposal, but knows
nothing of its action on patients or how it is ultimately employed. He may improve
his laboratory technique but he will never elaborate a more efficacious remedy
because he does not know wherein the original one falls short.
If the preparation of autogenous vaccines is to be rescued from the position of a
purely routine procedure, which it is now on the brink of occupying; and reinstated
in that which it ought to occupy, namely, an incompletely understood method of
treatment of certain infections with living organisms, the main centres for preparation
and study must be in the hospitals of Madras where the bacteriologists can be in
touch with the patients and not in a remote building like the King Institute.
Case sheets have been sent out during the past year and a good deal of second-
hand information has been collected regarding the progress of patients, but the details
furnished by practitioners are not complete. Besides being meagre they are some-
times entirely misleading ; so much so that even the nature of the disease is in doubt.
Probably also a tendency exists to apply the principle of " post hoc propter hoc."
These sources of error would be eliminated by first-hand observation. The results of the
year's work in this section will be found in Appendix I written by Dr. M. Kesava Poi.
TABLE IV.
Number of doses sent out.
1911.
1912.
1913.
Autogenous vaccines
..
•
..
..
. .
854
1,396
Stock vaccines
..
..
..
..
..
..
2,150
5,691
Total ..
1,600
3,004
7,087
Most of the autogenous vaccines as well as stock vaccines were supplied to the
hospitals at the Presidency.