Abstract
Inasmuch as intracranial complications following pneumococcus Type III mastoiditis are known to occur, as a rule, not earlier than several weeks after the initial infection, serious attempts to induce a state of active acquired immunity should receive special consideration. The use of prophylactic vaccination was suggested by Kolmer and Amano on the basis of their work in rabbits in which immunization with pneumococcus vaccines elicited protection against experimental meningitis. 1 Barach found that type-specific active acquired immunity appeared within 6 days after intradermal or intravenous injection of pneumococcus type-heterologous vaccines in cases of lobar pneumonia. 2
Accordingly, in September, 1931, we undertook to immunize every case of pneumococcus Type III mastoiditis admitted to the Otological service of The Mount Sinai Hospital as soon as the bacteriological diagnosis was made, whether that be before or after the operation. The following method of vaccination was employed:
The patients were given a course of 6 intradermal injections, 2 a week, in the following increasing doses: 0.1 cc., 0.2 cc., 0.3 cc., 0.5 cc., 0.7 cc., and 1 cc. For doses larger than 0.2 cc. several simultaneous injections of 0.2 cc. each were made. In order to avoid loss of time, a stock vaccine was used for the initial injection. This was done never later than 48 hours after the operation and sometimes before the operation. For the remaining 5 injections an autogenous vaccine was used. The autogenous vaccine was prepared by growing a pure culture of pneumococcus Type III in 100 cc. of 1% glucose broth for 24 hours. The organisms were centrifuged, washed once and then resuspended in 0.85% NaCl solution to obtain a concentration of six hundred million organisms per cc. The bacteria were then killed by heating at 60° for one-half hour.
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