Autoinoculation

Autoinoculation (from Greek autos-self and Latin inoculatio-inoculation), literally self-inoculation, a term proposed by Wright (A. E. Wright), to denote the spontaneous (automatic) immunization of the body by microbes and their products entering the blood from a local focus of infection. According to Wright's teaching, a normal organism contains a reserve of specific protective or bacteriotropic substances capable of destroying or weakening microbes that have entered the body; among these substances, opsonins (see) are of the greatest importance, whose action makes microbes more accessible to being engulfed and digested by phagocytes. The content of bacteriotropic substances, resp. opsonins, or, as Wright expresses it, 'bacteriotropic pressure,' varies in different parts of the body; for example, the tissues of the skin and spleen are characterized by low bacteriotropic pressure. In the presence of an infected focus, bacteria and their products are washed out by the lymph current from the focus, carried to areas with high bacteriotropic pressure, and cause there an increased formation of bacteriotropic substances, which are then delivered by the blood current to the sites affected by infection ('autoinoculation'). Such spontaneous autoinoculation, in Wright's opinion, underlies the processes of natural recovery from infectious diseases, and it is essentially what is relied upon in so-called 'expectant' treatment. In generalized infections, as, for example, in typhoid fever, autoinoculation occurs very frequently or perhaps continuously; in strictly localized infections (e.g., furunculosis of the skin, tuberculosis of lymph glands), autoinoculation is negligible or entirely absent; midway between these are such localized infections in which autoinoculation occurs only at times, manifesting itself as an intensification of general phenomena (e.g., initial stages of tuberculosis of the lungs, chronic gonorrheal arthritis). Spontaneous autoinoculation must be considered as a complicating factor in prescribing vaccine therapy. Wright distinguishes the following cases: 1) in generalized infections with pronounced autoinoculation, expectant treatment without vaccine therapy is advisable; 2) in localized processes with occasional autoinoculation, it is first necessary to suppress autoinoculation by complete rest, adding to this the internal administration of calcium salts, which increase the coagulability and viscosity of the blood and slow down the lymph current, and only then apply vaccine therapy; 3) in processes characterized by absence or insignificance of autoinoculation, vaccine therapy should be prescribed directly. What is the meaning of introducing a vaccine into the body when conditions for autoinoculation exist? To this question Wright answers that with autoinoculation, vaccinating elements, entering the bloodstream, undergo dilution, whereas in vaccine therapy, the immunizing substance is introduced in a concentrated form, thanks to which the formation of bacteriotropic substances occurs incomparably more energetically. Artificial autoinoculation. Can be caused or enhanced by various influences on the focus of infection-massage, active or passive movements, active or passive hyperemia (Birovsky bandage), warm compresses, hot fomentations, Finsen light therapy, surgical extirpation of the focus, etc. The essence of these influences amounts, mainly, to intensified washing of the focus by the lymph current, thanks to which, on the one hand, bacterial products are removed from the affected site, and, entering the bloodstream, lead to the formation of bacteriotropic substances, and on the other hand, such washing facilitates access for bacteriotropic substances to the focus. Artificial autoinoculation as a method of treatment has certain advantages compared to vaccine therapy: 1) with autoinoculation, time is not spent on bacteriological diagnosis and vaccine preparation; 2) immunization is carried out unmistakably by exactly the agent that caused the disease; 3) the antigenic capacity of this agent is not weakened by cultivating it on an artificial nutrient medium; 4) access of fresh lymph to the focus is provided. However, these advantages of artificial autoinoculation are outweighed by its negative aspects: 1) in therapeutic effect, autoinoculation yields to vaccine therapy, requires more time and patience and is more expensive; 2) immunization is produced by unknown and unregulated doses of bacteria and their products; 3) not all parts of the body are accessible to influences causing autoinoculation, and these influences cannot always be applied without pain and without harm to the diseased organ; 4) with autoinoculation, not only bacterial products but also live bacteria enter the blood from the focus of infection, which can create new foci.-Artificial autoinoculation has much greater significance as a diagnostic method. By causing an increased formation of bacteriotropic substances, autoinoculation raises the opsonic index; therefore, an increase in the index under the influences used for artificial inoculation indicates the presence of an active focus of infection and in many cases facilitates early diagnosis; conversely, the absence of an increase gives grounds to conclude that such a focus does not exist or has extinguished. The doctrine of autoinoculation has been developed almost exclusively by Wright and his collaborators (Douglas, Freeman, Wells, Fleming); other researchers have touched on this question little. Neufeld (F. Neufeld), who developed the doctrine of bacteriotropins independently of Wright, believes that fluctuations in the opsonic index during the course of infectious diseases depend on fluctuations in the content of complement, and not on autoinoculation.