1
Compared with the results obtained in other bacterial diseases it must be admitted that the
v a c c i n e t r e a t m e n t o f c h r o n i c b r o n c h i t i s a n d a s t h m a h a s b e e n u n s u c c e s s f u l o n t h e
w h o l e . T h i s i s d u e t o a n u m b e r o f c a u s e s —
(1) In a certain percentage of cases, as already explained, where the streptococcus Was
isolated and the vaccine prepared from it, it is certain that the causative organism has been
missed.
(2)
It is still an open question whether the common lung affection known as spasmodie
asthma is a microbic disease. It has been hitherto considered a nervous disease, affecting
primarily the muscular fibres of the bronchioles and causing secondarily, in most cases, a certain
amount of inflammation of the mucous membrane, in which micro-organisms subsequently get
a foothold. If the latter hypothesis be correct, it is too much to expect vaccine treatment to
eradicate a nervous disease. Many of the cases that were placed under such treatment during
the year were certainly of this nature.
(3)
In an obstinate complaint like chronic bronchitis which is often known to resist all
treatment the structure of the mucous membrane of the bronchi will in course of time be so
greatly changed that the most effective methods of treatment must necessarily take time to
restore the diseased structures to their healthy state. Considering that the majority of cases
were of long standing, that they came up for vaccine treatment after all medicinal and other
measures had failed and that the vaccine treatment was rarely sufficiently persisted in, it is not
surprising that not one case has yet progressed to a complete cure.
The rationale of vaccine therapy in such cases therefore is to try and deal with the micro-
organisms infecting the mucous membrane of the bronchi, on the supposition that it is the
inflammatory irritation caused by them that is the actual source of the paroxysms of cough and
dyspnoea and in the hope that once these organisms are successfully dealt with, the structure of
the lung will regain its normal character leading to ultimate recovery from the disease.
Tuberculosis.—In addition to the large number of doses of bacillary emulsion of Koch's
new tuberculin issued from the laboratory, a few autogenous vaccines were made for the
secondary infections complicating tuberculosis. In the three cases of pulmonary tuberculosis
placed under treatment the secondary organism was a streptococcus (cases 83, 92 and 106) but
the disease in each case had advanced so far that no benefit resulted from vaccine treatment.
It is a recognised fact that the therapeutic use of tuberculin is inapplicable to cases of tuberculosis
where hectic is present, as a result of a secondary infection. The first step in the vaccine
treatment of such cases is to combat the organisms causing the septic trouble, and when the
temperature conditions become more favourable, consequent on their destruction or inhibition, to
commence the course of tuberculin. Thus in case 92, one of fairly advanced tuberculosis of the
lungs, the secondary streptococcal infection was to a great extent checked with an autogenous
streptococcus vaccine but the general condition of the patient did not unfortunately allow of the
treatment being followed up.
The streptococcus was also the secondary organism in tubercular bone disease including
iliac abscess and caries of the ribs and spine (cases 57, 89,135 and 168). In one case (180) the
staphylococcus aureus was present. The culture in this case was made by the bed side and
when received at the laboratory was found to be a confluent growth from which it was not
possible to isolate anything else but staphylococci.
Case 89, one of tubercular caries of the ribs, was operated on several times without any
progress being made. Treated with an autogenous vaccine of a streptococcus isolated from the
discharge the local condition improved remarkably but unfortunately the patient succumbed
later on to tuberculosis of the lungs.
The demand for tuberculin both from public institutions and from private medical men was
large, old tuberculin for Von Pirquet's reaction being issued in capillary pipettes and for the
subcutaneous reaction in capsules containing dilutions ranging from 1/10 milligramme, to 10
milligramme to 1 c.c. For therapeutic use the bacillary emulsion only was supplied and the
few reports received regarding the results of tuberculin treatment showed that it was equally
efficacious in such widely different conditions as tuberculosis of the lungs, lymphatic glands,
bones and joints on the one hand and tubercular disease of the internal eye on the other.
Leprosy. —Leprolin obtained from the Parel Laboratory was used for the treatment of one
case, the same patient who was under treatment last year with no apparent benefit. With a
reduction of the dose and an increase in length of the intervals it was found that the patient
reported a slow but steady progress. Many of the nodules decreased in size and some dis-
appeared. There was also a partial restoration of the sense of touch in many of the anæsthetic
patches.
Serum therapy. —Antistreptococcic, antitetanic, antidiphtheritic, antidysenteric and
anti-venomous sera obtained from the Central Research Institute, Kasauli, were stored in the
refrigerator installed during the year and the following doses of each were issued up to the end
of December 1912:—