126g.1 MEIAxENDHTcmBit¢xa;]JOItA VACCINE TREATMENT OF CHRONIC BRONCHITIS AND ASTHMA. [JUNE 14, 1913. The Nose and Naso-ph7ary-nx. Chronic Gonorrhoeal Arthriti8. Rheumatoid arthritis in connexion with septic polypi in I believe this to be duLe to a mixed infection of the the nasal cavities is not uncommon. In a girl aged 18, gonococcus and staphylococcus. The joints are character- who had rheunmatoid arthritis well started in the joints istic. There is swelling and often oedema in the tendon of the fingers of both hands, a vaccine containing sheaths around, well seen in the wrist-joint, marked pain, Micrococcus catarrhalis and Staphylococcus aureus was and a very early tendency to stiffness and limitation of made from her own discharge. There was in this pus no movement of a most obdurate character. Adhesions forml attempt at all at phagocytosis. She was vaccinated, but both witlhin the joint and around it within the fibrous phagocytosis was most marked after, the second inoculation capsule, tending early to fix it. Any attempt at forcible of the'vaccine. The polypi were then removed and she movement is painful and only tends to again light up the made a complete recovery from her joint trouble, having trouble. had no recurrence, either in the joints or of the polypi. A vaccine should be made from the urethra by inserting Chronic suppuration in the sphenoidal and frontal the loop well into the meatus. The gonococcus grows sinuses and in the antrum of Higlhmiore are.again possible best on slightly alkaline agar the surface of wlliclh las foci of infection. I have opened a knee-joint for acute been smeared witlh decomlplemnentized blood serum. I pneuinococcal infection following on a pneumococcal am very indebted to Dr. D'Este Emery for drawing my infection of the maxillary antrum. attention to this and sending lue some tubes. I give 100 million gonococci and 150 million staphylo- Chronic Otorrhoea. cocei for a preliminary dose, and inicrease it to even I have seen one case of rheumatoid arthritis of both knee- 500 million gonococei. and 1,000 million staplhylococei, joints clear up in a middle-aged woman after vaccine provided the reaction is not great. After the second dose inoculation combined with clearing out of the antrum and an anaesthetic is given, a'nd the adlhesions in the joint middle ear. Here, again, few bacteria were intracellular. broken down. I have seen no lharm follow this proceeding, It is therefore very important in cases of these metastatic and witli nmassage and daily movements while under the joints to make a thorough exanmination to exclude a influence of vaccines I have patients back at their work primary focus in the mouth, nose, tllroat, and ear. again wlhose joints have been given up as hopeless. Bought vaccines do not appear to act so well as autogenous The Lungs. in these cases, and this has been most marked in some of Rheumatoid joints have been associated with bronchitis my cases. Gonococcal arthritis is perhaps one of tlle and bronchiectasis. I remlember a case of the disease types of case which best lends itself to auLtogenous associated with bronchitis in which the pneumo-bacillus vaccination. was isolated. A vaccine was prepared and given and the Combined with this the chronic gleet should receive joint condition improved markedly, and finally the patient attention, and the best method I find is massaging the went back to work. penis over a stout metal bougie passed into the uretlhra, followed by the insertion of a protargol bougie. Copaiba The Intestinal Tract. should at the same time be administered by the mouth. Rheumatoid arthritis is often associated with dyspepsia, and I have seen it in association with chronic gastric ulcer and chronic appendicitis. With both these conditions there is a degree of intestinal stasis. I have frequently VACCINES IN THE TREATMENT OF CHRONIC opened the abdomen and found the condition of pericolitis BRONCHITIS AND OF ASTHMA.-* of a membranous kind affecting peristalsis. I can recall cases of marked amelioration in rheumatoid joints after By J. H. HARVEY PIRIE, M.D., F.R.C.P.E., gastro-enterostomy and ileo-sicmoidostomy, and Mr. FORMERLY ASSISTANT PATHOLOGIST, ROYAL INFIRMARY, EDINBURGH. Arbuthnot Lane has had cures. In this type of case vaccines do not produtce much benefit. The condition CHRONIC bronchitis, with a tendency to frequently recur- causing the stasis must be removed. An x-ray examina- ring acute attacks, and asthma, with or without bronchitis, tion should be mnade after a bismuth meal and any stasis have this at least in common from the point of view witlh or kinlks looked for. If the intestine can be proved to be which I am here concerned-namely, that they are fre- working efficiently, a very careful bacteriological examina- quently obstinate in their character and difficult to cure. tion of the urine should be made. If organisms are found Any method, tllerefore, whiclh gives better or rnore per- -notably B. coli, in the absence of intestinal stasis-a manent prospects of relief than those commonly in use vaccine sshould be made, and in this special type of case seenis worthy of trial, and I lhope to show by a survey of I have seen a great deal of good follow. the cases I have lhad under treatment during the past three years that in vaccine therapy we lhave a remedy Leutcorrhoea. which, if it does not always effect a comnplete cure, does, This often dates from a confinement, and in a number of at least in most instances, give considerable relief, even in cases I have examined I have found a displaced uterus cases where otlher measures have failed more or less and retention of some products of conception whlich have completely. become adherent to tlle uterine wall. Any inflammatory RECURRENT BRONCHITIS. condition in the uterine annexes will by contraction tend The cases upon wlhicll this opinion is based are selected to deviate tlle uterus and cause passive congestion with ones-not in the sense that I lhave picked out all tllose in leucorrhoea. Ctultures taken fromn inside tlle cervix in which the results are good and discarded the others, but these cases have shown mixed infections, the commonest in the following respects: (1) All are cases in which the form of organismis being the B. coli, a diplococcus, and complaint was of some standing. (2) All lhave been under staphylococci. other forms of treatment for varying periods, but with Tlhe vaccine base should be given prior to rectifying more or less want of success. As, however, in most the uterus, so as to raise the immunity. I have seen instances the other methods of treatment (medicinal, many cases made worse by curettings and other operative lhygienic, etc.) were continued witlh, any difference in the procedures performed when the patient's immuunity was results may fairly be attributed to the additional factor- low, but I have never seen anything- but good follow that is, the vaccine. (3) Only those whlich have been when the surgical procedures have followed the second under observation, or have been followed up, for some inoculation of the vaccine. time have been included. This excludes cases whiclh have ,When once the primary focus is cut off and the only been under treatment quite recently and in whicll it patient's immunity raised to the particular infection, is too soon to speak with any certainty as to the results; local treatment by Bier's bandage, Scott's dressing, etc., also those in which treatment was only carried out for to induce an artificial hyperaemia with blood now en- very short periods and then, for one reason or another, riched with opsonins, may be instituted. It is useless given up. If the latter group were included, the failures to resort to these local measures, and baths and spa would certainly bulk larger, but it would hardly be fair to treatment alone; the symptoms only and not the cause judge a method by cases in which treatment had not been aLre treated. For contractions I usually apply extension given a reasonably long during vaccine. treatment. I have not seen drug cata- trial. phloresis do any good. * Read before the Medico-Chirurgical Society of Glasgow. JUNE 14, 1913.] VACCINE TREATMENT OF CHRONI-C BRONCHITIS AND ASTHMA. [TDzBJ 1269 vaccines were with doses ranging from 40 to 200 million resulted in complete Autogenous always employed, prepared freedom from bronchitis which has lasted up to date for almost usually from the sputum (obtained as free from contami- a year. In this case, however, the honours must probably be nation as possible, after cleansing of the mouth by brushing shared between the vaccine and the surgical measures in the anid rinsing out with boiled water), occasionally from nose. (Cure.) swabs taken from the naso-pharynx. The details of pre- CASE IV. of the vaccine have been modified from time to F., aged 22, who for three years has suffered from chronic paration bronchial catarrh, worst in winter, with frequent " catching of time, but it has been my invariable practice to include in colds," which often amount to actual bronchopneumonia. She it all organisms found abundantly both in film preparations is free from cough at times, but there are always rhles to be and in culture, so as to make as certain as possible of heard in the chest. Tuberculosis was suspected for a time, but including the actual offending germs. I believe this is tubercle bacilli have never been found in the sputum. Ex- because at we have no amination of the sputum at various times constan-tly yielded essential, present really satisfactory pneumococci and IlI.