characterized by inflammation of the connective tissue structures of the body, especially in the muscles and joints, and attended by pain, aggravated by exposure, with a tendency to recurrence. As a diagnostic word, " rheumatism" has deservedly come into disfavor; myalgia, arthritis, periostitis, sprain, fractures, neuritis, and almost any localized pain of undetermined origin has at times been catalogued under this head. There is now, however, a desire to classify these different aches and pains, and to designate them with a proper scientific nomenclature. By the studies of Pasteur and Koch it has become certain that many cases of so-called joint disease formerly called rheumatism are now known as infectious arthritis, due to the entrance of bacterial micro-organisms into the blood stream, and lodgment in the joints from points more or less remote.2

"There are, however, some cases, undoubtedly infectious in origin, in which there is complete failure to recover the organisms in culture, or to demonstrate them microscopically, and it is assumed that in these cases there is not actual lodgment of the infecting bacterium in the joints, but that its toxins, generated elsewhere and circulating in the body fluids, and exhibiting a selective chemical affinity for joint tissues, have set up a chemical inflammation which would persist so long as the toxins continued to be absorbed into the circulation."

"It may be added that acute inflammatory rheumatism itself, is not generally acknowledged to be a disease entity, but an acute infection with certain cocci. This conclusion is supported by analogy, and by sound bacterial investigation in which the postulates of Koch have been found to hold good, viz. (1) the organism must be universally found in lesion; (2) it must be capable of being cultivated in pure culture; (3) the culture when injected into susceptible animals must reproduce the original disease; (4) it must be recoverable from the infected animal. This disease is therefore now considered an acute infectious arthritis."

"Charot's joints, gonorrheal arthritis and the numerous infective joints are in turn differentiated from rheumatism by the discovery of their respective causes, they receiving names indicative of those causes, and our conception of their pathology is based entirely on their causation."

"We have also forms of arthritis in addition to those already mentioned, viz., the senile, the arterio-schlorotic, the glandular, dependent on disturbances of secretion in the ductless glands; the tropic, as that accompanying diseases of unknown etiology like psoriasis, and the "metabolic."

1 Brenneman N. Y. Med. Journal, Nov. 23, 1912.

2 Journal Allied Dental Societies, March, 1914.

With the increasing interest in this subject, and continued research work, we shall no doubt be able within a short time to more accurately classify these varied forms of tissue change, and thus more certainly eradicate the cause.

BACTERIAL VACCINES IN COLDS AND PNEUMONIA By EDWARD P. SWIFT, M.D., New York City.

Common colds, the causes of a large proportion of the minor illnesses of the winter season, and of not a few of the more serious ones, have been ascribed in a rather indefinite way,. both by the profession and the laity, to exposure.

To prove that this view is erroneous it is only necessary to call attention to the fact that the persons least subject to colds, such as policemen, street-cleaners, motormen, Arctic explorers, and the like, are those most exposed to all the inclemency of the elements.

We have always talked about "catching cold," but only recently have we appreciated the significance of the expression. That exposure in those who are unaccustomed to it, may by lowering resistance, act as a predisposing cause, may be freely admitted, as in the case of numerous other infectious diseases, but the presence of specific micro-organisms is essential to the development of the symptoms.

It is a curious fact that similar clinical conditions seem to be produced by a variety of organisms. For example, an epidemic of colds in London, reported by Allen in 1908, showed the following bacterial record: influenza bacillus in only 2.4 per cent. Friedländer's bacillus in 19 per cent, bacillus coryzæ segmentosus in 26.6 per cent, and micrococcus catarrhalis in 28.6 per cent.

Niles and Hastings in 1911 reported a series of cases in which were found: micrococcus catarrhalis, 15 per cent, streptococcus 7, pneumococcus 7, b., influenza 7, and micrococcus tetragenous 6 per cent.

Dr. George Mather of Chicago found the predominating organisms in the recent grip epidemic to be the hemolysing streptococcus and pneumococcus.

A study of the recent epidemic in New York in the Research Laboratories of the Department of Health, under the direction of Drs. Williams and Nammack, covering about fifty cases, showed influenza-like bacilli in nineteen, but often in such small numbers as not to be considered of etiological importance.

The influenza bacillus was found alone in six cases, and associated with some other organism in thirteen cases.

The pneumococcus was isolated in eighteen cases. Other

organisms found were the hemolytic streptococcus in six, Friedländer's bacillus in 3, staphylococcus in three, and micrococcus catarrhalis in only one.

There have been numerous reports of success in the treatment of colds by mixed stock vaccines, but my personal experience is limited to their use in a few selected cases as a prophylactic measure.

Case.-S. V. W., age 35, organist, has been subject for many years to recurring colds, especially in winter, accompanied by asthma and bronchitis, so that his general health had become considerably impaired. Was obliged to burn asthma-powder for relief at night. Given four injections at three-day intervals, in Dec. 1914, of vaccines, in millions of killed bacteria: 150 at first injection, 300 at second, 600 at third, and 1200 at fourth; and containing micrococcus catarrhalis, bacillus Friedländer, pneumococcus, streptococccus, and staphylococcus albus and aureus, in the proportion of one-sixth of each.

His condition began immediately to improve, and there was no recurrence of colds or asthmatic attacks until the middle of February 1916, when he suffered from an attack of moderate severity, lasting a week, but unaccompanied by asthma. States that he has not been as well in years as since the treatment, and has gained several pounds in weight.

B. M. F., lawyer, age 37, subject to frequent catarrhal colds in head and throat which have affected hearing. Injected with same dosage as in preceding case in Dec. 1914. No colds during remainder of winter and spring, or until early February 1916, when he developed a moderate bronchial catarrh, lasting a week, but with very little involvement of the nasal passages, such as formerly occurred.

E. S. and P. S., brothers, 35 and 40 years of age, injected in Jan. 1915. Each developed rather severe colds within a few weeks, one of which was complicated by a suppurative sinusitis.

Injected myself in Jan. 1915. No colds during remainder of winter or spring, but one rather severe one first of the following December; none since.

In view of the fact that the immunity conferred by colds is of brief duration, it is unlikely that their vaccines will be found to be of very much prophylactic value, but their apparent effect in some individuals justifies their further trial.

The treatment of pneumonia by vaccines, both prophylactic and therapeutic, demands, in my opinion, more attention than has yet been given it by most practitioners.

As has been shown by the work of Cole, Avery, Dochet and others, at the Rockefeller Institute, there are several forms of pneumococci, differing in virulence, and described briefly as

follows: Groups I and II, which are agglutinated by the experimental sera derived from immunized horses; Group III: pneumococcus mucosus capsulatus, recognized by its peculiar slimy growth; and Group IV, an atypical group of all the pneumococci that kill mice, but do not agglutinate, or grow in the characteristic manner of Group III.

It is asserted that the mortality in groups I and II is 30 per cent, compared with 40 per cent in group III, and only 10 per cent in group IV, the miscellaneous group.

Inasmuch as the clinical aspects of all forms are similar at the outset, it is evident that a stock vaccine should include bacteria from all groups. An autogenous vaccine is impracticable, since the effectiveness of the treatment is directly dependent upon its early administration.

Following are the notes of a few cases, mostly treated during the past winter:

Mrs. S., age 60, subject of chronic rheumatoid arthritis, attacked with typical symptoms of lobar pneumonia on Dec. 28th, 1914. Given 50 million killed pneumococci on that date, followed in 24 hours by 100 million, with prompt subsidence of the symptoms and recovery.

The same patient was again attacked by pneumonia in Oct. of 1915. The treatment was repeated with prompt improvement, and rather slow convalescence, but complete recovery.

Mrs. E. S., age 79, attacked Dec. 22nd, 1915, with lobar pneumonia involving the right lower lobe, and extending to both lungs. Fifty million pneumococcic vaccine given on that date, 100 million on the 23rd, and 200 million on the 25th. This patient had a hard fight. Temperature on the 3d day 104, pulse 140, respiration 50; 4th day temp. 102.2; pulse 150; resp. 40. 5th day, temp. 102.2; pulse 160; resp., 44. Active delirium. On the morning of the 6th day the temperature had dropped to 100, pulse to 98, and respiration to 36, indicating a crisis. Slept the following night, and made uninterrupted

recovery.

Miss J. H., home from college for the holidays, attacked Dec. 27th, 1915, by typical lobar pneumonia. Seen in consultation with Dr. Hall of Mamaroneck, on the 28th. Fifty million vaccine given on that date. Temp., 103.2; pulse 100; resp., 24; Dec. 29th A.M.: Temp. 101; pulse 90; resp., 22; P.M.: temp. 103.6; pulse 100; resp., 24. 100 million vaccine. administered on the 30th. Temperature was 102 to 104 during Dec. 30th, 31st, Jan. 1st, 2nd, and 3d, but the pulse remained at about 100, and respiration 24 to 28, with no delirium, and good general condition. Crisis on night of Jan. 3d, and rapid

recovery. While this case ran a typical course, the apparent well-being of the patient throughout, and the moderate pulse and respiration were remarkable.

Mrs. D., age 82, attacked Jan. 16th, 1916 by chill, pain in right side, temperature 103, crepitant rales in the lower right lobe. Fifty million pneumococcus vaccine given immediately. On the following morning pain and fever had mostly disappeared, but the cough, at first with rusty expectoration, continued for three or four days, though there was no increase of lung involvement, and the patient fully recovered.

Mrs. S., age 57; chill at 8 P.M. on March 10th, followed by fever and pain in left side. Thought it an ordinary cold and did not send for me until 8 the following evening, March 11th. Then had temp. 103; pulse 110; respiration 28. Complained of headache, thirst, and considerable pain in the left side. Crepitant rales in lower right lobe; otherwise normal breathing sounds. Administered 50 million vaccine at once. Mar. 12th. A.M. Less pain in side. Slept at intervals. Temp. 102.2; pulse 110; resp. 26. Less thirst. Physical signs same. 6.30 P.M. Temp. 102.1; pulse 104; resp., 26. Less pain, but coughs more, with rather profuse bloody sputum. Broncho-vesicular breathing with crepitant rales lower and middle lobe of right lung. Broncho-vesicular breathing left lung posteriorly. Vaccine, 100 million. Mar. 13th, A.M. Temp. 101.2; pulse 110; resp. 26. Little pain, cough moderate, sputum bloody, physical signs same. P.M., Temp. 101.4; pulse 104; resp. 28. Sputum still bloody but lighter in color. Mar. 14th A.M., temp. 101.4; pulse 106; resp. 28. Coughed much during night. Sputum still bloodtinged, but lighter in color. Rales in middle and lower lobe, right, are coarser, with more normal vesicular breathing. Fine crepitant rales in lower left; broncho-vesicular breathing in middle portion of left lung. Vaccine, 200 million. Mar. 14th, P.M., temp. 103.2; pulse 112; resp. 32. Sputum more bloody. Crepitant rales over entire lower and middle portion of left lung, with bronchial breathing in middle portion. Fewer rales on right side, but partial consolidation of lower lobe. Mar. 15th, A.M., temp. 101.1; pulse 104; resp. 28. Slept at intervals. Less cough than the night before. Moderate perspiration in the early morning. Looks better. Coarse rales over left lung. Less bronchial breathing. Right unchanged. Sputum still bloody. Perspired moderately during the night. Evening temperature 101.3; pulse 108; resp. 28. Mar. 16th, slept during the night, awoke in perspiration. Temp. 99; pulse 92; resp. 24. Harsh breathing sounds in left lung, with fewer rales. Few crepitant rales in lower right lobe, otherwise vesicular breathing. This patient had no delirium at any time, nor other evidences of severe illness.