directly upon personal experience rather than from theoretical considerations. I fully appreciate that the following is a very hackneyed method of treating the subject, but as it is a personal testimony rather than a compilation from others, it may be pardoned. The vaccine treatment is, of course, one introduced for the purpose of combating infectious diseases and is, accordingly, indicated only in such.

Probably of all diseased states treated by this new method, no one has given so uniformly successful results as has furunculosis, not only in abating the severity of individual abscesses, but in eradicating the tendencies toward remissions or recurrences. So true is this that I do not look for criticism from any source from the sincerely believed statement that vaccines should be given preference over all other therapeutic measures in every case of furunculosis, using various adjuvants, surgical or otherwise, only as the individual needs seem to require.

Other forms of staphylococcus infection yield in varying degrees. Septic wounds, accidental or post-operative, usually show very satisfactory results following the use of either autogenous or stock vaccines. Sometimes the results are very brilliant, and less startling benefit is seen in so many instances as to well justify the use of the method as routine. Acne, pustular in type, very frequently yields to this vaccine, and when with it is combined that of the acne bacillus, many more cases are rendered amenable.

When we pass from staphylococcus to streptococcus we at once go from a fairly settled field to one full of doubts and uncertainties. Some are very pessimistic concerning results in these infections, and as these are practically always acutely virulent, the skeptics are usually those who disclaim for vaccines. any benefit in acute infections. My personal experience cannot allow me to join with those but, on the contrary, forces me to become allied with those conservative enthusiasts who claim that when properly administered, streptococcus vaccines, even stock preparations, are capable of doing much good. Here, however, the autogenous emulsion is always preferable, when it can be obtained.

Streptococcus wounds, accidentally received or even postoperative, have shown such gratifying results so frequently that all possibility of coincidence or chance seems to have been eliminated. In the majority of cases the treatment is used in conjunction with other recognized methods, surgical or otherwise, and the results have been superior to those others where vaccines have not been used. I fully agree with Ross in the beneficent effect of vaccines in erysipelas. It is now adopted as a routine treatment for cases occurring among the nurses or employees of the Hospital and is usually employed in all others. By it the disease is shortened, the severity decreased, and the mortality much lessened.

Not a few cases of peritonitis due to this infection, in which the prognosis was extremely grave, have rapidly and steadily

become changed into happy convalescents. The same can be said of various forms of puerperal sepsis, particularly before the organisms have reached the blood and are producing a metritis, a cellulitis or a phlebitis. And even in some cases of general infection, recovery has occurred after all hope was gone. In my opinion vaccines carefully administered in minute doses by an experienced immunizator have a decided place in the treatment of puerperal infection and will not infrequently serve to change. the tide from an advancing to a receding one.

I have reported elsewhere results in immunizing nurses in scarlet fever wards against that disease. As there reported, after two years work, the results show a disease morbidity of four per cent. among those inoculated, compared with one of thirty-six per cent. among those not thus treated. No claim is made that streptococcus causes the disease. It is, however, a very common secondary infection.

Another secondary infection very often favorably influenced by vaccines is pulmonary tuberculosis. Here temperature may be lowered, cough decreased, physical conditions improved and general feelings of well-being much increased. One cause of frontal sinus suppuration persistent for years cleared up completely under vaccines, and with no other treatment.

Of minor importance to all but the possessor are those various inflammatory disturbances of the larynx, pharynx and bronchi. These are frequently very amenable to autogenous vaccine.

Of pneumococcus infections, pneumonia is the most important. Dr. Leary will doubtless speak of this topic, and I will merely say that I am convinced of the efficiency of vaccines in this disease when properly and carefully used. Pneumococcus infections elsewhere, bronchitis, laryngitis, empyema, pyorrhoea, alveolaris and otitis media, offer very favorable fields for the vaccine therapeutist. Involvement of the accessory nasal cavities has not been very encouraging, probably on account of the difficulties of procuring adequate drainage.

A field that somewhat surprised me is the one now opening, consisting of those cases of arthritis that at times follow tonsillitis or other pharyngeal infection. Not a few cases have gone on to complete cure after unavailing treatment by routine methods. Two cases of chronic asthma have been treated, both with excellent results. One of these, a physician of wide experience, was rendered comfortable and further attacks warded off, after thirty years of unavailing attempt at relief.

The subject of tuberculosis is an enormous one, and cannot be adequately considered here. Tuberculin in dosage of .0001 mg. to .001 mg. has, in my hands, been followed by much benefit. In pulmonary tuberculosis, associated with streptococcus or pneumococcus in the intestinal forms, with colon vaccine in involvement of the lymph nodes, the kidney or the testicle, tuberculin has given very encouraging results. In addition, two cases of tuberculosis of the meninges, so called by the best diagnosticians of

both schools, resulted in recovery after tuberculin. It is somewhat uncertain in just what form of tuberculosis some kind of vaccine is not indicated, unless it be the acute miliary type.

Colon vaccine in pyelitis and in cystitis gives excellent results. In various forms of entero-colitis, even the ulcerative type, much benefit has followed its use. Peritonitis due to colon infection has been repeatedly treated with vaccines with good results. A small number of women with endometritis associated with this organism have not been apparently much benefited.

Vaccines in typhoid prophylaxis are of the utmost importance. My opinion concerning their value in therapeutics is probably well known to all. During the past two and one-quarter years no fatal case of typhoid treated by vaccines has occurred in the Hospital, against about a ten-per-cent. mortality among those not thus treated. The method is steadily gaining favor.

In gonorrhoeal arthritis there is an all but universal consensus of opinion that gonococcus vaccine should be the first routine treatment and will often render all others unnecessary. In other forms of the disease various results have been reported, some obtaining amelioration in orchitis, in epididymitis, in vesiculitis, and in divers other locations. This question is not yet accurately determined. In acute urethritis the possibilities at present seem to be slight.

A few infections with bacillus pyocyaneus have been treated, apparently successfully, but the cases are too few to permit of any deductions.

One interesting subject now under investigation is the immunization of surgical patients against post-operative infection. While the great improvement noted in surgical technic during the past two decades has largely eliminated the question of sepsis, nevertheless, there is always the latent possibility of such, and in instances all too numerous this becomes a very active matter. In a moderate number of individuals we have immunized against staphylococcus and streptococcus and at times against bacillus coli (abdominal and vaginal operations). Following these has been absolutely no trouble from sepsis, although they were cases picked for their apparent susceptibility to such. In one a hæmatoma developed in the abdominal wound and from it were isolated both staphylococci and streptococci in numbers. The surgeons predicted an extensive infection, with probable secondary operation to clear out the infection. It did not cause any trouble, however, did not become purulent beyond the already present blood, and merely retarded convalescence for about a week. Further work in this line seems well indicated.

These somewhat irregularly collected statements may suffice to give in a very schematic manner my opinions concerning vaccines, derived from personal experience at the Massachusetts Homoeopathic Hospital. And as this was, I believe, the aim of the chairman in requesting the paper, I have now complied with his request and will give place to others bringing their personal testimonies from our allied institutions.

THE ATTITUDE of tHE AVERAGE PHYSICIAN TOWARDS VACCINE THERAPY, AND ITS REAL

VALUE IN MEDICINE. *

By H. W. NOWELL, M.D., Assistant Pathologist to Massachusetts

Homœopathic Hospital.

Mr. President, Ladies and Gentlemen:

The subject of my paper this evening is a broad one and might be far better put before you by one more experienced than I. However, the few years I have devoted to the subject of bacteriology enable me to draw a few conclusions, the value of which I will leave for you to judge.

I realize that this subject was not a part of the older physicians' study, and many have never taken the pains to even understand the theory, let alone the practical side and application.

Vaccine Therapy is looked upon by many of you as a something unnecessary. I believe this is due to a lack of light upon the subject. I often hear this expression, "I have never seen any results from the use of vaccine, not obtained by the indicated remedy." This may be true, from your standpoint, but I believe that in vaccines you have a valuable aid, and, when the same judgment and care is used as in prescribing your remedy, in many cases your results will be far better. Right here I want to say from careful observation that most of the vaccine prescribing is done by those who are wholly unfit to do so, and after everything else has failed. Vaccines were never intended as a cure-all. Patient study and preparation are necessary. Special knowledge is required if you expect to get results. Their improper use makes them unsafe. They should be administered only by those who have made a special study of the subject.

The pathologist is a conscientious physician. He is not seeking for glory. It is a credit to you to use him if his remedy is indicated. I do believe that you are the one to keep records of the cases where vaccines are used and report the same. You are better able to judge and compare the cases. Do not wait until everything has failed, then expect vaccine to save your patient. Use it with your other remedies as a part of your treatment if you think the remedies necessary.

Dr. W. B. Konkle's article in the "Medical Record" of October 7 shows the attitude of physicians toward the development of new ideas in medicine. He says, "They have, indeed, manifested betimes the grossest intolerance of reform and progress. The greatest hostility toward improvement and advancement in medicine has been encountered within the medical fold itself. Such pathfinders as Paracelsus, Vesalius, Harvey, and Jenner have at every move and turn found themselves confronted by the swords of their brethren. But in all their hanging back and holding back, doctors are markedly conscientious. It has been a question of lack of light. Honesty unillumined is a blind gladia

* Read before the Boston Homœopathic Medical Society, November 9, 1911.

master.

tor. Conscience operating in God's open day is a true and worthy But there is no tyranny more stern, more inflexible, more inexorable than the tyranny of a benighted conscience. Liberty is a daughter of the sun."

Now as to the real value of vaccine in medicine, simply this: vaccine, properly made, dosage used with good judgment, determined to a certain extent by each individual case, and surely indicated, will give the same percentage of results that one might expect from careful prescribing.

First I will take up the value of bacterial vaccine as used in preventive medicine. You are all familiar with the fact that the United States, the English and German governments require their soldiers to have prophylactic treatment against typhoid fever. Surely such treatment would not be allowed by our government if after careful experimentation the results were not decidedly in favor of vaccine.

In speaking of prophylactic treatment with vaccine, we mean that we produce artificial immunity against typhoid fever, or, as we have apparently shown at our Massachusetts Homœopathic Hospital, West Department, against scarlet fever, by giving the nurses immunizing doses of streptococcus vaccine, and from the laboratory we have seen many instances from the other vaccines, such as S. P. A. and colon. Great care and good judgment must be used in giving this treatment for prophylaxis. I believe individualization must enter in, to a degree. It is a dangerous thing to produce a state of anaphylaxis, and this condition may be brought about by too large and too frequent inoculations. This state is to be feared, as all resistance is at its lowest point, and any infection may go on without check.

You all know the theory of the opsonic index and its practical value. Now if we find a patient's index low to a certain species of bacteria and this patient is given a bacterial vaccine. which raises this index to normal, certainly this is sufficient evidence that there is some virtue in the use of vaccines.

Now how does this substance act in the body? There have been numerous theories, but the theory of Wright and Douglas has been accepted as the most plausible. They point that there are certain substances in serum which so affect bacteria that they are more easily taken up and disposed of by the leucocytes. It is now generally accepted by most investigators that both serum and leucocytes contain substances which, acting after the manner of ferments, are able to dissolve bacteria. Probably the cells of the body secrete the protective substance by means of which bacteria are destroyed. The action of the vaccine is to raise this resistance to the highest point. Next arises a most important question: What advantage has the bacterial vaccine over the indicated remedy? It seems to me this is one which is apparently satisfactorily answered on the side chain theory. The fact that certain substances (bacterial toxins in particular) give rise to the production of antibodies, whilst others, such as the alkaloids,