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 site of infection by the blood stream, it will be realized that the success or failure of vaccine therapy depends largely on the blood supply of the affected area. So long as the newly elaborated anti- bacterial substances can come into contact with the bacteria, success may be anticipated, but when barriers to their arrival exist, success is limited or denied by the extent or completeness of the barriers. Thus in acute lobar pneumonia the affected area of the lung is occupied by an impenetrable clot of blood; little good can therefore be expected from vaccine therapy once this clot has formed and as long as it remains. But this does not preclude the exploitation of vaccine therapy in pneumonia in the earliest stages of the disease or after resorption of the clot has begun. Fortunately, in the majority of infections there is no such general disturbance of the blood supply to the infected area; in such case it surely follows that a supply of blood rich in protective substances must constitute an advantage, as against a supply of blood poorer in such substances. It will be realized from these remarks that the utmost care is needed in the accurate bacteriological diagnosis of each infection before vaccine therapy is employed, and the vaccine must be prepared with care as to sterility and specificity.

The administration of the vaccine needs the knowledge not only of general medicine but of bacteriology and the principles of active immunization against microbic infections.

The Vaccine. For practical purposes bacterial vaccine may be defined as sterilized and enumerated suspensions of bacteria, the liquid medium being either physiological salt solution or dilute nutrient broth. The bacteria must be isolated in pure culture and strictly identified by the usual tests. The microbes thus identified are usually inoculated on to the surface of a solid medium (e.g. agar-agar) and, after growth has occurred, the bacterial colonies are floated off into sterile physiological salt solution. The suspension thus obtained is placed in a hermetically sealed tube and thoroughly shaken, if necessary by mechanical means, so as to break up the colonies and obtain an even suspension. A small sample of the sus- pension is then removed for enumeration, the tube once more hermetically sealed and the whole placed in a water bath at 60° C. for one hour. This temperature has been found to be sufficient to kill most of the pathogenic bacteria without profoundly altering their chemical composition. Sterility of the vaccine is not, however, pre- sumed and each one is subjected to cultural control before being certified sterile.

The enumeration of the suspension may be carried out in various ways. The original method of Wright is as follows:

It has been the practice for some 25 years to enumerate the corpuscles of the blood in a counting chamber of known depth and ruled with squares of known size. Wright, therefore, mixes an equal quantity of blood and the bacterial suspension. Films of the mixture are made and appropriately stained for microscopic examination. An adequate number, about 500 usually suffices, of red blood corpuscles are counted in a series of fields of the microscope and at the same time the number of bacteria seen is noted. The number of red blood corpuscles per cub. mm. has previously been determined in a counting chamber, so that all that remains to be done is to work out the proportion of bacteria to red cells and so to arrive at the number of bacteria per cub. mm. or cm. of the suspension. , There a're tech- nical difficulties in the way of enumerating certain bacteria, e.g. the tubercle bacilli ; in these cases the bacterial growth is weighed, and the dosage, instead of being expressed in millions of microbes per cub. cm., is given in milligrammes or their fractions, e.g. a usual dose of a staphylococcus vaccine will be 250,000,000 cocci, whilst that of a tubercle vaccine would be o-oooi milligrammes.

A vaccine made from cultures obtained directly from the patient to be treated is said to be an autogenous vaccine. A vaccine made not directly from cultures obtained from the patient but from cultures of the same species of microbe as that which is infecting him is termed a stock vaccine. In general it may be affirmed that autogenous vaccines are nearly invariably to be preferred to stock vaccines, whilst in the case of certain microbes they are indispensable. Stock vaccines, however, are usually effective, save time and expense and have very wide application. Latterly attempts have been made to reduce the toxic action of the bacterial sus- pensions and so-called sensitized and detoxicated vaccines have been recommended, but it is doubtful whether these procedures constitute a useful advance.

The accompanying table gives a summary of the microbes from which vaccines are commonly prepared, together with the minimal and maximal effective doses in which they are administered.

Vaccines are administered by hypodermic injection and the inoculations are painless.

Where the minimal effective dose is employed the inoculation is not followed by any local or constitutional disturbance. If there is any sensible constitutional change, that change is in the direction of increased well-being. When a medium dose is irioculated there may

Autogenous

Stock

Effective doses

vaccine

vaccine

Min-

Max-

advisable

adequate

imal

imal

million

million

Acne bacillus

In some cases

Generally

5

500

Staphylococcus.

Generally

5

1000

Streptococcus.

In most cases

i

50

Pneumococcus.

Generally

5

50

Influenza bac. .

Generally

If polyvalent

10

500

B. of Friedlander

Generally

1 t

5

IOO

B. coli

Generally

i

IOO

M. catarrhalis.

Generally

5

IOO

Bordet's bac.

Generally

5

500 >

Diphtheria bac.

Often

Often

10



50 '

Gonococcus

Generally

i

50

Actinomyces

Generally

i

25

Meningococcus.

Polyvalent

5

1000

M. melitensis

Generally

30

IOO

B. typhosus

Yes

10

IOO

B. paratyphosus A.

Yes

10

IOO

B. paratyphosus B. Tubercle bac.

(?)

Yes Nearly

10

'/MO.OOO

IOO

'/1000

always used

mg.

mg.

be a small amount of local tenderness and a transient aggravation

of the patient's symptoms, or slight constitutional disturbance, malaise, headache and possibly a slight rise in temperature. But none of these negative phase effects are at all marked except where an excessive dose has been employed.

It is outside the sphere of this article to enumerate the various diseases in which vaccine therapy finds application, but a few in which vaccines have proved of exceptional value may be mentioned.

Boils, carbuncles and other staphylococcal infections usually yield readily to treatment by staphylococcus vaccine. Erysipelas, puerperal septicaemia, acute surgical septicaemia and septic wounds are conditions benefited by treatment with a streptococcus vaccine., Certain forms of rheumatism, arthritis and fibrositis are relieved and the progress of the disease is arrested by treatment with an appropriate vaccine, and the same may be said in the case of certain 'cases of bronchial asthma, chronic bronchitis and recurrent colds.

The distressing symptoms of inflammation of the bladder due to infection by the bacillus coli are relieved and may entirely disappear under treatment with an autogenous vaccine.

Tuberculous disease of the glands, skin and joints is amenable to treatment with a tubercle vaccine, and in rigidly selected cases the same holds good for tuberculosis of the lung.

It may be confidently asserted that, with increasing knowledge, vaccine therapy will find wider application and will become recognized as a valuable weapon in the combating of microbic diseases. (A. C. I.)

VACHELL, HORACE ANNESLEY (1861–), English novelist and playwright, was born at Sydenham, Kent, Oct. 30 1861. Educated at Harrow and the Royal Military College, Sandhurst,; he received a. commission in the Rifle Brigade in 1883. In 1894 he published his first novel, and in 1897 the first to make its mark, viz. A Drama in Sunshine. Subsequent novels included John Charity (1900); Brothers (1904) and The Hill (1905), both Harrow school stories; The Waters of Jordan (1908) and The Fourth Dimension (1920). He is the author of many plays, some, such as Searchlights (1915) and The Case of Lady Camber (1915) original; others, such as Her Son (1907) and Quinney’s (1915), dramatizations of his own novels, or like Fishpingle (1916), afterwards issued as novels; whilst others again, e.g. Who is He?, (1915) and The House of Peril (1919), were dramatized versions; of novels by other authors.

VAIL, THEODORE NEWTON (1845–1920), American capitalist, was born on a farm in Carroll county, O., July 16 1845. When a child, he moved with his parents to New Jersey, studied at the Morristown Academy, and for two years studied medicine with an uncle. Meanwhile he had become interested in telegraphy. In 1866 he went with his parents to a farm in Iowa, but two years later became station agent and telegraph operator on the Union Pacific at Pine Bluffs, Wyo. Then he was appointed clerk in the railway mail service and his efficiency led to his being called to Washington, D.C., in 1873, where he was made assistant-superintendent of railway mail service, rising in 1875 to general superintendent. In 1878 he was made general manager of the American Bell Telephone Co., and for the next seven years was actively engaged in the development of the telephone business, for which he foresaw a great future. In 1885 he resigned from the Bell Co., and was elected president of the newly organized American