Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Clinical Use of Vaccines.—­Vaccines should not be given while a patient is in a negative phase, as a certain amount of the opsonin in the blood is used up in neutralising the substances injected, and this may reduce the opsonic index to such an extent that the vaccines themselves become dangerous.  As a rule, the propriety of using a vaccine can be determined from the general condition of the patient.  The initial dose should always be a small one, particularly if the disease is acute, and the subsequent dosage will be regulated by the effect produced.  If marked constitutional disturbance with rise of temperature follows the use of a vaccine, it indicates a negative phase, and calls for a diminution in the next dose.  If, on the other hand, the local as well as the general condition of the patient improves after the injection, it indicates a positive phase, and the original dose may be repeated or even increased.  Vaccines are best introduced subcutaneously, a part being selected which is not liable to pressure, as there is sometimes considerable local reaction.  Repeated doses may be necessary at intervals of a few days.

The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.

PYOGENIC BACTERIA

From the point of view of the surgeon the most important varieties of micro-organisms are those that cause inflammation and suppuration—­the pyogenic bacteria.  This group includes a great many species, and these are so widely distributed that they are to be met with under all conditions of everyday life.

The nature of the inflammatory and suppurative processes will be considered in detail later; suffice it here to say that they are brought about by the action of one or other of the organisms that we have now to consider.

It is found that the staphylococci, which cluster into groups, tend to produce localised lesions; while the chain-forms—­streptococci—­give rise to diffuse, spreading conditions.  Many varieties of pyogenic bacteria have now been differentiated, the best known being the staphylococcus aureus, the streptococcus, and the bacillus coli communis.

[Illustration:  FIG. 2.—­Staphylococcus aureus in Pus from case of Osteomyelitis. x 1000 diam.  Gram’s stain.]

Staphylococcus Aureus.—­This is the commonest organism found in localised inflammatory and suppurative conditions.  It varies greatly in its virulence, and is found in such widely different conditions as skin pustules, boils, carbuncles, and some acute inflammations of bone.  As seen by the microscope it occurs in grape-like clusters, fission of the individual cells taking place irregularly (Fig. 2).  When grown in artificial media, the colonies

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Manual of Surgery from Project Gutenberg. Public domain.