Vaccinotherapy

VACCINOTHERAPY, treatment with vaccines (see Vaccination, Vaccines). Wright is considered the founder of the doctrine of V.; he and his school not only developed the theoretical doctrine of V. but also introduced vaccines into widespread clinical practice. According to Wright's doctrine, the introduction of a vaccine into the body in an appropriate dose raises the opsonic index, i.e., it enhances the phagocytosis of microbes that are the cause of the disease. An excessive dose of vaccine, on the contrary, lowers the opsonic index, creating a prolonged "negative phase" of immunity (see). Reintroduction of the vaccine during this period can, according to Wright, adversely affect the patient's condition. Thus, according to Wright, the application of a vaccine, its dosage, and the intervals between injections must be accompanied by the mandatory determination of the opsonic index (see Opsonin). However, numerous observations by other researchers have shown that in V. it is quite sufficient to rely on clinical observation without determining the opsonic index. In agreement with Wright's school, in the treatment with vaccines it is necessary to care for improving lymph circulation in the diseased focus; for this purpose a Bier's incision, stagnation hyperemia according to Bier, a warming compress, etc., are recommended. Widespread for treatment are vaccines prepared from cultures of microbes killed by heating at a temperature of 60-70° or by the addition of formalin in an amount of 0.5-1%. Next, various types of tuberculin, which are extracts from bacteria, are widely spread. Vaccines from live cultures are applied, mainly, in the form of so-called "sensitized vaccines" of Metchnikoff and Bezredka. The best therapeutic effect is achieved by applying a vaccine from the strain of microbes that is the cause of the given disease (autovaccine). In those cases where the microbe cannot be isolated by culture from the given patient, or until an autovaccine is prepared, the application of ready-made polyvalent heterogenous vaccines (heterovaccine) from microbes isolated from other individuals with the corresponding disease (for example, in furunculosis - staphylococcal vaccine, in puerperal sepsis - streptococcal, etc.) is recommended. In practice, so-called combined vaccines also have great distribution. For instance, sometimes a medicinal substance, itself acting favorably on the course of a given process, is introduced into the composition of a vaccine (for example, gonococcal vaccine with urotropin; contains 40% urotropin). In Germany, so-called Yatren-hepat-vaccines are in use: in these preparations the microbial suspension is in a 4% solution of Yatren, which is also a means of killing microbes. At the same time, Yatren, representing iod-oxyquinoline-sulfuric acid + disodium carbonate, possesses non-specific irritating properties. Therefore, Yatren-vaccines are ascribed a double action: specific, depending on the antigen, and non-specific, connected with Yatren. There are other, less widespread types of combined vaccines. In the vast majority of cases, vaccines are applied subcutaneously, much less often into the muscle and vein. As a result of the introduction of vaccines, both local and general reactions are observed. Injections usually begin with 0.1-0.2 cc containing microbial bodies in an amount of 500-1,000 million in 1 cc and are repeated after 3-5 days after the complete disappearance of the reaction to the previous dose. Each subsequent dose is increased by 0.1-0.2 cc or the same dose is repeated, depending on the degree of reaction to the previous injection. Sometimes a vaccine is applied for a long time, and after 7-10 injections a break of 2-4 weeks is made, after which the same course of treatment is repeated. Contraindications to the application of V. are cardiac decompensation and damage to the renal parenchyma. Special caution is required during active tuberculosis and during pregnancy. At present, the area of application of V. is very wide. The treatment of chronic localized diseases of various organs, especially where the cause are pyogenic or microbes acting similarly to them, is undoubtedly indicated. Thus, V. is successfully applied in furunculosis, sycosis, carbuncles, joint diseases, phlegmons, in osteomyelitis, osteitis, and periostitis after infectious general diseases, in various complications after gonorrhea, in catarrhal pneumonias complicating influenza, whooping cough, etc., in pyelitis and cystitis, especially caused by Bact. coli comm., in fungal lesions of the skin and mucous membranes (but not of hair and nails), etc. The benefit of V. in acute diseases is disputed by many, but it is still recommended in epidemic cerebrospinal meningitis, especially in the form of autovaccine, when the presence of adhesions in the spinal canal hinders the introduction of serum, and in whooping cough. The significance of V. in septic processes is still unclear. Apparently, it gives success with intravenous application in puerperal diseases and not always in septic endocarditis. Diseases of the skin and mucous membranes poorly respond to V. (see Tuberculosis, Tuberculin for the application of tuberculin). Local application of vaccines is also possible. In this respect, the treatment with so-called antiviruses according to Bezredka (see) has entered wide practice. They are applied in the form of compresses or tampons at local lesions where, by localization of the process, this is possible. So far they have been used with benefit in furunculosis, abscesses, phlegmons, and generally purulent lesions of the skin and subcutaneous tissue, in lesions of the genital tract, serous cavities (tampons), and in diseases of the ear and eye.