:cines and Serums Viewed 
om the Standpoint of Many 
hysicians 
"The layman becomes skeptical about the trustworthi- 
ness of the pronouncements of science in general, and 
in this respect the average medical practitioner joins 
his ranks. The lay press spreads the errors, especially 
when they carry the endorsement of a prominent name, 
but it never retracts; and the public pays rich royalties 
into the pockets of those who know how to exploit an 
opportunity to promote health." 
Editorial, The Journal of the 
American Medical AssociaUfMP 
January 18, 1913. 
VIVISECTION INVESTIGATION LEAGUE 
United Charities Building 
105 East 22nd Street 
New York City Vaccines and Serums Viewed 
from the Standpoint of Many 
Physicians 
"The layman becomes skeptical about the trustworthi- 
ness of the pronouncements of science in general, and 
in this respect the average medieal practitioner joins 
his ranks. The lay press spreads the errors, especially 
when they carry the endorsement of a prominent name, 
but it never retracts ; and the public pays rich roya,lties 
into the pockets of those who know how to exploit an 
opportunity to promote health." 
Editorial, The Journal of the 
American Medical Association, 
January 18, 1913. 
VIVISECTION INVESTIGATION LEAGUE 
United Charities Building 
105 East 22nd Street 
New York City CONTENTS 
Page 
Vaccines and Serums Considered Generally 3 
Arthritis and Rheumatism 31 
Cerebro-Spinal Meningitis 33 
Diphtheria 45 
Hydrophobia 57 
Infantile Paralysis .... 64 
Influenza 66 
Pneumonia 72 
Smallpox 78 
Tetanus 91 
Tuberculosis 98 
Typhoid Fever 106 
Wasserman Test and Luetin Test 121 
Whooping Cough 126 
Colds ..................................................................................................................128 
Dysentery 128 
Hay Fever •. 128 
Lumbar Puncture 128 
Rattlesnake Venom ..128 
Skin Diseases 128 
Typhus 128 
Addenda 133 VACCINES AND SERUMS 
VIEWED FROM THE STANDPOINT OF MANY PHYSICIANS 
The following quotations from noteworthy sources are submitted as 
evidence that the use of vaccines and serums is of doubtful efficacy and 
of always possible danger, for it must be borne in mind that the ulti- 
mate results of this procedure no man knows. 
The whole subject of vaccine and serum therapy seems to be only 
dimly understood, opinions regarding such method of treatment being, 
apparently, at greatest variance. 
Although according to the words of medical men high in their pro- 
fession, the use of vaccines and serums is particularly subject to abuse, 
nevertheless their number is steadily increasing and these laboratory 
products are being used more and more widely with diminishing discre- 
tion by practitioners of all sorts and description. 
We feel the time has come when the layman, who is the subject of 
these doubtful methods, should, for his own protection, be made aware, 
at least, that opinions in the medical profession differ very much as re- 
gards the harmlessness and the beneficence of serums and vaccines. It 
is to this end that we publish the following quotations. 
That there has been, for some time, decided differences of opinion in 
regard to the beneficence of vaccines and serums is evidenced by state- 
ments made by Dr. John Blake White in a paper read before the Greater 
New York Medical Association, December 19, 1910 and published in 
American Medicine, March 1912: 
"There never was in history," says Dr. White, "a time, like 
the present, when greater caution is required to avoid being 
misled by popular clamor in favor of some pretentious anti- 
toxins. 
"The Italian specialist, Tomasoli, claimed remarkable healing 
results with hypodermic injections of a medicated solution of 
common salt and bicarbonate of soda, and without referring to 
similar reports by reputable authorities, the question may be 
very naturally raised, how much if any of the alleged virtues 
ascribed to some animal serums may not be justly attributed 
to the active antiseptic agency of their intermixed saline in- 
gredients if not to the presence of the very antiseptics used 
for their preservation. 
"Are we not so zealously seeking for specifics, that we are 
losing sight of rational therapeutics, doomed at last to find 
3 disappointment in the illusive claims of some new drug or ex- 
ploited serum?" 
Dr. White advocates the use of "solutions of pure chemical sub- 
stances" rather than 
"the less understood animal serums so much flaunted at the 
present day. It is without fear of proof to the contrary that I 
am ready to record the assertion that no benefit can be obtained 
from animal serums which cannot be realized from well selected 
and prepared chemical solutions administered in like manner for 
the same purposes." 
Referring to the use of vaccines in acute diseases, Dr. T. Wood 
Clarke, A.B., M.D., Utica, in the New York State Journal of Medicine, 
May, 1912, p. 243 states that: e 
"A vaccine given during an acute disease, when the body is 
itself, more or less successfully, exerting every effort to raise 
its own immunity bodies, when the life of the patient depends 
upon these bodies being produced before the vital spark is 
overwhelmed by the toxins, merely adds so much more burden 
to the already overloaded organism, and, while it can be ex- 
pected to do no good in the time allotted to it, may, on the 
contrary, by reducing- the resistance while increasing the poison, 
tilt the vital balance in the wrong direction and kill the patient." 
Referring to vaccines an editorial in The Journal of the American 
Medical Association, February 15, 1913, has this to say: 
"Vaccines . . . are supplied by the biologic departments of 
drug houses, and the preparation and sale of these products have 
come to occupy a prominent and in all probability a remunerative 
department, if we may judge by the space devoted to their 
advertising. 
"The thinking physician knows, however, that the treatment 
of infection with vaccines requires careful attention and thought, 
together with a study of the clinical and pathologic conditions 
of the individual case, and that unless this requirement is met, 
more failures than successes follow." 
"And now the physician is asked practically to disregard the 
little knowledge he already has of the mechanism of infection 
and inject into his patients a mixture of toxic bacterial deriva- 
tives, called Phylacogens, and see what will happen. Some- 
thing usually does happen, and the patient has good reason to 
remember the experience of the chill and violent constitutional 
symptoms that follow the injection. It hardly seems possible 
that physicians of experience ever would countenance the in- 
jection of such toxic substances into patients already over- 
whelmed with the poisons of infection, such as that by the 
streptococcus in erysipelas, or the pneumococcus in pneumonia." 
"To complete the list of Phylacogens so that the busy practi- 
tioner need not waste his time in thought, provided he is unable 
to determine on clinical grounds the nature of the illness in his 
patient, he is provided with Mixed Infection Phylacogen, . . ." 
Under "Current Comment," page 602, The Journal of the American 
Medical Association, February 22, 1913 comments as follows in respect 
to Phylacogens: 
"But whether it takes four years or one year for this thera- 
peutic rocket to flare itself out, the tragedy lies not in the 
widely heralded reputed successes, but in the many unreported 
failures, perhaps deaths, following the use of experimental 
4 novelties. Bacterial derivatives, like the Phylacogens, are poi- 
sons, powerful, dangerous and little understood. . . . Human 
nature being the same in the medical profession as elsewhere, 
the untoward effects will seldom or never be reported; the 
deaths which follow their administration will be ascribed, un- 
consciously perhaps, to 'unforseen complications'. . . . Ten years 
from now, when the Phylacogen craze is recalled to their memor- 
ies, thousands of our readers will blush with shame for the 
profession which tolerated it." 
In 1913, the American Medical Association appointed a Committee 
to study into the question of Vaccines. They reported in a series of 
articles entitled: "Bacterial Vaccine Therapy: Its Indications and Limi- 
tations." 
In The Journal of the American Medical Association, June 14, 1913, 
page 1880, (article VIII of the series) is the following: 
"Under ideal conditions vaccine therapy would be prosecuted 
only by those physicians whose training in the several special 
fields of bacteriology, immunology and practical medicine had 
thoroughly qualified them to pursue the treatment with scientific 
discrimination and caution. . . . But under present conditions 
such a desirable state is unattainable. In reality the medical 
profession has allowed itself to be exploited by mercantile inter- 
ests to a point at which promiscuous vaccine therapy with all 
its faults is widely practiced." 
In a "note" the article says: 
"In these articles the subject of phylacogens has not been 
considered, because, being neither serums nor vaccines, but in 
large measure toxic products of the metabolism of bacteria, they 
do not come within the scope of the present series. They have 
not been scientifically investigated; they are not standardized, 
nor are they standardizable; most serious and even fatal results 
have followed their use." 
In the last article of the series, June 28, 1913, page 2046, is the 
following: 
"The therapeutic possibilities of vaccine therapy have been 
exaggerated. 
"The promiscuous use of the stock bacterial vaccines of com- 
merce in the treatment of acute and chronic infections is an 
irrational procedure. 
"Ready-mixed commercial vaccines should be abolished. 
"In cases suitable for bacterial therapy, autogenous vaccines 
are with few exceptions superior. 
"Autogenous vaccines should be prepared by those in touch 
with the patient and not through the agency of remote labora- 
tories." 
From "Our Tendency to Fads," by Joseph Zeisler, M.D., Prof, of 
Dermatology, Northwestern University Medical School, ^he Journal of 
the American Medical Association, August 9, 1913, page 379: 
". . . almost anything is being treated by the injection of all 
sorts of serums and the so-called vaccines or bacterins . . . but 
when we see that vaccines are recommended and used for the 
treatment of vertigo, hay-fever, rheumatism and sciatica, of 
appendicitis and gall-stones, we are forced to regard such prac- 
tices as fads. . . . Enterprising pharmaceutical houses have 
5 done their share in complicating the matter, not to say making 
our lives miserable." 
He warns against use of phylacogens, the use of which he says, has 
been followed "by such disagreeable, not to say alarming coeffects, that 
I would under no circumstances be willing ever to use them again?' 
In the Zoophilist and Animals' Defender, September, 1913, is an article 
by Dr. Edward Berdoe, M.R.C.S. (Eng.), L.R.C.P. (Ed.) On page 78 
is the following: 
"In 1902, Sir William Collins, M.D., F.R.C.S., late Chairman of 
the London County Council, delivered before the Sanitary Con- 
gress at Manchester an address, under the title of 'The Man 
Versus the Microbe,' wherein he said that the disease germ had 
been too much with us, 'and we are in danger of losing sight 
of the man amid the luxuriant and magnificent flora of the 
bacteriological laboratory-we cannot see the man for the 
germs.' " 
Dr. Berdoe continues: 
"We grew to believe that where the bacillus could be detected 
in our bodies we had the malady which the organism represented. 
But we got over that phase when it was demonstrated that in 
our mouths, for example, the germs of a dozen or more diseases 
could be detected, however healthy we. might be. We found 
out, without much scientific research, that whatever might be 
the truth about the microbes, they could not do us harm unless 
they found a suitable soil in which to grow. Some of us won- 
dered whether the soil-the unhealthy body, in other words-did 
not grow the microbe, instead of the microbe growing the disease. 
The bad microbe requires the bad ground wherein to flourish; 
in the stony ground it perishes." 
The following extracts are from an article by Thomas J. Horder, 
M.D., London, F.R.C.P. Lond., Assistant Physician, St. Bartholomew's 
Hospital, published in The Lancet, January 31, 1914, page 310: 
While Dr. Horder is a believer in vaccines to a very limited extent he 
thinks that their 
1 "value is in direct proportion to the care and judgment be- 
stowed upon the diagnostic problem" and that, "The failures 
of vaccine therapy are probably more numerous than its suc- 
cesses." "Most infective processes are capable of spontaneous 
recovery, and in the majority of them we are doing other things 
to assist recovery besides giving vaccines." 
"At first sight," says Dr. Horder, "the growing popularity of 
inoculation treatment amongst practitioners suggests that its 
utility is thereby demonstrated. But on a further view we be- 
come aware of the fact that to a large extent this accession of 
practical interest on the part of the doctor is due to the forcing 
of his hand by the patient. This, and a natural desire not to be 
left behind, may be responsible for much of the increase in the 
bulk of vaccine therapy as seen today, rather than honest con- 
viction based upon personal experience. Just as hundreds of 
us joined the vogue for soured milk in the treatment of intes- 
tinal dyspepsia a few years back, and hundreds of us join the 
vogue for treating constipation by paraffin today, for reasons 
of necessity rather than conviction, so many of us inoculate 
our patients because it is expected of us rather than because we 
feel it is the best way to cure them. In short, inoculation treat- 
ment is fashionable. ... It must be confessed that a large 
amount of vaccine therapy is of the most discursive and slip- 
shod kind;" . . . "chemists now supply stock preparations which 
6 are mixtures of the endotoxins of several different micro-organ- 
isms: We have arrived at 'phylacogens.' This is a frank sub- 
mission to the fact that there are many medical men who feel 
that something should be injected into their patients, but that 
beyond this they are not prepared to go. . . . The use of phy- 
lacogens clearly demonstrates one thing-that the fear of ill- 
effects from the introduction of microbic poisons into the sys- 
tem has to a large extent died out, both in the mind of the 
patient and of the doctor, . . ." 
Under the heading: "Sees Life Menace in Unknown Serums," the 
Brooklyn Eagle, June 24, 1914, quoted from the speech of Dr. Henry 
Allen Higley, "a Brooklyn pathologist, at a meeting of the Homeo- 
pathic Medical Society of Kings County," as follows: 
"Rigid legal regulation is necessary to prevent the wide 
spreading of scurrilous serums and anti-toxins manufactured 
today in Manhattan and Brooklyn by all sorts of persons, char- 
latans some of them, for all sorts of diseases, in all sorts of 
conditions." "Nothing is more harmful than the indiscrimin- 
ate manufacture of sera and vaccines which are palmed off to 
practitioners." 
"For the protection of the general public and of the intelligent 
public, steps should be taken to halt this danger." 
In the Chairman's Address read before the section on Pharmacology 
and Therapeutics at the Sixty-fifth Annual Session of the American 
Medical Association, June, 1914, and published in The Journal of the 
American Medical Association, July 4, 1914, Dr. John F. Anderson, 
Director Hygienic Laboratory U. S. Public Health Service, made the 
following statement: 
"In recent years there has been manifested a very marked ten- 
dency to the use of certain agents or methods for therapeutic 
purposes which, unless checked, will, in the reaction that is 
bound soon or late to follow, have an unfortunate effect on 
progress in therapeutics. Many of these agents in the method 
of their exploitation almost force one to the conclusion that 
financial gain of the proposer or of the producer is the sole basis 
for their exploitation. 
"We know that the injection into the body of certain toxic 
substances may produce a certain primary reaction, but we 
know little of the secondary or remote effects when such sub- 
stances are introduced into the circulation or are given hypo- 
dermatically. We know less about the primary effects of the in- 
troduction of many other toxic substances now used for thera- 
peutic purposes and nothing of their secondary or remote action. 
No doubt many of them in their secondary effects do the body 
permanent harm and thus may reduce the natural resistance, 
against disease. 
"These unhealthy tendencies-and I do not hesitate so to term 
them-in therapeutics have of late been particularly evidenced 
in regard to the use of certain biologic products. It has not been 
long since physicians were teaching that, drugs given by the 
mouth would cure or relieve many morbid conditions, but now it 
seems to be the fashion to teach that in order to obtain a surer 
and more lasting effect it is necessary to introduce the drug into 
the body parenterally. [By any other way than through the 
gastro-intestinal tract]. This may be due in part to the exten- 
sive propaganda for the use of certain biologic preparations 
carried on by some of the users and manufacturers. 
"The mode of administration appears to have cast a spell not 
only over the laity, on whom a method unusual to them may 
7 be expected to have a psychologic effect, but also on some phy- 
sicians who seem easily persuaded to ascribe virtue to parenteral 
administration of almost any preparation. It may be granted 
that some effect can be readily produced by subcutaneous or 
intravenous injection, but that this effect is of real benefit to 
the patient is another matter." 
Extracts from an editorial in The Journal of the American Medical 
Association, August 29, 1914, page 785: 
"The noted advance in therapeutics shown in the develop- 
ment of vaccine therapy has brought with it grave dangers as 
well as advantages." The editorial refers to articles of its own 
in which the "unscientific character of mixed vaccines and of 
the mixed filtered products of a number of vaccines marketed 
as 'Phylacogens' has been especially emphasized and the danger 
from their indiscriminate use pointed out." 
The article refers especially to the address of Dr. John F. Anderson, 
"one of our foremost workers in this branch of biologic science," which 
was published in The Journal, July 4, 1914. Dr. Anderson is quoted as 
saying: 
"Bacterial therapy undoubtedly in some cases is a most valu- 
able method of treatment; but when the claim is made that a 
combination of the dead bodies or the filtered products of a 
number of different bacteria are useful for the treatment of 
certain diseases with a different specific cause, it would seem 
that the suggestion closely approaches quackery." 
The editorial, states that 
"the purveyors of bacterial vaccines have gradually increased 
the number of different bacteria in their mixed vaccines until 
some of those now advertised for sale contain as many as seven 
different kinds of bacteria, and some of the 'Phylacogens' contain 
the filtered products of at least eleven bacterial species!" 
"It is a case in which the physician becomes the sole guardian 
of the patient committed to his care." 
"If physicians would report their failures when these vaccines 
are used, and especially report the fatalities consequent on their 
use, with the name of the manufacturer of the particular pro- 
duct used, we are quite sure there would result a lessening in 
the enthusiasm of the purveyors of these products." 
The article also quotes from a recent book by Victor C. Vaughan, 
late president of the American Medical Association, as follows: 
"Every time an unbroken protein is introduced into the body 
it carries with it, and as a part of it, a poison. From thy very 
careless, rash, and unwarranted way in which 'vaccines' of most 
diverse origin and composition are now used in the treatment of 
disease, this matter certainly cannot be understood or its danger 
appreciated by those who subject their patients to such risks. 
It should be clearly understood that all proteins contain a poi- 
sonous group-a substance which in a dose of 0.5 mg. injected 
intravenously kills a guinea-pig. This poison is present in all 
the so-called 'vaccines' now so largely used, and it is not strange 
that death occasionally follows the use of 'Phylacogen' or similar 
preparations. Not only do these proteins contain a poison, but 
when introduced parenterally the poison is set free, not in the 
stomach, from which it may be removed, but in the blood and 
tissues. It is possible that vaccine therapy may become of 
great service in the treatment of disease. Even now there are 
8 occasional brilliant results which are reported while the failures 
and disasters are not so widely advertised." 
The editorial concludes: 
"Such a warning as this quotation contains, from a man so 
eminent as Dr. Vaughan, merits and should receive the careful 
attention of medical men; ..." 
Sir Dyce Duckworth, M.D., LL.D., F.R.C.P., in an article in The 
Lancet, London, November 28, 1914, says: 
"It may be noted that vaccine therapy itself is not yet void 
of empiricism. Multivalent vaccines, for example, are some- 
what akin to the 'blunderbuss' prescriptions of a century ago, 
... I suppose that not a few of us are far from satisfied with 
the efficacy of tuberculin treatment, or of the value of pneumo- 
coccus vaccine in cases of pneumonia; and we are not without 
evidence that some maladies, plainly of toxic origin, are amen- 
able to the older methods of treatment when vaccine therapy 
has failed to afford benefit. ... I should always prefer to begin 
with the older methods before resorting to vaccine treatment, 
and I would venture to suggest that some of us are now in dan- 
ger of losing the older acquired knowledge of appropriate treat- 
ment for many common ailments." 
From an article by Sir Rickman J. Godlee [Lister's nenhew], Bt., 
K.C.V.O., Past President, Royal College of Surgeons, England, British 
Dental Journal, March 15, 1915, page 265: 
"Sir James Goodhart, in a characteristic letter, has quite 
recently made a timely protest against the recklessness with 
which the removal of all the teeth is advised in some quarters. 
... as will have been guessed, I share his opinion in great 
measure and join in his protest. I cannot help thinking about 
the other organs that are condemned. To one surgeon the large 
intestine is the root of all evil; and he removes it entire, leav- 
ing behind gall-stones and trifles of that sort. Those who deal 
with the upper abdomen take away two-thirds of the stomach 
for an ulcer. Most of the thyroid is eliminated for what Sir 
Arbuthnot Lane thinks he could cure by colectomy. The ton- 
sils are taken out root and branch by the throat specialist. 
And now you come along and whip out all the teeth!. Can it 
be that you have at last reached the fountain and origin of all 
the trouble? And that, after removal of the teeth, the tonsils 
and the thyroid will shrink and the large intestine resume its 
functions? If not it is sad to contemplate the future prey of 
the specialties: 'Sans colon, sans spleen, sans tonsils, sans teeth, 
sans everything.' 
"Seriously I think that the idea is being pushed too hard; and 
I hold the same opinion about vaccines. Far be it from me to 
sneer at vaccines. They deserve and are getting a fair trial; f 
and their employment will take its place among other thera- 
peutic measures. But as so often happens with new remedies, 
we were given to expect too much from them, and this has led 
to disappointment. Being of a sanguine disposition, I shared 
in the hope, and I confess that I share in the disappointment. 
I am afraid there is a real danger of going on and on with the 
easy, if rather expensive, treatment by vaccines on the chance 
that it may do good, and of neglecting more old-fashioned but 
possibly more useful remedies." 
An editorial in The Journal of the American Medical Association, 
August 21, 1915, page 719, states: 
9 "In recent years the use of drugs in the treatment of the 
sick has been supplemented to a great extent by the use of 
serums and vaccines. A commercialism has developed in the 
sale of these products, however, which threatens to rival that 
connected with the supplying of drugs, the shotgun mixed vac- 
cines taking the place of shotgun nostrums. The difference is 
that in the case of vaccines it is the doctor who is directly 
duped, and not the layman;" 
"The essential basis of 'vaccine therapy' is the use of the 
specific organism or its products, but the use of such prepara- 
tions has gone far beyond such limitation. We are now 
advised by commercial houses that, when the specific organism 
is not known, a mixed vaccine or the mixed products of a 
number of organisms be used in the hope, it is to be supposed, 
that one of them may exert some specific action. 
"It is recognized that the shotgun prescription is unscientific 
and an admission on the part of its user of his failure to arrive 
at an accurate diagnosis; the same is true of the mixed stock 
vaccines. There is the added possibility of harm, because, as 
expressed by Vaughan, 'the parenteral administration of any 
foreign protein is always attended by the possibility of harm.' 
This warning applies not only to the mixed vaccines composed 
of the whole killed bacteria but also to the mixed filtered met- 
abolic products of a number of bacteria (phylacogens) which, 
on account of the possible presence of free toxic products, have 
. additional potentialities for harm." 
"It is humiliating that members of the medical profession 
should allow themselves to be influenced by the scientific jargon 
which the vaccine maker uses with an air of authority." 
"To emphasize again, the use of the mixed stock vaccines of 
commerce is irrational because it is based on the conception 
that infections are caused by more than one kind of micro- 
organism; it is harmful because it encourages superficial exam- 
ination, slipshod diagnosis and routine treatment without 
individualization;" 
In an address delivered before The Washington State Homeopathic 
Medical Society, November 13, 1915, Dr. C. P. Bryant, of Seattle, made 
the following remark: 
"Vaccines are unstable. No two individuals respond alike, 
statistics do not prove their usefulness, and there is evidence 
tto prove that other more serious conditions arise from their 
use." 
The Journal of the American Medical Association, December 11, 1915, 
under "Society Proceedings," page 2113, quotes from a number! of 
adddresses given at a meeting of The Philadelphia County Medical So- 
ciety, held October 13, 1915. Referring to "General Principles of Vac- 
cine and Serum Therapy," Dr. Thomas McCrae is reported to have said: 
"The dose of vaccine must be such that the patient can over- 
come it by his own resistance, which is a difficult thing to 
estimate." "In reference to the whole subject, we may say 
that we are dealing with very delicate reactions: how delicate, 
it is often impossible to know. Caution is necessary, ... In 
talking about the principles of vaccine therapy, we must not 
forget that perhaps the greatest principle of therapy is to 
be certain that our remedies will do no harm." 
Dr. Alfred Stengel is reported to have advised: 
". . . an attitude of conservatism should be held on the matter 
of vaccine and serum therapy. . . . The professional atti- 
10 tude at present" according- to Dr. Stengel "is to receive with 
open arms any and all sorts of vaccine and serum treatments 
resting on no sort of foundation, or on the flimsiest evidence. 
Sometimes it has been said that progress in drug therapeutics 
has been largely based on experiment in man, and that serum 
and vaccine therapy should be advanced by the same method. 
There is a fundamental difference, however, in these two 
methods of treatment. 
"So long as the gastro-intestinal tract is functionally intact, 
the administration of any non-toxic drug is a matter of little 
moment, and even toxic drugs in sublethal doses may be toler- 
ated, or if irritating, rejected. The subcutaneous or intraven- 
ous injection of vaccines or serums is, however, an entirely 
different matter, and we should not forget the distinction, . . . 
vaccines and serums are distinctly capable of doing harm. . . . 
I could easily produce evidence that both vaccines and serums 
are capable of causing injurious effects. . . . No one who has 
read the medical journals or the newspapers need be appre- 
hensive that vaccines and serums will fail to receive a fair trial, 
but there is grave reason to suspect that they will be abused." ' 
Dr. M. Howard Fussell referred to 
"the indiscriminate use of vaccines and serum. Unfortunately, 
many practitioners base their belief in the value of vaccines and 
serums on the statements of manufacturing firms and their 
detail agents." 
Dr. S. Solis Cohen: 
"At the present time we must use a scientific empiricism in 
the application of biologic agents, for I am not so sure that we 
have arrived at a scientific explanation of the action of 
vaccines." 
The Journal of the American Medical Association, December 11, 1915, 
page 2128, reviews an article by O. I. Molchanova entitled "Serum Sick- 
ness, at the Pediatric Clinic in Moscow, 1904-1913." 
We quote from the review: 
"Molchanova found so-called serum phenomena, such as 
urticaria, fever, adenitis, etc., in 56.7 per cent, of the patients 
given diphtheria antitoxin, and in 64.3 per cent, of those treated 
with antistreptococcus serum for scarlet fever. In those cases 
in which the antitoxin or serum for scarlet fever had been in- 
jected more than once, such phenomena were present in 100 
per cent., but when the antitoxin was injected for the first time, 
complications were noted in 47.5 per cent, and in 59.6 per cent, 
in the scarlet fever cases. The first sign of the serum disease 
was swelling of a gland in the inguinal region, as the serum 
was usually injected in the abdominal skin or in the gluteal 
muscles. . . . The most frequent sign, however, was a rash in 
the form of urticaria, erythema multiforme, measles-like, scar- 
latinaform or hemorrhagic." "Of other rarer complications, 
Molchanova mentions affections of the joints. . . elevation of 
temperature and albuminuria . . . and edema of the face, lids, 
upper lip. ... A very disagreeable complication was gastro- 
intestinal disorders, vomiting, diarrhea and abdominal pain. 
In four cases only there occurred cardiac collapse, with one 
death. . . . The anti-anaphylactic method of Besredka was 
used in fifteen patients, . . . but it did not prevent complica- 
tions." 
Dr. Walter R. Hadwen, London, in The Abolitionist, March 1, 1916, 
11 page 68, makes the following remarks in reference to the growing use 
of serums and vaccines: 
"Pasteurism has fallen like a blight upon one of the most 
useful professions that exist-the profession of medicine. It 
has suggested a routine method of dealing with disease which 
dispenses with the need for wisdom, observation, initiative 
and personal interest and care on the part of the doctor. It 
has diverted attention from sanitation, or when it has gone hand 
in hand with that true preventive of disease (as in the present 
war) it would seem to be in order to claim for itself the results 
which sanitation alone has achieved. It has tortured millions 
of animals and subjected millions of human beings to experimen- 
tal treatments containing an element of danger. It has exalted 
; „ the laboratory above the hospital. 
* "It has created and fostered baseless scares, and has taken 
( advantage thereof to reap financial profit. It is (to quote Dr. 
George Wilson, late Medical Officer of Health for Mid-Warwick) 
''steeped in financial interests'. It employs far too many people 
to render its overthrow easy; but the world must be saved from 
it." 
Quotations from an article entitled "Vaccine Treatment," by Ludvig 
Hektoen, M.D., The Journal of the American Medical Association, 
May 20, 1916: 
"Except as tested in Pasteur's experiments on inoculation 
| against rabies after the infection has been received, this ex- 
! planation of the supposedly curative action of vaccines has not 
J been put to the direct test in animal experiments, largely, it 
I seems, because the animal infections with which we are ac- 
i quainted are not regarded as suitable for that purpose since 
they do not appear to duplicate sufficiently the human condi- 
tions. Whether or not the practical results of vaccine treat- 
ment for curative purposes support the hypothesis as to the 
mode of action on which it is based is even now a debatable 
question." 
Referring to the introduction of vaccine treatment by Wright in 1902, 
Hektoen says that: 
"vaccine treatment. . rapidly passed into general use and, at 
least in this country, soon became the object of an unrestrained 
and indiscriminate exploitation, to which the medical profes- 
sion has offered but little resistance. In a short time various 
practices were introduced, which are not in harmony either 
with the conditions demanded by the primary hypothesis or 
with the teachings of bacteriology and immunology, and which 
before long reduced vaccine treatment as generally practiced 
from a carefully controlled, essentially scientific procedure to 
one of guesswork and routine." 
"The first departure from the course of safety and conserva- 
tism was the uncontrolled delegation of the making of vaccines 
to commercial concerns." 
"By accepting the mixed vaccines of commerce, the physician 
abandons reason and begins to grope in the dark, forgetting 
that 'a multitude of remedies is the child of ignorance.' His 
examination of patients tends to become more and more super- 
ficial, his diagnosis slipshod, and his treatment routine, without 
positive indications, and without individualization." 
"The simple fact is that we have no reliable evidence to show 
that vaccines, as used commonly, have the uniformly prompt 
and specific curative effects proclaimed by optomistic enthus- 
iasts and especially by certain vaccine makers. . . ." 
12 Speaking of Gay and Chickering's use of the typhoid vaccine, Hektoen 
says: 
"They report no alarming symptoms from the injections; but 
others using different methods have reported instances of col- 
lapse, of hemorrhage, and of hyperpyprexia with delirium and 
death, so that this treatment is not to be lightly undertaken." 
The following extracts are taken from an editorial entitled "Vaccine 
Treatment," appearing in The Journal of the American Medical Associa- 
tion, May 20th, 1916: 
"In this issue, Hektoen [page 1591] traces the stages by 
which vaccines which were first employed with attempted 
scientific control have come into indiscriminate and unrestrained 
use, with no guide beyond the statements which commercial 
vaccine makers are pleased to furnish with their wares. Al- 
ready most physicians are realizing that the many claims made 
for vaccines are not borne out by facts, and that judging from 
practical results there is something fundamentally wrong with 
the method as at present so widely practiced." 
"It has been difficult for most physicians to distinguish be- 
tween the relatively limited field of prophylactic immunization 
in which scientifically controlled experiments and carefully ob- 
served and analyzed results have confirmed the claims of the 
method, and the other field of the use of vaccines in which 
mixtures of bacteria and their products have been indiscrimin- 
ately introduced into patients suffering from all manner of 
disease, infectious and noninfectious, acute and chronic, without 
study of the patient, or knowledge of the etiology or pathology 
of the disease." 
"In regard to the more recently developed methods of intra- 
venous therapy in typhoid fever, Hektoen points out that certain 
new concepts and theories are introduced which need diligent 
study and correlation before their application to the problem 
can be settled. . . . Certainly the development here should 
proceed cautiously." 
"Already a similar procedure has been introduced for the 
intravenous treatment of other subacute and chronic infectious 
diseases, such as arthritis, and some observers have asserted 
that the amelioration of the symptoms in the joints following 
the treatment is sufficient to establish it as a worthy routine 
treatment. . . . Indeed, other observers have noted that patients 
so treated relapse, and that the number of those who do not 
relapse is apparently no greater than the number of untreated 
patients who recover spontaneously. Such treatment, ineffective 
in itself, actually hinders recovery by distracting attention from 
the search and removal of the cause of the arthritis. 
"The fact that much time and effort of the past ten years 
appear now to have been wasted, so far as positive results go, 
should make us doubly cautious in accepting a new and some- 
what similar procedure until opportunity has been afforded for 
its verification under conditions favorable for scientific control." 
That the injection of foreign substances into the veins is a method of 
procedure which should be questioned, is clearly evident in the following 
extracts from an editorial in The Journal of the American Medical Asso- 
ciation, November 11, 1916, page 1450. Speaking of the advantages 
claimed for this method of therapy, the editorial suggests that 
"These advantages in many cases are apparent rather than 
real; but even were they real advantages, they should not blind 
us to the various and serious dangers which this method in- 
13 volves. The technic, although not difficult, must be thoroughly 
mastered, or undue pain, infection, air embolism, or even death 
may result. . . 
Referring to the fall of blood pressure which is the immediate result 
of intravenous injections the editorial states that: 
"It is usually of short duration, but is certainly undesirable 
and sometimes may have serious results." "Deaths have re- 
sulted not only from a lack of knowledge of the technic of 
intravenous therapy, but also from a lack of knowledge of drugs 
which may be so administered." 
"The intravenous injection of a complex mixture would ap- 
pear to be particularly reprehensible. Little is known, as has 
been stated, of the results to be expected from intravenous 
therapy, even with simple substances." 
The following quotations are from an article by Dr. W. Wayne Bab- 
cock, Surgeon, Samaritan and Garretson Hospital, Philadelphia, publish- 
ed in the New York Medical Journal, December 9, 1916, page 1132. Dr. 
Babcock deplores 
"the heroic, and at times indiscriminate internal use of antisep- 
tics to supplant normal antibodies, of vaccines to lash the 
protective forces to increased endeavor, or serums to render 
less necessary the production of normal antitoxins. While we 
no longer see patients bled, and purged, and sweated until they 
collapse, we do from time to time observe patients with every 
evidence that their protective forces are struggling to the 
uttermost against a violent infection, now shocked by the intra- 
vascular injection of an antiseptic solution, again pale, perspir- 
ing, collapsed, from the throes of a violent chill after the in- 
travascular injection of a vaccine, or burning and gasping from 
the secondary pyrexia; or in another case struggling against 
the superadded toxicity of an alien serum or protein, while blood 
tests, lumbar punctures, aspirations, polygraphic tracings, and 
other records performed at frequent intervals, prevent rest, 
increase pain and mental anxiety, and add to the exhausting 
effects of the disease." 
"It is not long since that we had what has been well termed 
the 'carnivorous' period in surgery, in which the operator, proud 
of his boldness and daring, fell upon the patient, and with much 
tearing, rending,' and crushing, triumphantly tore away the 
diseased part." 
In Dr. Babcock's opinion, 
"the militant spirit has not entirely disappeared, and we have 
not fully learned the great principle that it is not what we put 
into the tissues, but what we get out of them that determines 
recovery from disease." 
"Too frequently we forget that vaccines and serums can 
never replace such timeworn aids to immunity as rest, support, 
noninterference, protection, and other important measures that 
have been reiterated and forgotten many times." 
From "The Phenomena of Anaphylaxis" by S. Wyard, M.D., B.S. 
Lond., M.R.C.P., Captain, R.A.M.C., The Lancet, January 20, 1917: 
"The extended use at the present time of prophylactic and 
14 therapeutic injections of antisera brings into especial promin- 
ence the condition of anaphylaxis." 
"The present state of our knowledge-or should it rather be 
ignorance?-does not allow of any real and satisfactory defini- 
tion of anaphylaxis. . . . The condition may be provisionally 
described as one of greatly increased sensitiveness of the animal 
organism to the introduction of foreign protein, so that injec- 
tions of the latter in amounts which are innocuous to controls 
produce in the hypersensitive animals symptoms of varying in- 
tensity and even acute death." 
"That anaphylaxis may ensue on suitable! treatment with 
bacterial vaccines has been recognized since the work of 
Rosenau and Anderson in 1907. . . ." 
In the case of diphtheria antitoxin Dr. Wyard states: 
"there have been many cases reported of severe illness after 
injection of this serum. A few cases even of death have also 
been recorded." 
"Hutinel has reported four deaths from anaphylaxis con- 
sequent upon intrathecal injection of antimeningococcus 
serum, . . 
"To explain the phenomena of anaphylaxis several theories 
have been from time to time propounded, but most of them 
have in one respect or another been found wanting." 
"No satisfactory theory has yet been found To explain the de- 
velopment of anti-anaphylaxis, and the methods of producing 
it are for the present entirely empirical." 
"It is obvious that nothing can be done to guard against the 
reaction after a first injection, as the individual gives no in- 
dication of his increased sensitiveness." 
"In mild cases [of anaphylaxis] the attack may be over before 
treatment can be applied; if more severe the exhibition of cer- 
tain drugs may prove of service: such are atropine, adrenalin, 
chloral hydrate, and pure oxygen. ... In cases of still greater 
severity artificial respiration may be necessary and may alone 
succeed in tiding the patient over the period of shock, but is 
better used in association with one or other of the above-men- 
tioned drugs. In a few instances of the utmost gravity no 
efforts will be of any avail, and death ensues. . . . Much pain 
and swelling find relief in a hot fomentation, while irritation 
is allayed of moistening the surface of the part with 1 in 60 
solution of carbolic acid." 
From Dr. George Morrison Coates, A.B., M.D., Fellow of the Ameri- 
can College of Surgeons, Philadelphia, in his paper, "Clinical Experi- 
ence with the Use of Vaccines in Diseases of the Ear, Nose, and Throat," 
published in The Journal of the American Medical Association, January 
20, 1917, comes the following frank statement: 
"In the popular craze for giving vaccine treatments which 
has pervaded alike the specialist and the general practitioner, 
vaccines have been administered for every known and unknown 
disease, with reason or without, more often the latter." ( 
"Of course the claims of the makers of commercial vaccines 
are usually absurd and misleading, although it is surprising 
how many men of intelligence will accept them at times, even 
in the face of all reason." 
The following extracts are from an article by David John Davis, M.D. 
Department of Experimental Medicine, University of Illinois, entitled 
15 "Vaccine Therapy, Its Possibilities and Limitations," published in The 
Journal of the American Medical Association, January 20, 1917: 
"Even to this day it is interesting to note that in the domain 
of animal diseases, . . . there are no natural diseases known 
in which vaccines for curative purposes have been of any ap- 
preciable value. Indeed, there is empirical evidence that vac- 
cination just before or during an attack of a disease may do 
harm." 
"Koch's work on tuberculosis in 1890 was perhaps the first 
serious attempt to app^y vaccine therapy to the human and it 
was, as we all know, a tailure at that time. Scores of attempts 
with almost every imaginable modification of the bacillus, in- 
cluding extracts and bodies, have since been made. Biggs 
states that treatment with tuberculin on the whole is being 
gradually given up in this country. This is after a trial of 
twenty-five years. ... A curative vaccine against the bacillus 
has, however, not been found." 
"Following the work of Wright, . . . there occurred a flood 
of commercialism in connection with the preparation of vaccines 
and bacterial products of all kinds." 
"On account of the very severe reactions occurring at times 
after the intravenous method [of inoculation] the question may 
be properly raised as to its possible dangers. . . . Even sub- 
cutaneous use of large doses may not be entirely free from 
harm." 
After citing an instance where very severe symptoms followed a sub- 
cutaneous injection of dead meningococci, the author calls attention to 
the fact that: 
"An enormous number of patients are now being treated and 
will be treated throughout the country by this method. Much 
of it will be done by inexperienced men and no doubt we may ex- 
pect some serious accidents to occur." 
Same magazine, page 166, from the report of Dr. Davis' remarks: 
"It is an interesting fact that so far as animal diseases are 
concerned we do not know of any instance in which vaccines 
are curative. . . . This is true of natural and experimental 
animal diseases." 
In the New York Medical Jottmal, February 10, 1917, page 283, Dr. 
William Seaman Bainbridge is reported to have said at a meeting of 
The Medical Association of the Greater City of New York: 
"Any final conclusions with regard to the comparative merits 
of the treatment employed in this war could not possibly be 
drawn at the present time. It would probably be years before 
the medical and surgical history ... of the great conflict could 
be justly written. As might be expected, opinions varied 
greatly among the workers concerning the value of different 
1 methods. ... In Berlin, for instance, it was the consensus that, 
so far as Germany was concerned, the use of vaccines for ordin- 
ary infections had been very disappointing." 
From an article by Augustus K. Detwiler, M.D., Omaha, read before 
the Southwestern Iowa Medical Society, Feb. 15, 1917, published in New 
York Medical Journal, June 2, 1917, page 1020: 
"In animal pathology, as far as I know, there are no natural 
16 diseases in which curative vaccines are of real value. Great 
hopes were based on serum therapy, but only diphtheria and 
tetanus toxins produce antitoxins in sufficient quantities to be 
available in the prophylaxis and treatment of the disease." 
"Great numbers of patients are now being treated and will 
continue to be treated by vaccines, for all sorts of diseases, and 
much harm is being done, so, I think, we should take a conser- 
vative position and advise against the haphazard use of un- 
standardized bacterial proteins in all kinds of obscure conditions." 
The following are quotations from the report of proceedings of the 
Medical Society of the State of New York, as given in the New York 
Medical Journal, May 19th, 1917: 
Discussing the "Present Status of Serum Therapy" Dr. Rufus I. Cole 
•of the Rockefeller Institute, is reported to have said: 
"While the receptive attitude toward the new and unusual was 
undoubtedly the proper one for the experimentalist, a more 
skeptical attitude was undoubtedly justified for the practitioner 
whose chief function was to apply new discoveries." 
Dr. Cole suggested that good intention, but 
"lack of time to weigh carefully all the evidence, had led many 
to employ so called biological therapeutical methods, which had 
little or no clincial evidence to support them, were not based on 
sound experimental observations, and not only did no good, but 
were actually harmful in many cases." 
Dr. W. B. Stone of Schenectady is reported to have said: 
"It is surprising how much slovenly practice masquerades 
under the name of vaccine therapy." 
Dr. Warren Coleman, of New York, expressed the opinion that: 
"A remedy which had been found useful by generations of 
physicians should not be discarded merely because its actions 
had not been subjected to the tests of a modern laboratory or 
because experimental and clinical results were at variance. 
. . . The conclusions reached by different experimenters con- 
cerning the same therapeutical agent did not always agree." 
According to Dr. J. M. Swan of Rochester: 
"There was a tendency to prescribe medicines without making 
u most careful study." 
Under the heading, "The Nonspecificity of Vaccine Therapy," Dr. 
Joseph L. Miller, of Chicago, referring to the intravenous injection of 
nonspecific agents is reported by the New York Medical Journal, June 
16, 1917, page 1159, to have said: 
"Although the method seemed to offer great possibilities it was 
not free from danger and in the present state of our knowledge 
it could not be regarded as having reached more than the ex- 
perimental stage. Much had still to be learned before it could 
be offered to the general practitioner with any measure of 
safety." 
From, "Reflections on the Limitations of Vaccine Treatment," by 
Robert J. Rowlette, M.D., Dub., F.R.C.P., Irei., Senior Physican to Jer- 
vis Street Hospital, Dublin, The Lancet, June 30, 1917: 
17 "It is notorious that no judgment in medical practice is more 
difficult than the estimation of the value of a particular method 
of treatment. A new method is introduced, it wins a certain 
amount of favor, it may become the fashion, and unless it is 
accompanied by some obtrusive disadvantages or dangers, many 
of us are convinced that the treatment is, if not 'the last word,' 
at least, 'a distinct advance,' and we go on with it until a new 
fashion takes the place of the old. Our reasoning on these 
matters is never logical, and rarely individual. We are governed 
by laws-if they be laws-of herd psychology." 
"It is difficult or impossible to arrange a therapeutic experi- 
ment in such a way that the conclusion is irresistible. The 
problem is not so complicated in surgical as in medical treat- 
ment, as the conditions more closely approach those of scientific 
experiment. Nevertheless, surgeons are not free from the in- 
fluence of fashion-that is to say, from the sway of inaccurate 
judgment. Gastro-enterostomy, appendicetomy, colectomy, Jack- 
son's membrane, have all had their vogue, and the nuciform sac 
is not the exclusive specialty of an imaginative surgeon." 
Extracts from an article, "Bacterin Therapy," by J. G. B. Bulloch, 
M.D., Washington, D. C., The Western Medical Times, July, 1917: 
"It would appear that there is too much desire to accept 
new and untried measures of treatment and to arrive at con- 
clusions too hurriedly. ..." "Should we not be cautious in 
accepting certain theories promulgated at the present day and 
be certain that we stand on firm ground, ere we jeopardize the 
lives of our patients by following a new line of treatment?" "Is 
there an absolute certainty that the treatment by bacterins is 
effective and devoid of painful consequences? . . . How many 
theories of the past have been found to be ephemeral?" 
Referring to experimental research in laboratories, Dr. Bulloch asks: 
"Does it necessarily follow that because animal tissues are 
affected by certain processes that this is sufficient proof that 
the human body will respond to like measures?" "Can we not 
remember how salvarsan was heralded as a sure cure for 
syphilis? Is this medicine now considered a specific, or do we 
still have to use mercury? We know it is not accepted as an 
antidote and that persons have been injured by an injudicious 
use of this vaunted cure." 
Speaking of the subsidence of certain diseases in localities where they 
formerly prevailed the author reminds us that, 
"We lose sight of the fact that improved methods of sanitation, 
the boiling of water and its filtration, destruction of refuse 
matter, better drainage and pure milk, with many improved 
x methods of hygiene, are many of the prime and most potent 
factors for the disappearance of disease, and the general im- 
provement of conditions. It will not do to' experiment upon 
the human family and those who do so ruthlessly should be 
■ severely punished." "And now shall we blindly accept bacterin 
therapy as our sure cure and relegate to the rear many old 
remedial measures which are known to affect at least an 
alleviation of suffering and in many cases a cure and abandon 
them for the dangers attendant upon the bacterin administra- 
tion?" 
In the same magazine, page 11, Dr. Eli G. Jones, Buffalo, predicts 
that: 
18 "In the near future, when the 'serum craze' and the craze 
for 'needless surgery' have spent tbeir force there will be a 
demand for the physician who knoivs materia medica and is 
fitted to heal the sick." "Our medical colleges are turning out 
physicians loaded down with technical knowledge, but they have 
neglected the most important thing of all, to teach them how 
to heal the sick." "I warned the profession several years 
ago that the introduction of 'serums' in the treatment of the 
sick was a fearful mistake! . . . By injecting serums into the 
body in the treatment of disease, we are 'creating a disease in 
the body. It has caused heart disease, and is the principal 
reason why the deaths from heart disease have doxibled during 
the past ten years. Our business as physicians is to heal the ' 
sick and never to create disease in the human body. In read- ' 
ing the pulse of a person after serums have been injected into 
the body, I have found much more force to the pulsations of the 
radial artery. The powerful pulsations of the artery give me 
the impression of a power behind the heart that is driving it to- 
its own destruction!" 
On page 325, The Journal of the American Medical Association, 
August 4, 1917, Dr. Henry A. Christian of Boston, says: 
"In more recent years with frequent therapeutic use of large 
amounts of foreign serums, serum sickness has become a well 
recognized syndrome [the aggregate symptoms of a disease; a 
complex of symptoms]." 
The following excerpts are from an article entitled "Standardization 
of Serums and Vaccines," by G. W. McCoy, Director, Hygienic Labora- 
tory, United States Public Health Service, Washington, D. C., Published 
in The Journal of the American Medical Association, August 4, 1917: 
"Those who have devoted the most time and have had imposed 
on them the greatest responsibilities in relation to the field of 
biologic products have thus far been willing to recognize as 
standardizable only a small number of preparations . . . stand- 
ards have been formulated for the antitoxins of diphtheria and 
tetanus." "At the Hygienic Laboratory, much time has been 
devoted also to the standardization of antityphoid vaccine, and 
(.here has been devised a tentative standard for this agent. This 
tentative standard requires that the dose intended for human 
oeings, when administered to rabbits in a certain manner, shall 
provoke a certain agglutinin response. It was recognized that 
the agglutinin response was not necessarily a measure of the 
prophylactic value of the vaccine as applied to man, but it was 
felt that the procedure would improve the quality of the vaccine 
on the market which had been found to be very variable." 
"This completes the list of preparations for which there are 
standards, only a small fraction of the great number of bio- 
logic products on the market. This does not mean that attempts 
at standardizing other products have not been made." "There 
are three fundamental difficulties in standardizing biologic pro- 
ducts. The first of these is the fact that none of the factors is 
constant. We are dealing with living organisms in which vital 
processes are going on, or with the products of these vital pro- 
cesses, and we know that neither processes nor products are con- 
stant." "The second great difficulty" the author states, is that 
"Individual laboratory animals vary'in their reactions to toxic 
agents to which they are susceptible, as well as to the antitoxic 
agents, these terms being used in a broad sense. 
19 "The main difficulty, however, is the fact that we lack labor- 
atory animals susceptible to many of the agents which we need 
to test; thus, the ordinary staphylococcus, the gonococcus, and 
the pertussis bacillus are good examples of organisms which we 
cannot submit to animal tests." 
"These points make it clear that, in the very nature of things, 
we cannot hope to have standards which are comparable to 
those of a purely physical nature, or even to those having a 
chemical basis." 
Of "Antimeningococcu^ Serum" the writer says: 
"Good authorities insist that the results of the therapeutic 
use of the serum afford the only reliable evidence of its value, 
and it may be remarked that almost any manufacturer can pro- 
duce glowing testimonials as to the clinical results of the use of 
his product. ... in spite of much experimental work we are 
without sufficient evidence as to the superiority of any method 
of testing. The multiplicity of types of meningococci, and the 
variations even among members of the same group of organisms, 
make accurate standardization impossible at the present time." 
"Finally, an additional obstacle to the standardization of the 
product is the fact that, even when all conditions are favorable, 
it is difficult for two workers, using the same method, to get 
comparable results." < 
Concerning "Antipneumococcus Serum:" 
"This serum illustrates the creation of a demand prior to the 
placing of the product on a sound scientific basis. . . . clini- 
cians working without group determinations and presumably 
without adequately controlling their work, have reported satis-1 
factory results from the use of the serum in pneumonia in 
general. We may be pardoned if we remain skeptical as to the 
validity of the observations." 
As to its standardization, the author says: 
"There seems to be no immediate prospect beyond the estab- 
lishment of a provisional standard." "Other Serums.'-When 
we come to consider these, we find that there is practically no 
ground for establishing standards." 
Concerning "Bacterial Vaccines." 
"It is perhaps not too sweeping to say that at present, as 
regards the majority of bacterial vaccines, potency standardiza- 
tion is both impracticable and undesirable. Aside from anti- 
typhoid vaccine, evidence of value is meager, and practically 
none of the vaccines can be submitted to potency tests on labor- 
atory animals. Generally speaking, the doses that have been 
adopted are purely arbitrary." 
Concerning "Tuberculin" it is stated: 
"These agents are employed comparatively little in the treat- 
ment of tuberculous infections, but they are used rather exten- 
sively in diagnosis. The varieties are legion. . . . Nor do we 
know whether or not the results of animal experiments are com- 
parable with the results that may be expected when the agent 
is applied to man." 
20 Concerning "Vaccine Virus." 
"The ultimate criterion of the potency of this agent is the 
percentage of 'takes' it will give, when used to vaccinate persons 
not previously successfully vaccinated. Whether any testing 
on laboratory animals can be used as a satisfactory substitute for 
this is uncertain." "It is the judgment of those who have had 
most experience with the subject that we should not at present 
insist on a vaccine which is free from contaminating micro- 
organisms." 
Of "Antirabic Virus" the author says that, 
"there is not sufficient evidence to warrant the adoption of a 
standard." 
"A factor that must be considered in discussing the standardi- 
zation of biologic products is the rate of deterioration. It is 
not too much to say that we know almost nothing of this, 
barring the two antitoxins for which we have potency standards." 
"It is not wise to attempt to standardize products in the 
purely experimental stage, or those for which there is no sound 
scientific basis." 
Dr. Warren B. Stone, Schenectady, N. Y.; New York State Journal 
of Medicine, August, 1917, page 358, while expressing his belief in Vac- 
cines calls attention to the 
"rampant and undesirable commercialism df the whole field of 
vaccine therapy, not only are stock vaccines advertised to cure 
every conceivable illness of an infectious nature, but their use 
has been advised in the treatment of conditions where bacteria 
have no etiological relationship. In order to lessen the diag- 
nostic effort of the medical profession, five or six bacteria are 
frequently compounded into one vaccine and each of the organ- 
isms may be, represented by several strains. So the more 
complex of these vaccines are so gauged and bored that they are 
likely to hit almost any condition at which they are aimed. It 
appears that they are gotten up with the express purpose that 
they may be used without brains. . . . Not only have vaccines 
been unduly exploited, but other bacterial products of a semi- 
secret nature have been given catchy names and we are asked 
to inject them into the toxin laden bodies of our patients and 
expect a wise Providence to produce a cure, and for which these 
unknown compounds seek a vicarious praise." 
Referring to the non-specific or foreign proteins injected into the 
body, Dr. Stone expresses himself as follows: 
"Perhaps a note of warning should be sounded, for, if these 
empirical substances have produced good results, who can foresee 
what may not be thrown into our blood streams in the hope of 
finding something still better." "A word of caution should also 
be introduced that possibly the production of these violent 
reactions may be developed at a price that is too dear to the 
patient." 
Extracts from an editorial in The Journal of the American Medical 
Association, August 25, 1917, entitled "Vaccine Treatment Again:" 
"In these columns we have called attention repeatedly to the 
post hoc ergo propter hoc fallacy in claims advanced in favor 
of the treatment of various infectious conditions with bacterial 
21 vaccines. The majority of the acute and subacute conditions 
are curable spontaneously without any such specific means as 
vaccines have been thought to be, and especially when the 
general condition of the patient receives good attention. ..." 
"As pointed out by Leake in his article on bacterial vaccine 
therapy, whenever this kind of study [comparative observations 
in the treated and untreated cases] has been made so far, the 
results appear to be about the same in the two groups. ... As 
for the strikingly favorable results in individual instances re- 
ported by vaccine enthusiasts, and repeated over and over again 
in advertisements, they are all matched, every one of them, by 
equally brilliant results in cases not treated with vaccine and 
of frequent occurrence everywhere ... as Leake says, the case 
in general for bacterial vaccine therapy is not proved." 
"The history of commercial vaccines is not creditable to many 
medical and scientific journals." 
The editorial refers to a prominent Journal of Bacteriology which, 
though 
"edited by a committee of distinguished bacteriologists carries a 
full page display advertisement which reads: 'Hay-Fever Suc- 
cessfully Treated with Bacterial Vaccines.' 
And the editorial asks: "Where is the evidence of the cure? 
Of the modification of the disease?" 
Of "Non-Specific Protein Reactions," Dr. Rufus I. Cole in New York 
State Journal of Medicine, August, 1917, page 355, says: 
"Finally, during the past few years considerable attention has 
been given to the fact that good results are said to have resulted 
in various infectious diseases from the reactions following the 
non-parenteral introduction into the body of all sorts of foreign 
proteins, and foreign blood serum has become one of the favor- 
ite substances with which to produce such non-specific reactions. 
It has long been known that the subcutaneous or intravenous in- 
jection of such substances is regularly followed by chill, eleva- 
tion of temperature with subsequent fall of temperature, and 
occasionally collapse. We owe the introduction of this method 
of therapy, however, principally to the results claimed from 
indiscriminate vaccine therapy or from mixed vaccines." "Before 
this method of therapy should receive general employment, we 
should first have evidence that the effects said to be produced 
do occur in the human body, and if so that they are beneficial, 
and finally that they are not likely to do harm. I do not believe 
these requirements have been met as yet. The use of this 
method of treatment by the general practitioner at present is 
unscientific and unjustifiable'" 
An article by Joseph L. Miller, M.D., Chicago, read at the Annual 
Session of the American Medical Association, June, 1917, and published 
in The Journal of the American Medical Association, September 8, 1917, 
is not a little significant in its illustration of the chaotic conditions at 
present existing in respect to vaccine therapy and the very evident dan- 
gers to which we, the subjects of medical speculation and medical rash- 
ness, are continually exposed. 
The original justification of vaccine therapy-its specific character- 
is questioned by Dr. Miller, who claims that any benefits obtained by 
Vaccine therapy are due, not to the specific character of the vaccine but 
to the reaction, fever, chills, etc. aroused in the patient by the introduc- 
tion of a foreign substance. Such reactions Dr. Rufus Cole of Rocke- 
22 feller Institute has recently referred to as "a distinct drawback" to the 
practice of vaccine therapy. 
The following extracts are from Dr. Miller's article: 
"Wright's conception of the value of vaccine therapy was based 
on the accuracy of the opsonic index. When later the opsonic 
index was shown to be an unreliable guide, and since the im- 
munologists had no better method for determining immune body 
formation, it was necessary in case vaccine therapy was to be 
continued that the clinician draw his own conclusions regarding 
the value of this method of treatment." 
Concerning acute infectious diseases, the writer says: 
"Spontaneous recovery is the rule; the duration and intensity 
of the infection is so variable that it is extremely difficult to 
draw accurate conclusions regarding the value of any special 
line of treatment." 
"Typhoid fever is the only acute infection, treated with vac- 
cines, in which a large series of cases with suitable controls 
has been reported. A study, however, of the accumulated 
statistics of typhoid does not lead to the conclusion that vac- 
cines when given subcutaneously have materially modified the 
course of the infection. We are disappointed when we search the 
literature for beneficial results from vaccine therapy in colon 
bacilli infection, acute or chronic rheumatism, bacillary dysen- 
tery, whooping cough, gonococcal infections, and dermatologic 
conditions, such as acne and furunculosis [boils]." 
The author states that in his treatment of arthritis [inflamation of 
the joints] he used not only typhoid vaccine but proteose and chicken ser- 
um. The latter two, he says, 
"were used in a sufficient number of cases to show that the 
results are apparently the same as with the typhoid vaccine. 
. . . Commercial vaccines are unreliable on account of the vari- 
able amount required to give the desired reaction. . . . Following 
the injection [given intravenously] the patient within a few 
minutes tol one hour has a chill, usually quite severe, with 
marked rise in temperature, 104 to 105 F." " ... in one in- 
stance a high fever persisted for two days. In several cases a 
second chill has occurred from six to twelve hours after the 
injection. ... At times there is nausea and severe headache, the 
former transient, the latter rarely persisting more than twenty- 
four hours. Not infrequently an extensive herpes [an acute 
inflammatory affection of the skin or mucous membrane] may 
develop after the typhoid, colon or gonococcus vaccine, and with 
somewhat greater frequency after a meningococcus vaccine." 
"That such violent reactions are not free from danger must 
be apparent." 
The writer of the article refers to, 
"one case, an acute arthritis in an alcoholic, who following the 
injection developed delirium tremens and died about fifty-two 
hours after the injection. In three other patients, all alcoholics, 
marked delirium developed soon after the injection, in one in- 
stance continuing for thirty hours. Dyspnea [difficult or labored 
breathing] and cyanosis [bluish discoloration of the skin] were 
noted in a few cases." "The literature contains reports of 
several fatalities, all apparently in typhoid patients. ..." 
Many consider the fever as the essential factor in the curative 
23 action. The Germans are now referring to this method of 
treatment as febrile therapy, believing that any agent that will 
cause a rise in temperature may give results." "It is too early 
to state whether or not this method of treatment will become a 
permanent therapeutic measure." 
"The chief objection to its continuance is the danger of grave 
or fatal reaction. . . . This form of therapy must be considered 
as still in the experimental stage, and should not be generally 
applied without first a careful consideration of the dangers asso- 
ciated with it." 
In the "Abstract of Discussion" following, Dr. Jacob Diner, New 
York, says, 
"The majority of physicians go by the label on the package." 
Dr. Torald Sollmann, Cleveland, suggests that, 
"the term 'vaccine therapy' is apt to be misleading. Apparently 
we are not dealing with immunity reactions, but with a phar- 
macologic reaction, the use of the vaccine being merely a 
method of producing this reaction. It will be interesting to 
learn whether similar reactions and similar cures cannot be se- 
cured by nonprotein pyretic [fever producing] agents." 
Dr. Fred I. Lakenbach, San Francisco, exclaims: 
"The whole subject of specific and nonspecific immunization is 
extremely perplexing." 
Quotations from a review by J. A. Beruti and N. P. Costa, in The 
Journal of the American Medical Association, September 8, 1917, page 
855: 
) "Beruti concludes from his own experience of articles the 
published data, that antistreptococcus serotherapy in puerperal 
septicemia [childbed fever] generally fails. He declares further 
that the intravenous route is irrational, as also large doses and 
attempts to use antistreptococcus serum in prophylaxis. Better 
results have been realized with nonspecific serotherapy." 
"His conclusions as to specific vaccine therapy are that it has 
not sustained its promise." 
Speaking of non-specific serotherapy: 
"Beruti himself used an extract of colon bacilli, instead of 
a vaccine, applying it in a number of very serious cases of 
puerperal septicemia and with constantly unfavorable results. 
The intense reaction that followed the intravenous injection 
'was unmistakably deleterious. . . . But why they are so de- 
cidedly beneficial in some cases and so decidedly the reverse in 
others is still a mystery. It is like shaking a clock that has 
stopped; it may start it to going perfectly thereafter, or it may 
have no effect or an injurious one. Costa regards the reaction 
to nonspecific vaccine as a kind of anaphylactic shock, liable to 
do harm." 
Extracts from an article by Albert David Kaiser, M. D., Rochester, 
N. Y., New York Medical Journal, September 29, 1917: 
I " . . • the professional attitude at present is to receive with 
open arms any and all sorts of vaccine and serum treatments 
resting on no sort of foundation or on the flimsiest evidence." 
"The greatest danger in serum or blood therapy lies in the pos- 
24 sible serum reaction. . . . The exact cause of these severe re- 
actions cannot be ascertained." 
"The use of antipneumococcus serum is still in its infancy . . . 
a typical pneumonia in which the etiological [causative] factor 
is an influenza bacillus, streptococcus, or type II, III, or IV 
pneumococcus, the infection cannot be helped by a serum." 
"Even less hopeful than the pneumococcus infections are the 
streptococcus infections. The use of antistreptococcus serum 
has been advocated in puerperal fever, acute septicemia, 
erysipelas, and scarlet fever. The reported cures from the use 
of this serum must be accepted with certain reservations." 
Though favoring its use in certain cases, Dr. Kaiser says: 
"It is undoubterly true that the value of blood and serum 
therapy has been overestimated. ..." 
From an article entitled: "Serum Sickness," by E. W. Goodall, M.D.^ 
London, Medical Superintendent of the North-Western Fever Hospital,. 
Hampstead; Late Medical Superintendent of the Eastern Fever Hos- 
pital, Homerton, Metropolitan Asylums Board; Temporary Lieutenant- 
Colonel, R.A.M.C., The Lancet, March 2, 1918: 
"Soon after the introduction and universal acceptance of the 
serum treatment of diphtheria in 1894, a method of treatment 
which was speedily extended to other bacterial diseases, it was 
noticed that in a considerable number of cases certain symp- 
toms, of which the most obvious was a cutaneous eruption, fol- 
lowed the injection of the serum." 
"I need hardly do more than state that it is the serum which 
is the primary cause of the disease and not the specific antitoxic 
principle it contains: 
"It will be convenient to deal with serum sickness under three 
heads: as it occurs, first, in the vast majority of persons who 
undergo an attack after a primary injection of serum, or a 
series of injections given within a week or so; secondly, in 
persons who have been reinjected after a lapse of a period of at 
least 10 days from the primary injection; and, thirdly, in a few 
persons after a primary injection." , 
"A rash occurs in rather more than one-third of the cases 
injected;" 
"The rash is often accompanied by pyrexia [fever]. ... In a 
severe case the fever may go on for ten days, a fortnight, or 
longer." 
"In some of the more severe cases there is moderate enlarge- 
ment of the glands, especially those of the neck. . . . There may 
also be tonsilitis." 
"Perspiration is usually a prominent symptom in all but the 
mildest cases. Not infrequently, too, there is albuminuria, and 
vomiting is not uncommon." 
"These, then, are the usual symptoms of an ordinary attack ' 
of serum sickness; to them are sometimes added others which, 
by analogy with other diseases, may be termed complications. 
The most frequent of these is one which usually goes by the 
name of 'joint pains,' but which is, I have no doubt, an arthri- 
tis [inflammation of a joint]. It occurred in 376 of the 8726 ■ x 
above-mentioned cases of diphtheria-4.3 per cent. . . . The 
arthritis seldom persists for longer than two or three days, and 
very rarely recurs." "It must, however, at the same time be 
remembered that the serum of some horses is more provocative 
of serum sickness than is that of others. . . ." 
25 " ... in the vast majority of cases there is a distinct period, 
free from any symptoms attributable to the serum, between the 
injection of the serum and the onset of the sickness. Of 464 
consecutive cases which I have analysed the rash appeared in 3 
to 22 days after the first injection. In 404 of these cases the 
duration of the latent period was 6 to 14 days." 
"I will now turn to a study of the illness as it shows itself 
in persons who have been treated with serum previously. 
"After the serum treatment of diphtheria and certain other 
diseases had been in vogue for a few years it came to be 
noticed that when a person was injected with serum a second 
time some weeks or months after the first injection an attack 
of serum sickness might occur which differed in one way or 
another from the usual form which I have described above. 
These second injections were given for relapses or second 
attacks of diphtheria, or in cases of scarlet fever or diphtheria 
which had received a prophylactic injection some time pre- 
viously." 
"When, therefore, I speak of a re-injected person I mean one 
who has received serum treatment a second time after the lapse 
of a period from the first injection which is at least equal in 
length to the latent period of the normal reaction." 
"In a re-injected person the reaction may be a normal one, 
both as regards the latent period and the symptoms. But that 
is not common; usually the reaction departs from the normal, 
and its abnormality may be shown in one of three ways or a 
combination of them. In one the latent period is shortened, 
in another the attack of serum sickness is unusually severe, 
while in the third unwonted symptoms are present. 
"The most common abnormality is shortening of the latent 
period." 
"The second abnormality is exhibited by unusual severity 
of the attack. This may occur irrespective of the length of 
the latent period. In these cases the rash, usually urticaria, 
often with gigantic wheals, is very profuse and comes out with 
extraordinary celerity. The mucous membranes of the mouth, 
nose, pharynx, larynx, and possibly also of the stomach, seem 
to be invaded. The tongue may be swollen and the respiration 
embarrassed, and there may be vomiting and epigastric pain. 
In a few cases the patient is seized with faintness and muscular 
weakness. The temperature may for a short time be high. 
Usually these most unpleasant, not to say threatening, symp- 
toms pass off as quickly as they arose. Occasionally there is 
an exceptionally smart attack of arthritis. Fortunately this 
class of cases is by no means numerous." 
"Lastly, there are some cases, happily also few in number, 
in which unusual symptoms occur. They are always part of 
an immediate reaction, and consist of rigors, sometimes severe 
and prolonged, muscular twitchings, and even convulsions, drow- 
siness, dypspnoea (not apparently due to urticaria of the 
larynx), collapse, vomiting, and a high temperature. There may 
also be abdominal pain and diarrhoea. The rash, always urti- 
caria, may precede or follow these symptoms, which are not all 
present in every case. Nor are the most severe of them of long 
duration; but prostration may remain, and it is some time 
before the patient completely recovers." 
"It is a point of importance as well as of interest to know 
how long a person will remain in the supersensitive state which 
has been induced by the primary injection." 
"The answer to the question how long the supersensibility 
26 lasts has not yet been furnished, at any rate so far man is con- 
cerned. Possibly it may last for a person's lifetime. I have 
known it to be present upwards of seven years after the primary 
injection." 
"It now remains for me to speak of the third of the classes 
into which I have divided cases of serum sickness. They are 
to be met with in persons who have never previously been 
treated with serum. They possess to a marked degree the pec- 
uliarities of absence of the latent period and excessive severity 
of symptoms. It is, indeed, this group which has furnished 
nearly all the instances of death immediately after an injection 
of serum." 
"The symptoms are: irritation (sensations of itching and 
burning), with very acute oedema of the skin and of the mucous 
membranes of the nose, mouth, and throat; urgent dyspnoea 
and cyanosis; and foaming at the mouth. In some cases there 
is a rash, usually urticaria; in others there is not. In fatal 
cases death has been due to inability to breathe, and there may 
be convulsions and coma. Respiration stops before the heart 
ceases to beat." 
" . . . those persons in whom an attack of asthma is excited 
by the emanations from the horse seem especially to be prone 
to fall victims to these evil effects of horse serum." 
The New York Medical Journal, April 6, 1918, page 671, reviewing a 
"book by John A. Kolmer, M.D., says: 
". . . vaccine therapy, which half a dozen years ago was 
rather timidly undertaken by the few, has now become a routine 
method of treatment with the many-though only too often, it 
must be admitted, with results that leave much to be desired." 
Excerpts from the report of the Council on Pharmacy and Chemistry, 
The Journal of the American Medical Association, June 22, 1918, page 
1967: 
"In view of the rapid development of bacterial therapy, the 
possibility for harm that attends the use of bacterial vaccines 
and the skepticism among experienced clinicians as to the value 
of vaccines representing a combination of organisms, the 
Council has felt that it should scrutinize the claims for such 
agents with exceptional care. . . ." 
". . . in many institutions in which cases are studied and 
the results of therapeutic measures carefully observed and con- 
trolled, vaccines of any sort are practically never used-cer- 
tainly here the stock mixed vaccine has no recognition." 
"It is not surprising that a large number of favorable reports 
can be accumulated when we appreciate how promptly men 
* report what they consider to be their successes and how com- 
monly they leave their failures unrecorded. Bearing in mind 
the fact that these stock mixed vaccines, though before the 
profession for many years, have not been used, or continued 
in use, in hospitals where work is rigidly controlled and that 
they are used practically not at all in the large government 
hospital service, a candid critic must hold that there is no sub- 
stantial evidence in favor of the therapeutic use of a mixed 
vaccine, certainly not for stock 'goods' and that probably there 
is but a limited field for the employment of autogenous vac- 
cines." 
Excerpts from an article, "Measures for the Prevention and Control 
■of Respiratory Infection in Military Camps," by Joseph A. Capps, M.D., 
27 Major, M. R. C., U. S. Army, Camp Grant, Rockford, Ill., The Journal of 
the American Medical Association, August 10, 1918, page 448: 
"The two great surprises of the last year in the Army camps 
have been, first, the rarity of gastrointestinal infections, and, 
secondly, the frequency of respiratory infections, particularly 
of the streptococcus group. 
"In former wars, infections of the alimentary tract, such as 
typhoid and dysentery, were responsible for the great epidemics. 
In our training camps of to-day, typhoid and paratyphoid are 
curiosities and dysentery [for which there is no routine inoc- 
■ulation] is an exceptional occurrence. The disappearance of this 
formidable group of diseases can be attributed in part to the 
general use of typhoid inoculation and in large measure to the 
safeguarding of the drinking water from contamination. 
. "During the Spanish-American War the danger arising from 
polluted water was well known, but careful and comprehensive 
methods of protection were not carried out. To-day an army 
camp digs its own wells, builds reservoirs, subjects the water 
to frequent bacteriologic examinations, and in other ways 
rigidly and scientifically applies the knowledge gained by 
previous failure. No expense is too lavish, no effort too great, 
to provide this insurance of soldiers against water-borne infec- 
tions. And the results abundantly justify the expenditure." 
The following quotation clearly indicates that dead bacilli are not the- 
harmless agents that certain vivisectors who have used them in experi- 
ments upon human beings would have us believe. 
The Journal of the American Medical Association, September 7, 1918, 
page 857, reviews an article in Archives de Medecine des Enfants, Paris: 
"Meat Poisoning.-Fully 220 children developed severe poi- 
soning after eating at the municipal canteen, and it was traced 
to paratyphoid bacilli in the meat. The bacilli had been killed 
by the cooking given the meat, so no infection resulted, but 
the toxins were not modified by the cooking, and severe ali- 
mentary disturbances followed, suggesting cholera, and three 
of the 220 died. Seven of the fourteen attendants at the canteen 
were also affected." 
From an editorial, "Are Antitoxins Protein in Nature?", The Journal 
of the American Medical Association, September 28, 1918, Page 1061: 
"Ehrlich's hypothesis that an antitoxin consists of 'cell 
receptors' that have been produced in excess and secreted by 
body cells into the blood has doubtless been a helpful concep- 
tion. ... To the chemically trained mind, however, it falls far 
short of suggesting something definite or tangible and in any 
way comparable with the more familiar compounds that are 
known to play some part in biologic processes." 
". . . the actual chemical nature of antitoxins is unknown, 
. . . Although it is possible to retain all of the immunity 
units along with only a part of the protein, no one has succeed- 
ed in separating the antitoxins from their associated proteins." 
From Buenos Aires Letters, The Journal of American Medical 
Association, November 16, 1918, page 1675: 
"The experience of Drs. Fernandez and Zubizarreta at the 
Children's Hospital has brought them to different conclusions 
from those recently announced by Dr. Penna at the Academia 
de Medicina. They observed twenty instances of serum sickness 
28 among sixty-seven patients injected, and hence they are unable 
to confirm that beef serum is able to ward off serum by-effects." 
From an article by William W. Duke, M.D., The Journal of the Ameri- 
can Medical Association, November 23, 1918, page 1703: 
"It is generally recognized that when a person has one or 
more infectious diseases, one may influence the other occasion- 
ally to the apparent advantage of the patient, but more fre- 
quently to his disadvantage. In other words, increased suscep- 
tibility to one organism may result from infection with 
another. ... It is well known, for instance, that latent tuber- 
culosis may become active and rapidly progressive after an 
attack of tonsilitis, measles or pneumonia. Osler mentions 
the fact that quiescent maladies, such as congenital syphilis 
and tuberculosis, may be lighted into activity by vaccination." 
Referring to the term allergy, the author says: 
"This term, introduced by Pirquet, is used to designate the 
changed condition of human beings or animals, caused by in- 
fectious diseases or produced by inoculation with alien proteins, 
which causes the individual to react in a peculiar way if the 
bacteria responsible for the infectious disease or if the protein 
with which he may have been inoculated is reintroduced into 
the circulation. The ensuing reaction is in some respects pro- 
tective and beneficial, but in other respects may be harmful and 
even dangerous." 
"The inoculation of infected persons with an alien protein, 
such as typhoid bacilli or albumose, may cause general re- 
actions that render the patient's condition temporarily worse. 
. . . For example, in persons with arthritis the joint pains may 
often be more severe a few hours after the intravenous injection 
of typhoid bacilli. Persons with tabes dorsalis frequently 
have sharp, darting pains in the legs after similar intravenous 
injections. The reactions that are produced by the injection of 
alien proteins are often very similar to reactions that follow 
inoculation with the specific organism that causes the person's 
disease. It is not inconceivable that frequently repeated inoc- 
ulations with a nonspecific virus might cause repeated reactions 
in inflammatory lesions due to other organisms and in this way 
do harm and cause an exacerbation of the disease." 
From an article on "Anaphylactic Shock" [Acute symptoms arising 
from the patient's sensitiveness to the foreign material injected], by 
Julian H. Lewis, Ph.D., M.D., Chicago, The Journal of the American 
Medical Association, February 1, 1919: 
"From the beginning, the great bane of serum therapy has , 
been serum sickness the occurrence and severity of which can 
never be predicted. Individuals who do not give a history of 
previous sensitization often give reactions varying from death x. 
to an uncomfortable urticaria in certain diseases in which re- 
peated doses of serum are given; and on the occurrence of suc- 
cessive infections, each of which call for serum treatment, the 
serum sickness is much more likely to occur and with greater 
severity. / 
"Since the recognition of the fact that serum disease is a 
phenomenon of protein sensitization, or anaphylaxis, much 
research work has been done to find a means to prevent it, and 
as a result many suggestions have appeared in the literature, 
most of which have proved worthless or impracticable." ". . . 
29 no satisfactory method for producing the state of antianaphy- 
laxis in a sensitized person has yet been devised. . . 
In regard to the serum treatment of pneumonia the author says that 
"the concentration of antipneumonia serum has not been suc- 
cessfully accomplished" and "the promulgators of the use of 
antipneumonic serum advise the use of large volumes of the 
serum (from 50 to 100 c.c.) injected directly into veins. Both 
of these factors are no doubt responsible for the many reports 
of serious anaphylaxis reaction, especially from the army camps, 
where many cases of pneumonia have been treated with anti- 
serum." ". . . it is to be recommended that when immune 
serum must be given intravenously, it should be given slowly 
and in a diluted form, the Woodyatt pump serving as an excel- 
lent means of doing so. The exact quantitative relations must 
be worked out experimentally with patients." 
30 ARTHRITIS AND RHEUMATISM 
■In The Journal of the American Medical Association, February 15, 
1913, is an article by Dr. Willard J. Stone, Toledo, Ohio, entitled "The 
Use and Abuse of Bacterical Therapy," in which the writer refers to 
misleading advertisements of manufacturers of vaccines and serums. 
Speaking of the use of such products in the treatment of rheumatism 
he calls attention to the absurdity of such methods as: 
"the etiology [cause] of acute or chronic rheumatism is un- 
known and the treatment purely empirical." 
Of tuberculin he says: 
"I have never been able to satisfy myself that tuberculin- 
treated patients, in the aggregate, improved any more under 
its use than those without it. I have, on the contrary, repeat- 
edly seen harmful results from its indiscriminate use. . . ." 
New York Tribune, July 3, 1915: 
"Chicago, July 2-Members of the American Institute of 
Homeopathy concluded their annual convention here to-day and 
adjourned. In the closing hours of the convention Dr. Frank 
Branen of Chicago, attacked the serum treatment of rheuma- 
tism. . . ." "Rheumatism is widely variable" said Dr. Branen. 
"Its cause is not uniform. Consequently it is not possible to 
obtain uniform results from any one antitoxin. The treatment, 
furthermore, is not devoid of danger." 
Extracts from an article, "The Use of Antistreptococcus Serum in 
Chronic Arthritis," by Homer K. Nicoll, M. D., Chicago, The Journal of 
the American Medical Association, December 19, 1914, page 2225: 
"The serum used was a polyvalent horse serum. . . ." "At 
no time was there observed any especial relief from the pain 
and disability with which the patients suffered." 
"Serum sickness, consisting of various degrees of headache, 
nausea, rise in temperature, aching of joints, and urticaria, was 
observed in eighteen of the twenty patients receiving the \ 
serum. . . . Five of the patients developed rather marked 
symptoms of anaphylactic shock and in four cases it was so 
severe as to appear dangerous to life." 
Under "Conclusions," the author states: 
"The administration of horse serum in repeated doses may be 
followed in 25 per cent, of the cases by dangerous degrees of 
anaphylaxis, even in patients who give no history of previous 
use of horse serum or of asthmatic symptoms." "Heating and 
aging the serum does not completely remove its toxicity." 
"Clinical observation and the estimation of immune bodies do not 
show any added advantage from the use of an antiserum in 
chronic arthritis even when a concentrated serum with much 
31 greater potency than the usual commercial serums was em- 
ployed. In two cases, acute streptococcus infections arose during 
and in spite of its administration." "In view of these facts, 
the use of antistreptococcus serum in the treatment of chronic 
arthritis, is, under present conditions, neither advisable nor 
justifiable." 
Dr. Frank Billings, of Chicago, speaking of the use of vaccines in the 
treatment of various diseases, is reported in The Journal of the Ameri- 
can Medical Association, May 27th, 1916, page 1741, to have said: 
"We have treated over 500 cases of chronic infectious arthri- 
tise [inflammation of a joint], a number of cases of infectious en- 
docarditis [inflammation of the lining membrane of the heart] 
... a number of patients suffering from pyelitis [inflammation 
of the kidney], colon bacillus infection, and other infections. 
While this work was going on, especially with the arthritides, I 
have attempted to see what could be done with the same class of 
patients without vaccines. 
"Before we knew much of bacteriology or vaccine or serum 
treatment, we recognized that certain individuals were more 
susceptible to disease than others because of exposure to cold, 
to extreme fatigue, to any kind of mental or physical strain, 
to poor general nutrition, and to many other causes. Age in 
such cases plays an important part, and especially as to the re- 
sistance of the tissues and the possibility of tissue regeneration 
when once infected. Alongside with vaccination we have at- 
tempted to find out conditions of that kind in patients and have 
sought by hygienic and other measures of treatment to re- 
I move them, and I find, so far as I can determine, that patients 
who had no vaccines with these general processes had their de- 
fenses aroused quite as quickly and fully as those who received 
vaccines. If one did not pay attention to general hygiene and 
to the building up of these patients, the vaccines of themselves 
did not bring forth a response ... in certain instances, under 
certain conditions, and in certain individuals the use of vac- 
cines seems to be of benefit; but take them as a class in general 
disease, I have yet to see the benefit of them. 
"Vaccination, as practiced all over the country by the use 
of commercial vaccines, is a disgrace to the medical profession. 
The fault is not to be laid at the doors of the people who manu- 
facture these things; they would not continue to manufacture 
them if the doctors did not use them, and that is not the worst 
of it. Not only do they manufacture them and put them up in 
polyvalent forms and advise them to be used in this and that 
way, but these firms make the diagnoses for the doctors and tell 
them when and how to use them. The great trouble is that 
the average doctor is unthinking and unscientific enough to use 
a method of treatment which costs him but little thought, and 
he is so thoughtless that he disregards the results on his 
patients." 
In the same report Dr. Thomas W. Hastings, of New York, is quoted 
as saying: 
"For years specific therapy, particularly in the form of vac- 
cine therapy, has been abused, mainly because care has not been 
taken to determine the specific factor involved . . . frequently 
specific diagnoses of the factors concerned are not made before 
serum is employed. The day has come when the rank and file 
of physicians in this country should recognize the fact that it 
takes specialists to do this work, if it is done at all, and that 
the commercial use of polyvalent vaccines, without specific 
diagnoses, should be discontinued." 
32 CEREBRO-SPINAL MENINGITIS 
Quotations from an article by Worth Hale, United States Public 
Health Service, Hygienic laboratory, Bzdletin No. 91, December, 1918. 
The article, while approving of the Flexner serum, calls attention to 
dangers in its use: 
"The serum treatment of cerebrospinal fever appears, how- 
ever, to entail certain dangers to the patient and recently there 
have appeared a number of reports describing alarming symp- 
toms and, in a number of instances, death. These untoward 
results occurred in such close relation to the administration of 
the treatment that the treatment, rather than the disease, 
seemed to be responsible." 
In an article, "A Possible Source of Danger in the Use of Anti- 
Meningitis Serum," S. P. Kramer, M.D., Surgeon to the Cincinnati 
Hospital, in The Journal of the American Medical Association, May 3, 
1913, describes the death of eight children, six of which occurred as a 
direct result of the inoculation with antimeningitis serum, the other 
two dying of the disease itself. 
Referring to one of the cases, Dr. Kramer says: 
"The child's nurse, Miss Augusta Miltz, told us that she had 
seen three immediate deaths following the administration of 
antimeningitis serum at the Cincinnati Hospital last year. On 
going over the records these cases were found and will be 
given." "The records show three other deaths at the Cincin- 
nati Hospital during the past year, immediately following the 
injection of the serum, all occurring in young children." 
After describing a number of cases, Dr. Kramer says: 
"We have here six deaths coming on with respiratory par- 
alysis a few minutes after the injection, and two cases in which 
the respiratory paralysis was relieved by artificial respiration, 
the children dying later of the disease." 
"In the U. S. Public Health Reports (January 26, 1912), Dr. 
W. H. Frost has described similar deaths following the injec- 
tion of antimeningitis serum. In The Journal (March 1, 1913), 
Dr. Arthur H. Parmelee has reported ten cases of respiratory 
failure. A letter from Dr. Parmelee states that respiratory 
failure in all these cases came on within fifteen minutes after 
the administration of serum." "Indeed, so common has this 
castastrophe become that in a circular issued by the New York 
Department of Health, directions are given as to what should 
be done when breathing stops following the administration of 
serum." 
The British Medical Journal, February 13, 1915, page 287, contains 
an account by Dr. J. Rupert Collins of the case of a nine year old boy 
suffering from cerebro-spinal meningitis, whom he and Dr. Dighton 
treated with anti-meningococcus serum, and an autogenous vaccine. 
Notwithstanding the ceaseless ministrations of his physicians, which in- 
33 eluded drawing off cerebro-spinal fluid and injecting vaccine and anti- 
meningoccus serum several timesL the boy died. 
"The only comment," says Dr. Collins, "which I have to make 
i ?n the case is that we were disappointed with the anti-men- 
ingococcic serum which, as far as we could judge, produced no 
clinical improvement." 
New York Medical Journal, April 3, 1915, page 697, reviewing an 
article, "Treatment of Epidemic Cerebrospinal Meningitis," British Medi- 
cal Journal, February 27, 1915. 
"The use of serum was found to be disappointing and was 
soon abandoned in favor of soamin. It was found that intra- 
muscular administration of five grains of this arsenical on each 
of the first two days of treatment, followed by a dose of three 
grains on the fourth day, and perhaps one or two additional 
doses of this size, gave seven recoveries in eight consecutive 
cases. Such small doses into the muscles . . . seem to be 
perfectly safe. The meningococci in the spinal fluid were 
found to be reduced in number or to have completely disap- 
peared after this form of treatment. The work here reported 
by Low is mainly that of Gilks, and of Shircore and Ross in 
Africa." 
The following quotations are from an article on Cerebro-Spinal Men- 
ingitis, by Sir William Osler, Bart., M.D., F.R.S., Regius Professor of 
Medicine, Oxford University in The Practitioner, London, January 1916: 
"In the first year of the war there were, in the home Army, 
' 462 deaths [from cerebro-spinal meningitis], which places the 
disease second on the list of causes of death from acute infec- 
tions-probably a very much larger proportion than among the 
civil population." 
! "The germ is ubiquitous, and is harboured by many who show 
no symptoms of the disease, but producing in others a mild 
catarrh, and only in a few reaching the meninges." 
"The prophylactic use of anti-meningitic serum is still on 
trial; we do not know enough to recommend it or to discourage 
it" 
As to the value of serum therapy Dr. Osler says: 
"We are agreed as to the value of withdrawal of fluid from 
the spinal meninges. On the value of specific therapy, however, 
there is a grave difference of opinion." 
"We must be disappointed in many quarters with the serum 
' treatment." "I was much interested in the outbreak among 
Canadian soldiers at Salisbury, where 40 cases were treated, 
with 26 deaths-a mortality of 63 per cent. The sera used were 
from Burroughs Wellcome, Lister Institute, Mulford, and Parke 
Davis. It was said that a few of the patients treated with 
Mulford's serum suggested that some improvement had taken 
place, but it was hardly striking enough to justify its use. 
There was no benefit from the other sera." "There were no 
better results at Haslar. There were 30 cases there, with a 
mortality of 52 per cent., and the use of the serum was aban- 
doned after eight deaths in 12 cases." 
Dr. Osler suggests that "this widespread failure" may have been due 
to, "inert sera." 
In the same magazine, page 6, A. Gardner Robb, M.B., D.P.H., Medical 
34 Superintendent, City Fever Hospital, Belfast, a believer in the serum 
treatment, says: 
"In a recent and very excellent work on cerebro-spinal men- 
ingitis, the author, who had large experience of the serum 
treatment in a comparatively recent epidemic, and had a gross 
mortality rate of 25 per cent., excludes over 40 per cent, of his 
fatal cases, because they were 'hopeless from the first,' or died 
within 24 hours, etc. He then publishes a table of cases repor- 
ted from various places all over the world. The mortality from 
these places is a gross rate, whereas the author's is a 'cor- 
rected' rate. Naturally, his results are about twice as good 
as those obtained by others." 
"I believe it is quite impossible to say in the first few hours 
of illness that any case is hopeless." 
The author refers to an increase in the mortality in 1915 and 
questions: 
"Is the increase in the mortality to be accounted for by dif- 
ferences in the strain-strains not provided for in the polyval- 
ent serum available?" "Was the serum available of as high a 
standard of immunity value?" 
"The withdrawal of fluid often gives rise to very severe pain, 
and, as Sophian says, the injection at times gives rise to pain 
which may be almost unbearable." 
"The best dosage for any age, infant or adult, has not been 
as yet worked out. ... I am quite sure we often use more 
serum than is necessary, but at present we have no means of 
estimating the risk of withholding it in cases not distinctly 
improving." 
In the same magazine, page 12, is an article on meningitis, by H. D. 
Rolleston, M.D., F.R.C.P., Surgeon-General (Temp.) Royal Navy; 
Senior Physician, St. George's Hospital, from which we quote: 
"From the commencement of the war to July 31st, 1915, 
there were 170 cases of cerebro-spinal fever in the Royal Navy. 
The following is a summary of the results of treatment in 163 
cases, 89 of which (or 54.6 per cent.) proved fatal." 
Then follows a table giving the varieties of treatment and the results. 
According to this table, treatment with Antimeningococcic serum alone 
shows a mortality of 69.4 per cent., treatment with Soamin alone shows 
a mortality of 33.3 per cent., treatment with Lumbar puncture alone 
shows a mortality of 30.8 per cent. 
Referring to this table, the author says: 
"The most noticeable feature about the tabulated particulars 
was the failure of the intrathecal injection of antimeningococcic 
serum, though this was obtained from various sources. The 
cases treated solely by the intrathecal injection of serum and 
whole 163 cases. Flexner, in The Journal of Experimental 
Medicine, 1913, emphasized the importance of injecting anti- 
lumbar puncture showed a higher death-rate than that of the 
meningococcic serum intrathecally as early as possible in the 
disease." 
Referring to the cases in the Royal Navy, the author says: 
"The failure of the injected serum to reduce the mortality 
clearly was not due to its being given too late. The serum 
35 treatment . . . was given a thorough trial in these cases, but 
proved most disappointing. . . . Alarming symptoms directly 
after the intrathecal injection occurred in two cases only. . . . 
Serum rashes were noted in 20 per cent, of the cases, but may 
have been more frequent; in a few cases, there were also arthri- 
tic pains. . . . Soamin seemed to give good results, and to have 
a beneficial effect in the septicaemic stage." 
In the same magazine, page 15, Sir Michael G. Foster, M.D., Capt. 
R.A.M.C., First Eastern General Hospital, Cambridge, reports the re- 
covery of three patients treated only by lumbar puncture and drawing 
off of the fluid. 
"The staff then began," says Dr. Foster, "to employ serum; 
six cases were treated with it, and two were admitted from 
outside after having received an injection. Of the eight cases, 
four died. They concluded that they were not doing very well 
with the serum, and, bearing in mind the good result from simple 
lumbar puncture in the first, very acute, case, they treated all 
the succeeding cases in that way, repeating it as often as the 
symptoms persisted. By the end of March, 28 cases had been 
treated, most of them by lumbar puncture. Twenty cases were 
treated without serum, and there were four deaths, though in 
the next seven cases there were five deaths. About that date, 
there seemed to be a peculiarly virulent type of case. Towards 
the end of the epidemic, they had a series of nine cases with 
only one death. During the time I had charge of the ward, i. e., 
to the middle of June, there were 42 cases, 14 deaths. 
"I submit that frequent drainage of the cerebro-spinal fluid 
during the persistance of the symptoms is a satisfactory form 
of treatment, at all events until a more satisfactory serum is 
available than there now seems to be. The simple procedure 
resulted in a very striking relief of symptoms, especially of 
the very intense headache." 
Same magazine, page 18, from an article by J. F. Gaskell, M.D., 
F.R.C.P., D.P.H., Capt. R.A.M.C., First Eastern General Hospital, 
Cambridge: 
"The net result of the cases at the hospital is a mortality 
of 39 per cent., and most of the cases were treated by lumbar 
puncture, unsupplemented by any other form of treatment. I 
contend that the details of the cases showed up as well under 
that simple procedure as other series in which lumbar puncture 
and the injection of serum had been carried out." 
Same magazine, page 33, from an article on meningitis, by Sheffield 
Neave, M.R.C.P., M.R.C.S., Temp. Captain R.A.M.C., Late Travelling 
Pathologist, Government of Soudan: 
"Treatment by serum does not seem to have been as success- 
ful in this country as generally appears in text-books." 
The following excerpts are from the chapter on Treatment in a book, 
"Cerebro-Spinal Fever," by Sir Michael Foster, M.A., M.D., K.C.B., 
F.R.S., D.C.L., D.Sc., LL.D., and J. F. Gaskell, M.A., M.D., published 
in 1916: 
"Our own experience was confined to soldiers treated in the 
First Eastern General Hospital. . . . Our final results from 
January 20th to June 15th, during which time we had joint 
36 charge of the ward set apart for these cases, are shown in the 
following table: 
Cases 
Total number .39 
Recovered 
25 
Died 
14 
Percentage 
Mortality 
36.0 
Treated with serum 9 
4 
5 
55.0 
Treated without serum..3O 
21 
9 
30.0 
"A study of the above table demonstrates the want of suc- 
cess attending treatment with serum, as contrasted with the 
comparative success attending simple lumbar puncture. . . . 
Flexner, in his report on serum treatment, published in 1913, 
states that 288 patients over 20 years of age had been treated, 
with 108 deaths, a mortality of 37 per cent. Of our own cases, 
24 were over 20 years of age; of these 8 died, giving a mortality 
percentage of 33. Twenty of these cases, however, were treated 
by lumbar puncture alone, with 4 deaths, a mortality percentage 
of 20. In as far as small numbers can afford ground for judg- 
ment, the results of simple lumbar puncture will bear compar- 
ison with the results obtained by serum treatment in former 
epidemics. 
"The comparative failure of serum treatment in this epidemic 
is obvious from a study of the results obtained in widely separ- 
ated localities." 
The authors refer to Dr. David Morgan's favorable experience with 
cerebro-spinal meningitis whose method of treatment consisted of lum- 
bar puncture: 
"In commenting on his results, Morgan remarks that, had 
serum been used, the notable reduction in the death rate would 
have been attributed to its effects. Further, he calls attention 
to the fact that lumbar puncture, with the evacuation of a con- 
siderable quantity of fluid, is an essential preliminary to the in- 
jection of serum. This, in his opinion, raises the question as to 
how far the beneficial effects of serum treatment may not be 
due to the preliminary lumbar puncture. We would submit that 
the results which we have obtained materially strengthen the 
pertinence of this query." 
"The injection of serum involves on the one hand the intro- 
duction of a foreign proteid, on the other the replacement of 
fluid, with consequent return of the pressure which has just 
been relieved. The conjecture, that the presence of a foreign 
proteid may exercise toxic effects on the brain, is borne out by 
the not infrequent subsequent increase of headache and rise of 
temperature, the latter symptom being in marked contrast to the 
decided fall of temperature which follows lumbar puncture. Ex- 
perience has proved that the replacement of fluid, if carried to an 
extreme, may have the most alarming consequences. Sophian's 
studies on blood pressure show that the introduction of serum 
above an amount, which varies in each individual case, may cause 
a sudden fall in blood pressure with signs of extreme collapse. 
He also finds that the injection of even small quantities of serum 
causes an appreciable fall in blood pressure. He further states 
that alarming hydrocephalic symptoms may arise at an interval 
of some hours after the injection of serum. In our somewhat 
limited experience, the introduction of serum caused for the 
most part a decided aggravation of cerebral symptoms. From 
these data it is obvious that both immediate and comparatively 
remote effects may follow the injection of serum. . . . The es- 
sential point remains that, whatever the bactericidal action of 
serum may be, its use is attended by certain immediate disad- 
37 vantages." "The essential point to be borne in mind is that the 
introduction of serum is an operation by no means devoid of 
danger. . . . Too much insistence cannot be laid on the danger 
attending the injection of an amount of serum equal to the 
quantity of cerebro-spinal fluid removed. . . . The main danger 
to be guarded against is death from shock during the injection 
of the serum; more remote dangers are of a minor character." 
"Opinion differs materially as to the dosage of serum to be 
employed." 
"We have already repeatedly insisted on the view held by us 
that the essence of all treatment of cerebro-spinal fever lies in 
the adequate drainage of the sub-arachnoid space. Other meth- 
ods of treatment have also been employed which require a brief 
notice. The subcutaneous injection of serum has already been 
referred to, and its want of success indicated. Serum has also 
been introduced intravenously and intramuscularly with equally 
disappointing results." 
Referring to "the advisability of the routine use of vaccination as a 
protective measure during an epidemic" the authors say: 
"The wisdom of a general adoption of such a procedure would 
appear doubtful. A vaccinated person would be more, rather 
than less, susceptible during the negative phase." 
Concerning the epidemic of cerebro-spinal meningitis in the army camps 
of England, The London Letter, The Journal of the American Medical 
Association, March 18, 1916, page 906, says: 
1". . . 24 cerebro-spinal fever laboratories were established." 
"With regard to treatment, four different kinds of serum were 
used, but the results were not very encouraging, and judgment 
is suspended meanwhile." "Vaccines were also employed, but 
the general experience of vaccine treatment seem to have been 
little more favorable than that of serum." 
The following quotations are from a review of . n article on meningi- 
tis by E. Suffer, Archives de Medicine des Enfants, published in The 
Journal of the American Medical Association, September 16, 1916, page 
909: 
"The prognosis depends in large measure on the character of 
the epidemic, statistics showing wide variations, and the mor- 
tality is high even with serotherapy. Patients still die under 
it. . . . In the cases with favorable outcome under serotherapy, 
Suffer was never convinced that this had been the unmistakable 
result of the specific action of the serum. . . . Physiologic salt 
solution might answer as well." 
"Suffer says in conclusion that those who advocated injecting 
the antiserum directly into the ventricles fail to mention the 
dangers of such a procedure." 
The case of a child where this was done is described: 
"The child of 4 collapsed and stopped breathing after 18 c.c. of 
the tepid antiserum had been injected very slowly into the vent- 
ricle. Twenty minutes elapsed before respiration and pulsation 
were restored and rhythmic traction of the tongue had to be 
kept up for another hour before the child was breathing regu- 
larly. She was unconscious for hours afterward and died five 
days later after alternating periods of improvement and aggra- 
vation." 
Quotations from an editorial comment, The Journal of the American 
Medical Association, June 23, 1917, page 1933: 
38 "• . . according to reports in the medical journals it has been 
found that commercial meningitis serum may be of doubtful 
potency. ... We are quite prepared to agree that the super- 
vision of the U. S. Public Health Service of the manufacture of 
antimeningitis serum is performed as adequately and conscient- 
iously as possible under the circumstances; but in view of the 
lack of definite standards for a polyvalent serum, as antimenin- 
gitis serum at present is, there necessarily is left a very con- 
siderable latitude for the manufacturer." 
In an article in New York Medical Journal, July 14, 1917, Dr. R. C. 
Rosenberger, Prof, of Hygiene and Bacteriology, Jefferson Medical Col- 
lege, and Dr. D. F. Bentley, Jr., report on sixty-seven cases of epidemic 
cerebro-spinal meningitis occurring in the Philadelphia General Hospital 
in February, March and April, 1917. While advocating the use of serum 
the writers admit that: 
"In this epidemic the mortality was exceptionally high, al- 
though the serum treatment was instituted as soon as the case 
was diagnosed and some even before a diagnosis was confirmed 
bacteriologically." 
"Following the administration of the serum, headaches were 
common, cramps in the legs were almost constantly noticed, 
and in only one case was syncope [fainting] present, and this 
followed the too rapid introduction of the serum. In three cases 
urticaria developed after the third or fourth injection of serum. 
In one of these the wheals were of the giant type." 
Extracts from an article on Epidemic Meningitis, by Simon Flex- 
ner, M.D., (the well-known serum advocate), The Journal of the Ameri- 
can Medical Association, September 8, 1917, page 820: 
"The use of the antimeningococcic serum, like all other thera- 
peutic serums, is attended with so-called serum disease. It is 
even possible that this annoying, but usually harmless attendant 
on serum therapy is more frequent after subarachnoid [intra- 
spinal injection] than after subcutaneous [under the skin] ad- 
ministration. From one-third to one-half of the treated patients 
develop some degree of serum disease. The condition comes on 
about the eighth or tenth day with fever, the usual skin erup- 
tion, pain in the joints, digestive disturbance, etc. The impor- 
tant thing is not to mistake these symptoms for a relapse of 
the infection." "A certain number of the patients responding 
to the serum treatment suffer recrudescences or relapses of the 
severe symptoms/' 
"Certain accidents, though rare, are known to attend the suba- 
rachnoid injection of the antimeningococcic serum. They are 
sometimes alarming, but of very brief duration and sometimes 
so serious as to threaten life... They arise chiefly from two 
causes: (1) increased intracanial pressure, and (2) anaphylaxis 
[acute symptoms arising from the patient's sensitiveness to the 
foreign material injected]. The notion, advanced a few years 
ago, that the phenolic preservative employed to maintain steril- 
ity in the serum is the dangerous agent, has not been supported 
by painstaking experimental study, and close observation of 
treated cases of epidemic meningitis." 
From a report of U. R. Webb, Surgeon, United States Navy, United 
States Naval Medical Bulletin, January, 1918, page 84: 
"J. W. D. A-S.-Admitted at 2:30 p. m., February 16, 1917, 
with well-marked symptoms and physical signs of meningitis. 
His condition was good and seemed in no way desperate. His 
39 health record stated that spinal puncture had been made and 
than an undetermined amount of antimeningitis serum had been 
injected. Spinal puncture was made soon after admission to hos- 
pital and 20 c.c. of cloudy fluid were withdrawn and 15 c.c. of 
serum injected. Reaction was satisfactory and his condition 
was considered excellent until 8:55 p.m., when he suddenly died 
from respiratory failure." 
" W. C. H. A-S.-Admitted on the afternoon of May 20, 
1917, with well-marked symptoms and physical signs of menin- 
gitis. Spinal puncture was made, fluid withdrawn was cloudy. . . . 
Twenty c.c. of antimeningitis serum were injected. The patient 
rested well and seemed to improve during the night, but died 
suddenly at 5 a.m., about 12 hours after his admission." 
"E. T. A-S.-Admitted with measles on June 1, 1917, his 
convalescence from this disease was slow, and he was still under 
treatment in hospital when on July 10 he developed a tempera- 
ture ranging as high as 104°, photophobia stiffness and soreness 
in muscles of neck and back with marked Kemig's. Spinal 
puncture revealed turbid fluid containing many meningococci. 
Forty c.c. spinal fluid removed and 30 c.c. antimeningitis serum 
(New York State Board of Health) injected by gravity method. 
Patient reacted well to treatment until 18 hours after, when his 
pulse was noticed to become weak and irregular. This condition 
did not respond to stimulants, and he died 21 hours after receiv- 
ing serum." 
The Journal of the American Medical Association, January 12, 1918, 
page 130, Review of articles in The Lancet, London: "Serum Disease 
After Inthrathecal Injections of Serum" and "Serum Sickness in Cere- 
bro-Spinal Meningitis." 
"Out of ninty-six bacteriologically proved cases of cerebro- 
spinal fever treated by serums and surviving for ten days or 
more, fifty-eight, or 60 per cent., had a serum reaction, as judg- 
ed by the appearance of a rash. Among these fifty-eight cases 
there were nine, or 15.5 per cent., in which the rash was preced- 
ed or accompanied by a more or less definite recrudescence of 
meningitic manifestations, thus, especially when preceding the 
rash, suggesting a relapse of the disease. These symptoms are re- 
lieved by lumbar puncture, and under the assumption that they 
point to a relapse, a fresh injection of serum may be given, as 
was done in six out of the nine cases. The three patients not so 
injected recovered, and of the six cases injected intrathecally 
with serum, five were made worse, four eventually proving fatal, 
though it is not suggested that death was thus induced." 
"There were sixty cases in Ker's series, but a certain number 
of these patients died before there was any probability of a re- 
action occurring. Forty-eight patients, however, lived nine days 
or over, and thirty-six, or 76 per cent., of these suffered from 
serum sickness. The reactions were, as a rule, sharp, and in 
most cases were accompanied by considerable fever. . . . There 
was much skin irritation, and those patients whose conscious- 
ness was not blunted by their original illness were much dis- 
tressed by the itching. Arthritis [inflammation of joints] was 
noted in six patients, but was very severe, and may have been 
present in a milder form in some others. Adenitis [inflammation 
of a gland] of the cervical glands was very well marked in two 
instances. An interesting point was the occurrence in nine cases 
of prodromal fever for twelve or twenty four hours before any 
other symptoms." 
In The Journal of the American Medical Association, February 23, 
40 1918, page 563, Surgeon O. J. Mink, U. S. Navy, Great Lakes, Illinois, 
is reported to have said in regard to meningitis: 
"In all, the regiment [Second Regiment] had from twenty- 
five to thirty cases during a period of about three weeks. . . . 
Many steps were taken to remedy the conditions in this regi- 
ment, but it is impossible to state honestly that any measures 
had the slightest effect on the disease, except the general care 
of a regiment that was far below par physically, and the grad- 
ual hardening of this regiment to the conditions that they en- 
countered." "In this regiment a careful study of carriers leads 
to the conclusion that measures to control the disease through 
the carrier method are absolutely worthless." "We found bar- 
racks in which meningitis developed that contained 8 or 9 per 
cent, of carriers. On the other hand, we found barracks in 
which no meningitis developed that contained 25 or 30 per cent, 
of carriers... In the instances in which a large percentage of car- 
riers was found, carriers were removed; and in other instances 
the carriers were left in the barracks. New cases failed to de- 
veloped in both instances. . . . Other factors in controlling the 
disease are of so much greater importance and have been so 
neglected, owing to the enthusiasm of studying carriers, that it 
seems necessary to point out a few fallacies in the theory. . . . 
So large a proportion of persons in perfect health carry the 
meningocococcus in their throats that the segregation of all 
carriers would practically mean the disbanding of the present 
training station. If we segregate three out of every ten men as 
meningococcus carriers, we could with equal reason segregate 
three more of every ten as pneumococcus carriers, as we find 
that the distribution, spread and etiologic factors are practical- 
ly the same in the two diseases. 
"As we progress in the war and in the experience of training 
the recruit, meningitis will disappear, and we shall probably 
attribute this to the intensive study of the carrier; and years 
from now, in the advent of another war, the recruit will again 
furnish the ever present problem of meningitis." 
The following quotations are from the Public Health Reports issued 
by the United States Public Health Service, March 22, 1918, pages 404 
and 405. Note what is said regarding carriers, susceptibility and the 
resistance-lowering influence of inoculation. 
"Epidemiological study of cerebrospinal fever under condi- 
tions obtaining in the Navy indicates that the incidence of car- 
riers and the incidence of the disease must be considered sepa- 
rately. Where carriers are found it does not necessarily follow- 
that cases of cerebrospinal fever will occur." "Without the men- 
ingococcus cerebrospinal fever could not occur. On the other 
hand, it is now well known that although many persons in a camp 
may harbor the meningococcus in the nasopharynx, relatively 
few of the men exposed contract the disease, although many of 
them become meningococcus carriers. All meningococci may not 
be and probably are not virulent. Individuals vary in suscepti- 
bility, and indeed susceptibility seems to vary from time to time 
in the same individual. Other infections, age, exposure, fatigue, 
mental depression, digestive disturbances, lack of food, and un- 
suitable clothing, individually or collectively, undoubtedly play 
an important role." 
"While the recruit is in detention it is necessary that he be 
immunized against smallpox, typhoid, and paratyphoid infec- 
tions. It would be folly not to recognize that so potent an influ- 
ence for good did not also have a certain degree of resistance- 
lowering influence, a further and important reason for avoiding 
strenuous training activities during the detention period." 
41 Excerpts from "Potency of Antimeningococcic Serum," by G. W. Mc- 
Coy, M.D., Director, Hygienic Laboratory; N. E. Wayson, M.D., Passed 
Assistant Surgeon, U. S. Public Health Service; and Hugh B. Corbitt, 
A.B., Bacteriologist, U. S. Public Health Service, Washington, D. C., 
published in The Journal of the American Medical Association, July 27, 
1918, page 246: 
"During the past year there has been much discussion of the 
therapeutic value of the anti-meningococci serum available in 
the American market, and of its potency as determined by la- 
boratory tests. While the question of the potency of this agent 
is still under investigation and is far from being settled, it ap- 
pears desirable to present this brief review of the situation as 
it exists at present. 
"Epidemics of cerebro-spinal meningitis occurring in 1915 
and 1916, in England and continental Europe, with the mobili- 
zation of troops, afforded an opporunity to extend the therapeu- 
tic use of antimeningococcic serum, and to analyze the results 
of treatment with better controls than is usual* 
"The conclusion reached as to the efficacy of the serum treat- 
ment were conflicting." 
"A number of methods of testing anti-meningococcic serum 
have been employed, but none has won general acceptance." 
"Unfortunately there is no satisfactory evidence as to the 
correlation of the results of any of these methods of testing 
with the results of the therapeutic application of the serum to 
the disease in map." 
"The animal protection test is rather attractive because it 
seems to produce conditions that are analogous to those under 
which the serum is used in the treatment of the disease; but 
our lack of knowledge of the mechanism of infection and pro- 
tection in man, and of the virulence of cultures for laboratory 
animals, does not permit the adoption of this test without fur- 
ther study. In other words, it may be quite possible that the 
protective action of the serum in animals and the curative action 
in man do not run parallel. Therefore it seemed wise, tenta- 
tively, to adopt test tube experiments to determine the activity 
of the serum used in the United States." 
"Even with the use of the same test, the readings made by 
different persons on a given specimen varied considerably. It 
is scarcely an exaggeration to say that the various reagents 
used in the tests may be varied in concentration and quantity so 
as to show almost any result;" 
Excerpts from "Report of a Case of Anaphylatic Shock, with Failure 
to Desensitize by Intraspinal Administration of Serum," by Lewis Fox 
Frissell, M.D., New York, The Journal of the American Medical Associa- 
tion, August 31, 1918, page 729: 
"This case of anaphylactic shock in cerebro-spinal meningitis 
is reported in order to record the failure of serum administered 
intraspinally to desenitize the patient to its intravenous admin- 
istration." 
"The patient, a woman, aged 40, first seen by me one week 
after the onset of her illness, had had severe headache, with 
moderate temperature, at first declining and then rising, on the 
day when first seen, April 13. . . . Twenty c.c. of antimeningo- 
coccus serum (New York Board of Health) were given intra- 
spinally, on the 14th 40c.c., and again on the 15th 20 c.c., or 80 
c.c. in all. 
"As the patient had been seen late, though her symptoms 
were somewhat ameliorated, in consultation with Dr. Amoss of 
the Rockefeller Institute it was decided to begin intravenous 
42 treatment. ... At the end of the administration the patient 
complained of extreme dyspnea [difficult or labored breathing], 
and became unconscious and pulseless. She was breathing rapid- 
ly, in complete coma, with contracted pupils (morphin had been 
given one-half hour previously) and throughout the chest were 
heard many sibilant and sonorous rales, and a few moist crepita- 
tions. The muscles of the jaw were clenched, and the tongue, 
which had become edematous [swollen], dropped back into the 
throat and prevented her breathing. Epinephrin, 10 minims, 
caffein sodiobenzoate and atropin were administered during the 
attack, and within ten minutes the patient again became con- 
scious. In the effort to open her mouth to pull forward her 
tongue, two teeth had to be removed, and the hemorrhages from 
this condition continued several hours, all ordinary styptics 
and packing failing to control it." 
"Thereafter, between the 16th and the 19th, 120 c.c. more of 
serum were given intraspinally." "The patient jnade a sub- 
sequent uninterrupted recovery, except for a severe urticarial 
eruption lasting from April 26 to May 2." 
It may be noted that the patient was subjected to this severe treat- 
ment although, as the report states, "her symptoms were somewhat 
ameliorated" before the treatment began. 
"Report of a Severe Case of Epidemic Meningitis Treated by the Com- 
bined Intravenous and Intraspinal Administration of Antimenigococcus 
Serum," by T. P. Caplinger, M.D., Captain, M.R.C., U.S. Army, Camp 
Logan, Houston, Texas; The Journal of the American Medical Associa- 
tion, August 31, 1918, page 745: 
"Lieutenant M. was admitted April 25, 1918, and a diagnosis 
of epidemic meningitis was confirmed by laboratory methods. 
He was given 30 c.c. of antimeningococcus serum intraspinally 
daily for seven consecutive days with but slight improvement. 
On the seventh day he was given 30 c.c. of undiluted serum in- 
travenously, and the same amount on the following day com- 
bined with the same sized doze intraspinally. 
"The patient showed marked improvement, but developed a 
severe anaphylaxis." w 
"On the eleventh day the patient was seized with a hard chill 
followed by a rise in temperature to 103 and all the former 
symptoms. The spinal fluid again became cloudy. He was 
given 15 c.c. of serum intraspinally, and one hour later 60 c.c. 
were given intravenously diluted with an equal amount of sterile 
sodium chlorid solution. This was repeated on the twelfth day. 
The fluid cleared and has remained so since. There was a mark- 
ed and severe reaction from the last two doses; there were three 
or four convulsive seizures and involuntary voiding of urine and 
feces, followed by a severe arthritis and erythema, This lasted 
for four days. The temperature reached 104 and the pulse 160. 
The patient was given digitalis internally, and an ice bag was 
applied to the precordia with good results. He is now well on 
the road to recovery, with a partial paralysis of the right ex- 
ternal rectus muscle which is improving under potassium iodid. 
... He has a soft systolic murmur with reduplication of the 
second pulmonic sound over the pulmonary area, which we think 
is purely functional. 
"The patient was given a total of 540 c.c. of serum and re- 
ceived eighteen spinal punctures." 
From an article by Louis T. de M. Sajous, B.S., M.D., New York 
Medical Journal, December 7, 1918, page 1002: 
"Certain clinical reports on the use of serum in epidemic 
cerebrospinal meningitis have been far less encouraging than 
43 might have been expected, in view of current statments con- 
cerning the efficacy of specific treatment in this disease. Thus 
a mortality of sixty-one per cent., in spite of serum therapy, 
has been reported by Rolleston, of sixty-eight per cent, by 
Ellis, and of fifty-five per cent, by Gaskell and Foster. Of 
seventeen English clinicians employing serum, not less than 
seven deemed it altogether valueless. . . unanimity of opinion 
and procedure has not so far been attained." 
From an article, "Outbreak of Meningitis at Norfolk, Va.," by L. T. 
Royster, M.D. and W. P. McDowell, M.D., The Journal of the American 
Medical Association, January 11, 1919, page 93: 
"During the period from January 1 to May 15, 1918, there 
occurred in the city proper, and immediately contiguous su- 
burbs, forty cases of cerebrospinal meningitis . . . twenty-two, 
or 55 per cent., died and eighteen, or 45 per cent., recovered." 
"In every case treated with serum, commercial stock serum was 
used. The intraspinal method alone was employed. . . . One 
patient refused treatment and recovered. Another received one 
injection, refused further treatment and recovered." "Five died 
without treatment, one of these because of the fulminant nature 
of the case, the others because of late diagnosis. One died of 
anaphylactic shock, [caused by the injection of serum] five days 
intervening between the last two injections." 
44 DIPHTHERIA 
The following excerpts are from a paper on Diphtheria Antitoxin, by 
Dr. Joseph E. Winters, of the Willard Parker Hospital, read before the 
New York Academy of Medicine, and published in Medical Record, June 
20, 1896. The article is very long and includes numerous examples in 
support of Dr. Winters' conclusion that antitoxin is not curative and 
that it is also dangerous in its effects-in some instances even causing 
death. 
"If there is at work but a single factor, viz., antitoxin, in the ! 
reduction of mortality, that reduction must be below the lowest 
mortality recorded in the natural history of the disease in any 
part of the world, and it must be steadily maintained below this 
rate in all parts of the world; otherwise, the variations in mor- 
tality may be said to be due to the epidemic character of the 
disease." 
Dr. Winters gives figures from various cities and hospitals showing 
great variation in the mortality from diphtheria in different years and 
adds: 
"These normal variations in the type of the disease must be 
given due consideration when estimating the value of a mode of 
treatment." 
"Reports on the antitoxin treatment have ingeniously com- V* 
pared years of highest mortality instead of including all years." 
"Dr. J. W. Brannan in a report before the Society of Alumni ' 
of Bellevue Hospital, has shown that pneumonia was the cause 
of death in 53.22 per cent, of the fatal cases of diphtheria in 
the Willard Parker Hospital; whereas, before the antitoxin 
treatment, pneumonia was a cause of death in only 16.90 per > 
cent, in this hospital. . . . All conditions in the hospital were < 
precisely the same in 1895 as in 1894, with the exception of the: 
addition of the antitoxin treatment. The enormous increase of 
pneumonia as the cause of death in the Willard Parker Hospi- 
tal during the antitoxin treatment has no other explanation 
than the hypodermic injection of serum albumin. These pneu- 
monias are, as I stated in April last, septic pneumonias; clinic- 
ally they have the stamp of a septic process." 
"It is now stated that the bad effects which formerly resulted 
from the use of antitoxin were due to the amount of serum in- 
jected, and that with the use of a more concentrated serum 
there will be less pneumonia and bad after-effects than formerly. 
This is a very weak admission. It is an admission that there 
are bad effects from the serum. Last year it was asserted most 
positively by the advocates of this treatment that there were no 
bad effects; that it was absolutely harmless in doses of any 
amount." 
"My impressions, with reference to the use of antitoxin were 
gained first in the autumn of 1894, when I saw Dr. Halliday 
come under treatment at the Willard Parker Hospital. He was 
brought to us as soon as the diagnosis of diphtheria was made, 
partly for isolation and partly to get the benefit of the anti- 
toxin. He had an uncomplicated, but severe, diphtheria, invol- 
ving most of the throat. He was a strong, healthy young man 
of perfect habits. He was given antitoxin as soon as admitted- 
45 given the full dosage, I understand-and in addition, every 
other possible treatment, of course, that could be suggested. 
At the end of two weeks and one day he died of a straight, un- 
complicated diphtheria, the antitoxin not having had the slight- 
est influence on a single symptom from beginning to end. . . . 
4 In that autumn only five patients with diphtheria were treated 
with antitoxin. Four out of the five died, and the fifth was des- 
perately ill. He had a peculiarly long and tedious convalescence. 
It was these five cases that led me to study with the greatest 
care and anxiety-an anxiety such as I have never experienced 
in connection with any other subject-the action of antitoxin." 
"I could not possibly have brought myself to the position in 
which I find myself to-night had it not been for my strong con- 
viction regarding the injurious effects of antitoxin. Could I 
have found that antitoxin did not do any harm, even though it 
was valueless in the treatment of diphtheria-even though it 
did not reduce the mortality-I would never have said anything 
against it. It is because I believe that it is dangerous that my 
convictions compel me to speak." 
From an article "Diphtheria With and Without Antitoxin," by Dr. 
William L. Stowell, read before the New York Academy of Medicine, 
and published in Medical Record, June 20, 1896: 
"From March, 1888, to March, 1895, inclusive, I treated 176 
cases for Demilt Dispensary without antitoxin. . . . The mor- 
tality for the seven years was 13.06 per cent. During the year 
from March, 1895, to March, 1896, I treated 64 cases with 5 
deaths; a mortality of 7.8 per cent. The mortality of the total 
number, 240 cases, was 11.25 per cent. This compares more than 
favorably with the report of the health inspectors who treated 
255 tenement-house cases with antitoxin, with a mortality of 
15.69 per cent." 
"It seems a singular coincidence that the number of cases of 
diphtheria should increase so markedly with the establishment 
of bacterial cultures in 1893. During the three years previous 
to that year the number of reported diphtheria cases in this 
city was 4,359, 4,974 and 4,654 respectively. The numbers then 
jumped to 6,469, 9,155, and 9,925 for the next three years, i.e., 
to the end of 1895." 
"We know that the bacilli are in many places and in many 
throats without giving rise to symptoms." 
"Something more than the presence of bacilli is needed to con- 
stitute the disease of diphtheria." 
"The number of deaths from diphtheria in this city in 1894 
was 2,359; in 1895, from the same cause, 1,634. The two years 
are compared, and by some persons antitoxin is credited with 
the fall in mortality. This is not entirely fair, as 1,634, a low 
rate in a mild year, is compared with the fatal list of 1894, the 
greatest diphtheria death list on record in this city. . . . The 
nearest approach to this was in 1875 when 2,329 died. The fol- 
lowing year, in 1876, the diphtheria deaths fell to 1,750 and in 
1877 dropped to 951, a fall of 800 in a year, and no enthusiasm 
was created. In 1881 the diphtheria deaths were 2,249, but fell 
the next year 724 points to 1,525." 
Referring to the reports concerning diphtheria in the Willard Parker 
Hospital, Dr. Stowell says: 
"In 1894, 703 patients with diphtheria entered, of whom 195 
died; mortality 27 per cent. In 1895, 822 entered with diphthe- 
ria and 190 died, a mortality of 23.10 per cent. The gain is, 
therefore, less than 4 per cent, for 1895, an antitoxin year, as 
46 •compared with the most fatal year on record. . . . Much is said 
•of the wonders of 1895 with antitoxin and its low fatality . . 
but the mortality was still less in 1888, 1889, 1890, and 1893, 
without antitoxin.". 
"In reviewing the results of antitoxin treatment I find that I 
could not escape the unusual complications. 
"A table will show the frequency of broncho-pneumonia, ne- 
phritis, etc., with and without antitoxin." Then follows a table 
and the conclusion, "The increase of broncho-pneumonia is so 
marked that we must believe that the presence of antitoxin fav- 
ors the development of pneumonia germs." 
From an article on Diphtheria, by Dr. P. H. Ernst, read before the 
New York Academy of Medicine and published in Medical Record, June 
20, 1896: 
"When I began the use of antitoxin I had implicit faith in its 
remedial effects, but careful observation of the cases just enu- 
merated convinced me that antitoxin does not exert the slightest 
favorable influence on the course of diphtheria. In fact, it is my 
opinion that the antitoxin patients who recovered had a more 
protracted convalesence, the anaemia especially being more 
marked and less amenable to treatment than in those who re- 
covered without antitoxin." 
From an article, "The Failure of Antitoxin in the Treatment of Diph- 
theria," by J. Edward Herman, M. D.; read before the Brooklyn Patho- 
logical Society and published in Medical Record, May 27, 1899. 
"In a statistical study of the antitoxin treatment of diphtheria 
it must not be forgotten that in late years there has been a de- 
cline in the death rate of other infectious diseases than diph- 
theria, against which no new remedy has been directed." 
The author gives statistics showing a reduction in the death rate for 
typhoid fever and scarlet fever, and says: 
"Much of the decrease in the infectious-disease mortality is 
due to sanitary improvement, and this is one factor which is 
usually ignored when the antitoxin question is considered. There 
can be no doubt, as was clearly pointed out by Deming, that 
'good results are shown in many localities in the reduction of 
the mortality rate from diphtheria by sanitary measures alone." 
"Another thing which should be kept in mind is this: Anti- 
toxin statistics are based on the treatment of cases which have 
been diagnosed as being diphtheria by the microscope; and 
comparison is made with the results of treatment in the past, 
of cases which were diagnosed on their merits as being examples 
of clinical diphtheria." 
"Such a firm believer in antitoxin as Jordan concedes: 'It is 
probably true that the basing of the diagnosis of diphtheria up- 
on a bacteriological examination has led to the inclusion of 
cases which would formerly have been classed as simple sore 
throats.' Another ardent advocate, Kortright, admits: 'Probably 
part of this decrease may be due to improved methods of diag- 
nosis, by means of which cases formerly called tonsillitis are 
now classed as tonsillar diphtheria.' This factor in increasing K 
the number of cases reported and thus reducing the case fatality 
is admitted by Lotz and Tavel, and others, and it is a fatal ad- 
mission;" 
"The words of Niemeyer should also be heeded: 'The reputed 
successful remedies have usually originated in the last stage of 
epidemics, at which time the cases are usually milder and re- 
cover more frequently even without treatment.' " 
47 "It must be remembered that the diapiostic value of the 
Klebs-Loeffler bacillus has not been indisputably established. 
Its presence is not an infallible indication that diphtheria exists. 
. . . Dr. Gross of the Boston Children's Hospital found the 
bacilli in eight per cent, of normal throats. On the other hand,. 
Hennig, in a series of 35 cases of clinical diphtheria, carefully 
examined bacteriologically for him by Professor Esmarch and 
Dr. Czaplewski, found the Klebs-Loeffler bacillus in only 57 per 
cent. In 4,054 cases sent to the New York Board of Health for 
diagnosis, the examination of 951 was indecisive. 
"In Basle, Switzerland, notwithstanding there is now a low case 
fatality, the death rate is higher than it was in any year back 
to 1881. To make clear that the low case fatality is due to the 
greater number of mild cases reported, Kassowitz shows that 
while, for the ten years before antitoxin was used, an average 
of 245 cases was reported each year, at once in 1895 with the 
introduction of antitoxin the number reported jumped up to 645, 
. and in 1896 the number had reached 835." 
"The average yearly death rate from 1885 to 1894, in Basle, 
was 29 per 100,000 population. In 1895 it went up to 65, and in 
1896 it was still 49. This conclusively demonstrates, to say the 
least, that antitoxin has no power to save life." 
"In Trieste during 1895, through an agreement between all 
the physicians of the city, almost every case, in some months 
every case, was treated with antitoxin. Yet the number of 
deaths this year, Kassowitz points out, was greater than ever 
recorded. The deaths ranged from 98 in 1889 to 222 in 1893. 
But in the antitoxin year 1895, 271 died. Antitoxin was never 
subjected to a fairer test than this. With practically all the diph- 
theria cases in the city treated with this reputed specific, nothing 
can explain away this pitiable result." 
Dr. Herman gives tables showing the mortality rate for diphtheria in 
many of the largest cities before and after the use of antitoxin and the 
showing is better for those years which preceded the use of antitoxin: 
"The New York City diphtheria death rate fell from 24.8 in 
1864 to 7.4 in 1867-a difference in these four years of 17 deaths 
per 10,000 population, compared with the smaller decline of only 
11 in the four antitoxin years 1894 to 1898." 
"Until antitoxin brings down the diphtheria death rate to a 
point lower than it ever was before, and keeps it at that point, 
in every place, it must be considered a failure." 
"Diphtheria exerts its harmful effects especially through 
sepsis, paralyses of the heart and other organs, impairment of 
the function of the kidneys, and the mechanical presence of an 
abnormal formation known as the false membrane. On none 
of these does antitoxin act beneficially. ... On the other hand, 
it has been demonstrated that antitoxin acts injuriously by 
causing paralysis of the heart and other portions of the body, 
on the kidneys, on the skin and the joints, and that it causes 
septic pneumonia, etc." 
The author gives numerous examples of unfavorable results from the 
use of antitoxin as reported by various writers on the subject, especially 
as to the effect of the antitoxin treatment on the heart and kidneys: 
"There is no convincing evidence that antitoxin exerts any in- 
fluence on the false membrane in causing its early detachment 
of disappearence, or in preventing it from spreading. Even if 
it did, it would not signify much, for the membrane is simply 
the effect of something; it is not the disease. Patients often die 
after the membrane has disappeared. . . . Back of the forma- 
tion of the false membrane is that deranged condition of the 
48 system permitting the growth of pernicious bacteria, which ab- 
normal state is really the disease. We do not know but what 
the formation of the false membrane is nature's method of pro- 
tecting the patient, and until it shuts off the air from the lungs 
the membrane may serve some useful purpose." 
"It is a common thing, in cases not treated with antitoxin, 
for the membrane to begin to fall off after the first day and 
completely to disappear in three or four days. . . . Yet antitoxin 
advocates claim everything, because in some cases treated with 
antitoxin the false membrane begins to disappear, as they say, 
early; in two or three days (Wiemer), or three or four days 
(Baginsky). This also happens earlier and later. In fact, with 
antitoxin it is often very much later. . . . Winters saw it re- 
main ten days in two cases, and in another at the end of the 
twenty-second day it was still present. 
"It is conceded that eruptions are often caused by the injec- 
tion • of antitoxin." Here instances are cited as also after the 
statement, "joint troubles also follow the use of antitoxin." 
"Before antitoxin was used in the Willard Parker Hospital, 
16 per cent, of the fatal cases died of pneumonia. During nine 
months of 1895, 53 per cent, of the deaths were caused by this 
disease. Winters thought 'the enormous increase of pneumonia 
has no other explanation than the hypodermic injection of 
serum.' " 
"Finally we have the startling fact that the injection of anti- 
toxin for the purpose of immunization has killed many people. 
Korach and Alfoldi, and many others have reported deaths fol- 
lowing prophylactic doses of antitoxin." i 
"The cases which are now lost when treated without anti- 
toxin, the septic cases, the bad kidney cases, the paralytic cases, 
and the stenotic cases, are just the ones which it has been shown 
cannot be cured with antitoxin. And from all the bad effects, 
pointed out above, caused by the use of antitoxin, it follows 
that many lives have been sacrificed which might have been 
saved with the usual time-honored remedies." 
The following excerpts are from the chapter on "Diphtherial Anti- 
toxine," in the book, "Serums, Vaccine and T oxines," by William Cecil 
Bosanquet, M.A., M. D. Oxon, F.R.C.P. Lond., and John W. H. Eyre, 
M.D., M. S. Dunelm, F.R.S. Edin.: 
"It is extremely difficult to obtain definite proof of the cura- 
tive value of any drug, since the course of almost every disease 
is variable, and sudden improvements and relapses are liable to 
occur from natural causes, apart from the action of any remedy. 
The fluctuations are often ascribed to any drug which is being 
tried in the case, and there is no means by which the question, 
Post hoc or Propter hoc? can be decided. In the case of diph- 
theria the natural variations of the disease are even more mark- 
ed than in many other disorders, and it is impossible to judge 
of the efficacy of antitoxine with any approach to accuracy in in- 
dividual cases. 
"Dependence must therefore be placed to a great extent on 
collected statistics. Even here a manifest source of fallacy is 
introduced by the undoubted fact that infective diseases exhibit 
great fluctuations in virulence when viewed over considerable 
periods of time, the mortality from them rising and falling in 
accordance with obscure periodic laws which are not well under- 
stood. Hence a fall in the mortality of an infective disease may 
occur apart from any new remedy which has come into vogue 
during the period of time under consideration. In the case of 
diphtheria there is reason to believe that the disease has be- 
come more common in recent years, and also that the type of 
case seen is, on the whole, less virulent-apart from the use of 
49 antitoxine-than used to be the case. It does not seem, there- 
fore, to be logical to ascribe all the reduction which has un- 
doubted taken place in the mortality from diphtheria to this 
remedy. We have to remember also that, as previously stated, 
there is a tendency to class as diphtheria, owing to the mere 
presence of B. diphtheriae in the throat, cases which in earlier 
days would not have been considered to be suffering from this 
disease (e.g. cases of mild sore throat without any formation of 
membrane, which would in all probability recover without any 
treatment); such instances swell the number of cases of diph- 
theria without adding to the deaths which occur, thus reducing 
the rate of mortality." 
Referring to the report of the Metropolitan Asylums Board Hospitals, 
the authors say: 
"It is noteworthy that, while the case-mortality in these hospi- 
tals has so distinctly fallen, as shown by the table, yet the mor- 
tality throughout the country generally did not decrease up to 
1901. [Treatment with antitoxin introduced in 1894]. Since 
that date both the general and the hospital mortality has fallen 
notably. This decline cannot, however, be altogether' attributed 
to the use of serum, for the general mortality for the years 
1871-76 was only 0.11; that for the following six years, 0.15; 
and that for the next five years, 0.23. There is clearly a rise 
and fall in the mortality apart from the use of any particular 
remedy." 
While pronouncing themselves in favor of antitoxin the authors say, 
"it is necessary to bear in mind that some authorities who 
have had good opportunities of judging of its value are still 
sceptical as to its usefulness. Among American writers we may 
mention Hermann and Rupp, both of whom decline to subscribe 
to the general verdict in favor of the remedy. On the continent 
of Europe Kassowitz is equally opposed to the prevailing view. 
He points out that, although a fall in the mortality from diph- 
theria was experienced in many parts of the world synchronous- 
ly with the introduction of antitoxine, yet latterly the death- 
rate has risen again in many places in spite of its continued use. 
Hence the fall in the death-rate cannot be ascribed to the anti- 
toxine. There is much truth in this argument, as has already 
been admitted;" 
"It cannot be denied that in a certain number of instances the 
injection of diphtherial antitoxine has been followed by death, 
directly attributable to the action of the serum." 
From an article, "Diphtheria in Manila," by Carroll Fox, Passed 
Assistant Surgeon, Public Health and Marine-Hospital Service, Assist- 
ant Director of Health, Philippine Islands, Public Health Reports, June 
21, 1912: 
"A persual of the morbidity and mortality reports for the city 
of Manila would indicate that diphtheria is increasing. . . ." 
After giving a table of reported cases and deaths the writer 
says: "It will be seen that there is almost a steady increase in 
the number of cases and deaths reported." 
"Previous to the American occupation there are no records, 
but physicians state that they know of very few cases during 
Spanish times." 
"From the end of the fiscal year (June 30, 1911) to date 
z (April 2, 1912) there have been reported in the city of Manila 
39 cases, with 12 deaths, which is a case fatality of 30.77 per 
cent. This fatality rate is altogethei' too high, considering that 
diphtheria antitoxin was used in all but two cases. . . ." 
50 .Referring to the use of the serum in the cases of "contacts" and "bacil- 
lus carriers," Dr. Fox says: 
"In addition to this there is the danger, though remote, of the 
sudden death which sometimes follows the administration of a 
serum; the possibility of the first dose sensitizing the individual 
to a second dose; and the short period of immunity produced." 
Quotations from an article by Ludvig Hektoen, M.D., Chicago, The 
Journal of the American Medical Association, April 13, 1912, page 1081: 
"Generally speaking the severe, general symptoms produced 
by different proteins are quite uniform and characteristic in the 
same species, while in different species the symptoms may 
vary. . . 
"In human beings the injection of therapeutic serums may 
give rise to a variety of allergic phenomena. A few instances 
of alarming collapse and even of death, the immediate symp- 
toms being not unlike those of immediate anaphylaxis in guinea- 
pigs, have occurred after the first injection of anti-diphtheria 
serum, and in such cases it is not clear how sensitization has 
been produced." 
"The ordinary symptoms of serum disease are so familiar 
that it is only necessary to mention them: urticarial and erythe- 
matous eruptions, local and general edema, swelling of lymph- 
nodes, pains in the joints, headache, weakness, fever and leuko- 
penia. In some cases there may be a bloody diarrhea." 
Quotations from an article by Benjamin White, Ph.D., Brooklyn, 
N. Y., New York State Journal of Medicine, May, 1912, page 235: 
"As we ascend in the scale of animal life, the aspects of ana- 
phylaxis change. . . . The manifestations of anaphylaxis in man 
are of a very different nature. They vary from scarcely notice- 
able symptoms to the most profound general bodily disturbances. 
. . . the initial injection of an intrinsically non-toxic ser- 
um, such as horse serum, may produce acute and somewhat 
grave disturbances when injected into man. Alarming symp- 
toms, including collapse and in a few cases even death, some- 
times follow the therapeutic injection of anti-toxin." 
Quotation from a review in The Journal of the American Medical 
Association, March 1, 1913, of an article by Rendu published in the 
Lyon Medical'. 
"Rendu treated a series of 66 diphtheria patients, half of 
them with antitoxin, the others with hot air passed directly into 
the mouth through a tube connected with an ordinary electric \ 
dryer, such as is used by hairdressers. He got practically the 
same results in the two series of cases. . . . The hot air wasi 
used alone merely to test its efficacy as compared with diph- 
theria antitoxin. . . . The effect of the hot air is bactericidal." ' 
Referring to Frederick Loeffler, the German professor who discovered 
the organism which is alleged to be the cause of diphtheria, the Medi- 
cal Times, London, April 17, 1915, page 239, remarks: 
"His discoveries have, in our opinion, been greatly over-rated, 
and have had the effect of diverting to some extent the energies 
of medical men from the carrying out of effective preventive 
measures for the extinction of infectious diseases. With a per- 
fect system of hygiene, such diseases as diphtheria could not 
exist." 
Excerpts from the report of a discussion following an article on, "The 
51 Recent Methods of Treating Diphtheria," The Journal of the American 
Medical Association, August 14, 1915: 
Dr. John Zahorsky, St. Louis: 
"We tried all the methods of making the injections [of anti- 
toxin], cutaneous, intramuscular, and intravenous, and found 
that the intravenous was not always practicable on account of 
the reaction. . . . As to the relative value of the subcutaneous 
and intramuscular methods, I am as yet not decided. . . . Much 
of the serum on the market is not perfectly clear; it has small 
particles which it ought not to have and I would be afraid to 
use it for fear it might do some harm." 
Dr. Arthur A. O'Neil, San Francisco: 
"The paper does not agree with what we have found with ref- 
erence to diphtheria in San Francisco. ... In our cases the 
small amounts of antitoxin advocated by Park do not seem ap- 
plicable. . . . We give the antitoxin intravenously or intramus- 
cularly and usually in massive doses, forty or sixty thousand 
units at a time. Even with these large doses the mortality is 
from 12 to 15 per cent. ... I believe in giving massive doses 
and giving them frequently." 
Dr. Henry D. Chapin, New York: 
"I think it is unsafe to argue from institutional work that we 
will find the same things in private practice. I have tried both 
large and small doses of antitoxin and I have found an average 
dose as effective as the very large doses, and I cannot under- 
stand why these very large doses are necessary. ... I do not 
think it is safe to let it go forth that we favor large doses or that 
such large doses as mentioned in the paper help us in our work." 
Dr. Jesse M. McGavin, Portland, Oregon: 
"I agree with Dr. Chapin regarding large doses of antitoxin." 
Dr. W. W. Behlow, San Francisco: 
"I disagree with Dr. Chapin and Dr. McGavin and agree with 
Dr. O'Neil with regard to the large doses of antitoxin. . . . 
Why is it that small doses give good results in the hands of 
some men while in the hands of others they do not?" 
Dr. Frank C. Neff, Kansas City: 
"I do not think there is anything in my paper that would in- 
dicate that I advocate small doses. An average early dose of 
6000 units in children who have a mild case and of 10,000 units 
in severe cases [compare these figures with those of Dr. O'Neil] 
constitutes fairly large amounts for single doses." 
An article on Diphtheria in the Weekly Bulletin of the Department 
of Health, City of New York, February 19, 1916, page 61, admits that 
"the incidence of diphtheria in New York City does not steadily 
diminish, and the relatively high mortality as compared with 
other acute infectious diseases steadily persists." 
"We do not know the cause, nor have we a specific remedy for 
either scarlet fever or measles, yet the case fatality of these 
diseases is less than one-half that of diphtheria." 
In the Weekly Bulletin, April 1, 1916, page 108, we find: 
"Diphtheria in 1915 destroyed more lives than did scarlet 
fever, measles and typhoid fever combined." 
52 The New York Medical Journal, May 20, 1916, page 1001, reviewing 
an article in Archives of Internal Medicine, on "Serum Sickness among 
500 Patients Receiving Diphtheria Antitoxin," by Mills Sturtevant, says: 
"Of the 500 cases, 422 received serum once, while seventy- 
eight received two or more injections. ... Of the 422 cases re- 
ceiving one injection, twenty per cent, showed a reaction, the 
rash being urticarial in sixty-three instances, and erythematous 
in twenty-one; small vesicles were also noted in two cases. Re- 
action took place from the first to the seventeenth day, usually 
occurring between the fifth to the ninth day. ... In nineteen per 
cent, of the reacting cases, nausea and vomiting were noted. 
Joint pains, at times marked and with local redness and swell- 
ing, occurred in about fourteen per cent, of these cases, and also 
occasionally albuminuria and edema. Administration of a given 
amount of serum in two or more doses is not less likely to pro- 
duce a reaction than if it is injected as one dose." 
Paris Letter, The Journal of the American Medical Association, June 
3, 1916, page 1791: 
"The minister of the interior, having requested the Academie 
de medecine to report to him on the accidents following the in- 
jection of antidiphtheric serum, Dr. Netter of the Faculte de 
medecine de Paris has deposited a report on this subject in 
which he puts the matter in its proper perspective. The fear 
of these accidents, which is very widespread, both in the medi- 
cal profession and among the people, has too often formed an 
obstacle to the use of the serum in cases in which this was ab- 
solutely necessary. ... It is, of course, known that disagree- 
able sequelae, and even death, have been observed as the result 
of a single injection. With injections spaced out at intervals of 
more than ten days, these accidents are more immediate and 
more alarming. This is the phenomenon of anaphylaxis. Never 
theless, serum anaphylaxis is far less frequent and less grave 
in man than in the guinea-pig." 
Extracts from an article "Diphtheria Spread not Reduced By Anti- 
toxin," New York World, June 12, 1916: 
"A special inquiry by the Department of Health shows that 
the discovery and widespread use of diphtheria antitoxin since 
1907 has not materially reduced either the prevalence of the 
disease or the percentage of deaths, particularly in the last five 
years. 
"In the whole city, in 1907, there were 15,298 reported cases 
of diphtheria, as against 15,279 in 1915. The numbers in the 
years 1908 to 1914, inclusive, were as follows: 16,431, 15,098, 
16,940, 13,485, 13,553, 14,535, 17,130. 
"The number of reported deaths in 1911 was 1,281 as against 
1,278 deaths in 1915. 
"The percentage of deaths in 1915 was 8.2, as against 8.7 in 
1914, a difference of but a fraction of a unit." 
"In the same nine-year period the number of reported cases 
of scarlet fever, also a children's ailment, for which there is no 
antitoxin, has decreased from 15,811 in 1907 to 9,879 in 1915," 
"The reported deaths from scarlet fever were 291 in 1915, as 
against 796 in 1907." 
"In measles, another children's disease for which there is no 
antitoxin, there were 38,186 reported cases in 1915, as against 
38,276 in 1908, and there has been a general reduction since 
1907 in the percentage of fatal cases." 
Extracts from an article on acute infections in Philadelphia during 
53 1911-1915, by Edwin E. Graham, M.D., Philadelphia, The Journal of the 
American Medical Association, October 28, 1916, page 1272: 
"Between 5 and 10 years of age, diphtheria caused more 
deaths than all the other acute infections together, so that from 
the second to the tenth year the mortality from diphtheria is 
higher than that of all the other acute infections combined." 
"Diphtheria is in reality the most fatal of the acute infections 
in this group, since it caused approximately twice as many 
deaths as any of the others, ..." 
"The bureau of health, in its annual report for 1914, states 
that during the last ten years the case death rate of diphtheria 
has not changed more than 1 per cent., notwithstanding the use 
of antitoxin, . . ." 
Quotation from an editorial in American Medicine, January, 1917, 
page 8: 
". . . the diphtheria death rate is still responsible for about 
4 per cent, of the total mortality of children under the age of 
fifteen years." ". . . diphtheria, as a disease, still maintains an 
undesirably high incidence and death rate throughout the 
world." 
"While the mortality rate, in the United States, has been 
gradually decreasing from 1900, the existence of a death rate 
of 17.9 in 1914 is far higher than is warranted in the face of the 
degree of preventability- of the disease. It is a higher death 
rate than that of typhoid fever, whooping cough, influenza, dia- 
betes, meningitis, malaria, measles, scarlet fever, dysentery 
and numerous other diseases, in which modern medicine has 
attained even less adequate knowledge of the methods of pre- 
vention and control." 
Quotation from "Serum Disease, Anaphylaxis, and Allergie," by F. E. 
Stewart, Ph.D., M.D., Phar.D., Philadelphia, New York Medical Journal, 
October 6, 1917, page 646: 
Speaking of deaths following the administration of diphtheria anti- 
toxin, Dr. Stewart says: 
"These patients, so far as known, were not previously sensi- 
tized by an injection of the antitoxin. On the contrary, the sudden 
deaths followed the initial dose." "The large doses of horse 
protein, which necessarily accompany the requisite number of 
antitoxic units, may become a source of inconvenience or 
danger." 
Excerpts from an article, "The Serum .Treatment of Diphtheria," by 
W. Scott Tebb, M.A., M.D., Cantab., Late Public Analyst and Bacterio- 
logist to the Metropolitan Borough of Southwark and Medical Officer of 
Health to the Urban District of Penge, in The Abolitionist, February 1, 
1917: 
"Although there is no reliable evidence to show that the 
serum treatment has diminished the severity or the mortality of 
diphtheria, no medical man with a reputation to lose would care 
to say that it was a harmless remedy. In addition to providing 
mankind with a new disease, called by Germans the 'Serum- 
krankheit,' it appears to leave the system in a condition of in- 
creased susceptibility to the poison, so that a further injection 
on some subsequent occasion may become a source of consider- 
able danger. The literature of the subject is full of instances 
of this description. The customary symptoms of the 'serum 
disease' after injection are more or less fever, an irritable rash, 
sometimes pains in the joints, and often oedema or swelling of 
the tissues under the skin and mucous membrane. 
54 "Mya and Sevestre have pointed out that this swelling may 
involve the upper air-passages and give rise to a condition of 
anxiety from serious difficulty of breathing. Sevestre says that 
such 'accidents' are little known, and although not very com- 
mon, are, on the other hand, not absolutely rare. Among other 
dangers of serum some authors cite instances of its lighting up 
old tubercular trouble. One authority notices that according to 
the autopsies of children dying in the diphtheria wards, a large 
proportion showed evidence of pulmonary tuberculosis or case- 
ous tracheobronchial glands." 
"The nearest approach to a numerical estimate of the fatal 
results of the serum treatment is given in an Offiical Report of 
the German Government. From inquiries directed to medical 
men, it was elicited that the treatment was 'harmful' or 'per- 
haps harmful' in 62 of the total deaths which occurred among 
4,979 patients inoculated, that is to say, according to the evi- 
dence of the doctor attending the patient, the serum possibly 
contributed to a fatal result in one person to every 80 submit- 
ted to treatment. These figures do not represent the total in- 
jury and mortality attributable to serum, for as Gaucher, Rose- 
nau and others have pointed out, a number of serum 'accidents' 
are not reported. In support of this a well-known French auth- 
ority states that the doctor connected with an English infect- 
ious hospital had affirmed to him that he had seen several in- 
fants attacked with a mild form of diphtheria which had rapid- 
ly proved fatal after inoculation with Aronson's serum." 
"A review of the Anti-diphtheric Treatment has demonstra- 
ted no saving of life, but it appears that a new disease, with 
very definite symptoms and lethal [death] properties, has been 
created. . . . Medical literature is full of instances of alarming 
collapse and other severe results of injection; and how many 
more cases must there be about which the doctor never unbur- 
dens himself! 
"It cannot therefore be said that the medical profession, in 
pursuing this dangerous practice, are following their legitimate 
vocation 'to prevent disease, to relieve suffering and to heal the 
the sick,' and their advocacy of a doubtful specific tends to di- 
vert attention from the real cause of zymotic ailments, and thus 
indefinitely postpones the extinction of these maladies by the 
only true remedy of sanitary reform." 
Quotation from a review of an article by Kjelgaard, Copenhagen, "Case 
of Anaphylaxis," The Journal of the American Medical Association, 
June 29, 1918, page 2060. The review states that Kjelgaard, seven years 
ago gave himself a preventive injection of diphtheria antioxin and that 
recently he took another injection. His personal experience changed his 
belief as to the harmlessness of antitoxin: 
"The sixth day intensely itching urticaria developed, prevent- 
ing sleep, and the face, lips and throat swelled, the pulse became 
imperceptible, and deep breathing was impossible. There were 
pains in the eye as if an insect had got in the eye. As these 
symptoms subsided, pains and tenderness developed in joints 
and tendons, with fleeting contractures. The symptoms grad- 
ually wore off in the course of ten or twelve days leaving mere- 
ly lassitude in the legs." 
Excerpts from an editorial, The Journal of the American Medical 
Association, September 7, 1918, page 827: 
"Despite the fact that diphtheria antitoxin has proved to be a 
therapeutic remedy of great importance . . . the presence of 
diphtheria among us still presents a serious hygienic problem. 
55 In spite of the extensive use of small prophylactic doses of anti- 
toxin, the morbidity and mortality from diphtheria remain sur- 
prisingly high and constant. . . . An estimate based on figures 
obtained a few years ago from the registration area in the 
United States indicates that the yearly mortality from diph- 
theria in this country is more than 23,000, the morbidity pre- 
sumably being ten times greater." 
56 HYDROPHOBIA 
The Philadelphia Public Ledger, May 25, 1908, published an article on 
Hydrophobia in which the views of a number of prominent physicians 
were given. The article gives the opinion of Dr. Charles K. Mills, who 
it states, is "acknowledged to be one of the foremost neurologists in the 
world," as follows: 
"I have seen many patients suffering from what was called 
hydrophobia, both in my own practice and in consultation with 
other physicians, yet all were examples of diseases of entirely 
different character with symptoms resembling those supposed 
to be symptoms of hydrophobia. I do not feel justified in say- 
ing that hydrophobia does not exist, but I have never seen a so- 
called case that could not be explained on some other view than 
that of the introduction of a specific morbid virus." 
The article quotes the views of Dr. Joseph W. Hearn as follows: 
"I am of the opinion that the bite of a dog is no more danger- 
ous than the scratch of a pin or the puncture of an infectious 
nail, but because of exaggerated printed and oral accounts the 
picture of hydrophobia is so stamped upon the public mind that 
the thought of it, after being bitten by a dog, throws imagina- 
tive people into such panics of nervous excitement that they un- 
consciously reproduce its supposed symptoms. Although I have 
practiced surgery in private and in many of the hospitals of 
Philadelphia for the past 20 years, I have never seen a case of 
hydrophobia either in man or dog, nor do I know any other 
physician or surgeon who has." 
Continuing to quote from the Ledger: 
"Dr. Charles W. Dulles, lecturer on the history of medicine in 
the University of Pennsylvania, who has been repeatedly ap- 
pointed by the medical societies of the State to investigate rab- 
ies and has read various papers on the subject before the Ameri- 
can Medical Association, the College of Physicians, of Philadel- 
phia; Philadelphia County Medical Society, the Medical Society 
of Pennsylvania, the Medico-Legal Society of New York, and has 
corresponded on the subject with most of the distinguished med- 
ical men of Europe, said yesterday to a Public Ledger reporter: 
"I have always insisted, and have so stated a thousand times, that 
the word hydrophobia should be used exactly as the word convul- 
sions is used, to indicate a condition, without any prejudice as to 
its cause. People have these symptoms and die, but what causes 
them is another question. I do not believe that there is any- 
thing specific in the saliva of a dog to cause this disorder, be- 
cause it has appeared after a great many injuries of a totally 
different character.' 'I have made a careful study of a large num- 
ber of reported cases of mad dog bites and I have found that 
only a very small proportion of them resulted in death, not more 
than two or three per cent. The condition is what is called psy- 
chosis or extreme nervous excitability, and it may be due to 
many different causes, one of the commonest of which is) 
fear'. " 
57 Referring to England, where there are no Pasteur Institutes, Dr. Dul- 
les is reported to have said: 
"For 25 years I have been studying this subject, and I have 
gathered data upon it from every part of the world. I have 
made it a practice to correspond with every physician reported 
to have or to have had a case of hydrophobia in charge. In the 
last report of the Registrar General of England (that for 1906) 
appears this statement: 'Not a single death from this disease 
(hydrophobia) has been reported either in 1906 or any of the 
preceding three years. In the course of the last eight years 
only two deaths by hydrophobia have been reported in England 
and Wales, and these were registered in the year 1902."' 
In regard to the Pasteur treatment, Dr. Dulles is quoted as saying: 
"I have repeatedly at medical meetings asserted that there 
has been no good result from the use of the Pasteur method in 
treating hydrophobia. It has been shown by statistics that in 
countries where that method is employed the number of deaths 
from hydrophobia has increased and not diminished." . . 
there has been no increase in the number of cases of hydropho- 
bia in human beings except in and about the towns or cities 
where Pasteur institutes have been in operation or Pasteur in- 
stitute statements have been circulated. In other words, it is 
in these regions that hysterical excitement over imaginary dan- 
ger is most stimulated." "I have been much impressed with the 
commercial aspect of the Pasteur institutes." 
The Ledger article concludes: 
"Dr. William Osler, formerly of Johns Hopkins University, 
but now of Oxford, in his standard work on pathology, speaks 
of hydrophobia as an ailment of exceedingly rare occurrence. 
He describes lyssophobia, or pseudo hydrophobia, as follows: 
'This is a very interesting affection, which may closely re- 
semble hydrophobia, but is really nothing more than a neurotic 
or hysterical manifestation. A nervous person bitten by a dog, 
either rabid or supposed to be rabid, has within a few months, 
or even later, symptoms somewhat resembling the true disease. 
He may have paroxysms, in which he says he is unable to drink, 
grasps at his throat and becomes emotional. ... It is not im- 
probable that the majority of the cases of alleged recovery in 
rabies have been of the hysterical form.' " 
The following excerpts are from an address on hydrophobia by Dr. 
Charles W. Dulles, Late Lecturer on History of Medicine, University of 
Pennsylvania, 1893-1908; Consulting Surgeon to Rush Hospital; Mana- 
ger of University Hospital, read before the International Anti-Vivisec- 
tion and Animal Protection Congress, Washington, D. C., Dec. 10, 1913: 
"In this connection it is interesting to note that in France, 
which isi full of Pasteur Institutes, there are supposed to be 
annually thousands of cases with the infection of hydrophobia, 
while in Great Britain, where there is no Pasteur Institute, the 
disease does not occur. Another curious thing is that in Con- 
stantinople, where dogs have for centuries run w'ild in the 
streets, there was so little hydrophobia that it was long denied 
that it existed there at all; but since a Pasteur Institute has 
been established cases have been quite frequent, according to 
the Pasteur people. This has been the experience of every 
country in which Pasteur Institutes have been established." 
"The Pasteur method I likewise think is injurious and respon- 
sible for many deaths. For some time after the introduction of 
this method the Zoophilist, published in Great Britain, printed 
58 the names, the addresses and some circumstances of the death 
of a very large number of persons who had been treated at the 
Institute in Paris;" "In contrast to this I might cite my own 
experience in the treatment of persons bitten by dogs supposed 
to be mad, which has furnished not a single case of the devel- 
oped disease in thirty years. This consists in antiseptic treat- 
ment of the wound and in the securing of confidence on the part 
of those in dread of hydrophobia. There is nothing in this 
method that is not well known to all who have thoughtfully 
considered the subject; but it is in singular contrast to methods 
frequently pursued." "Although I have probably seen more cases 
of so-called hydrophobia than any other medical man, it is in vain 
that I beg my colleagues to adopt methods-not original to me, 
because they have been put before the world many years ago- 
that consist in the mildest and most negative treatment: quiet, 
gentleness, absence of appearance of excitement, and no medi- 
cine except that of a very simple character. By the use of these 
methods I have seen the paroxysms of hydrophobia subside." 
"For a number of years I made, at the request of the Medical 
Society of the State of Pennsylvania, an annual report on hy- 
drophobia, with considerable sympathy on the part of my col- 
leagues. The general tone of the medical men of the State 
seem to be that of conservatism, and presented a marked con- 
trast to that of the members of our profession in other states 
until a Pasteur Institute was established in Pittsburgh. It may 
have been a mere coincidence, but it was a fact, that during all 
that time we had much fewer cases of so-called hydrophobia in 
Pennsylvania than occurred in some near-by states. During this 
time, wherever Pasteur Institutes were established the number 
of cases of supposed infection-the number of cases claimed to \ 
be saved from death by these institutes-increased enormously 
and incredibly, while the deaths from hydrophobia also in- 
creased." 
"The belief in witch-craft once had the support of the highest 
authority in church, in state, and in science; but though it can 
still be found in ignorant communities, even in this enlightened 
country, it has been largely banished from civilized lands. We 
may, therefore, hope that in due time the illusions in regard to 
hydrophobia may disappear and that they shall some day cease 
to color the teachings of medical men or to fill with horror the 
minds of the people." 
Quotation from an article on Hydrophobia by Dr. W. O. Stillman, 
President of the American Humane Association, National Humane Re- 
view, December, 1914: 
"Only three or four deaths in a million, in the human race, 
are credited to this dread disease, and probably three out of the 
four are due to fright rather than to genuine hydrophobia." 
"The editor of this magazine has been actively practising medi- 
cine for nearly forty years. For nearly twenty years, as presi- 
dent of a large local humane society, he has had charge of pub- 
lic dog kennels which have received many thousand of dogs. In 
spite of a constant lookout for hydrophobia and rabies, he has 
never seen a case. 
"The point of this discussion lies in fact that the public has 
been systematically terrorized by rabies literature let loose by 
departments of agriculture, and by sensational newspaper 
alarms. These have resulted in many imaginary cases of hydro- 
phobia and an immense amount of wholly unnecssary suffering. 
Why not try to exercise a little common sense in regard to this 
enormously exaggerated danger? 
59 Excerpts from an article, "Paralysis During Pasteur Antirabic Treat- 
ment, with Reports of Seven Personal Cases, One Terminating Fatally^ 
and Six Other Previously Unreported Cases," by Frank S. Fielder, M.D., 
York, The Journal of the American Medical Association, June 3,. 
1916: 
"In the vast majority of instances, the Pasteur antirabic 
treatment is neither accompanied nor followed by any compli- 
cations of importance." 
"There is one rare complication, however, the so-called 'treat- 
ment paralysis,' which has long engaged the attention of those 
in charge of antirabic institutes, and the true nature and cause 
of which are not fully understood." 
". . . the possibility of paralysis should always be explained 
to those in whom infection is doubtful, or who are inclined to 
insist on being treated merely as a sentimental matter of pre- 
caution." 
"The symptoms vary all the way from a slight degree of neu- 
ritis, with little or no motor involvement, to an acute ascending 
paralysis which may be fatal." 
"The frequency of paralysis as a complication of antirabic 
treatment is variously estimated by different writers, but its 
real frequency is unknown, since many cases, especially the 
mild ones, are doubtless not reported." 
"A number of cases have occurred in which the biting animal 
was not mad, and others in which the patients were not bitten, 
but had taken antirabic treatment merely as a precaution." 
". . . the mortality among the severe cases is high." "In most 
instances this paralysis is caused by the antirabic treatment it- 
self (fixed virus infection, or toxin, or both). It is not often 
due to street virus infection modified by the treatment." "Per- 
sonal idiosyncracy is an important predisposing condition." "The 
administration of antirabic treatment is therefore not entirely 
devoid of risk." 
Quotation from a review of an article in California State Journal of 
Medicine, The Journal of the American Medical Association, July 1^ 
1916, page 74: 
"Of the thirty-three cases of rabies analyzed by Geiger, nine 
were having administered the Pasteur treatment or had com- 
pleted the regular course. Of these, three came down with de- 
finite symptoms on the seventeenth day of treatment and one 
on the nineteenth day. Of the remaining, two showed symptoms 
in four days, two fifteen days, and cne three weeks after the 
completion of the full course of treatment." 
From a review of an article by C. R. Mejio, Semana Medica, Buenos 
Aires, The Journal of the American Medical Association, May 12, 1917r 
page 1442: 
"Paralysis After Pasteur Treatment for Rabies-Mejio 
reported six years ago ten cases of paralytic accidents consecu- 
tive to Pasteur treatment in prophylaxis of rabies. . . . Since 
then he has encountered a number of cases but in this later 
series the disturbances were of the nature of peripheral neuritis, 
polyneuritis or acute ascending paralysis. In the totM 19,800 
persons who have been treated at the Pasteur Institute at 
Buenos Aires in his charge, twenty-four developed these para- 
lytic accidents and in four the consequences were fatal." 
It must be remembered that the anti-rabic treatment is given 
as a preventive of a barely possible later development of hyd- 
rophobia. 
From an article: "Neuritis and Paralysis as a Complication of the in- 
60 -tensive Pasteur Treatment." by J. C. Geiger, M.D., Assistant Director, 
Bureau of Communicable Diseases of the California State Board of 
Health, The Journal of the American Medical Association, February 17, 
1917, page 513: 
"Remlinger, Stimson, Simon, Hasseltine and Fielder, in a 
summary of the literature with a report of their personal cases, 
show the sum total of paralyses following the Pasteur treatment 
to be 142, with twenty-four deaths. With the additional cases 
described in Table 1, the number of paralyses is increased to 
150, without taking into consideration the seven cases reported 
as neuritis." 
In his "Study of Cases" the author says: 
"The paralysis occurred in one person (Case 2) who was not 
bitten. Agam, it occurred in one person (Case 6) who was 
bitten, but not by an animal which was rabid." 
"In Case 3, though the treatment was discontinued and re- 
sumed with no ulterior results, I am convinced from observa- 
tions of Cases 5 and 6 and the alarming symptoms presented 
that the continuation of the treatment was bad judgment. There 
must be a border line, so to speak. The latter cases around the 
seventh day of treatment presented definite prodromal [precur- 
sory] symptoms of nausea and temperature. In Case 6 the 
treatment was discontinued for two days, with a return of the 
patient's condition to normal. The resuming of the treatment 
brought on an immediate and much aggravated return of the in- 
itial symptoms coincident with the appearance of the paralysis." 
"There is no doubt that in some persons to whom the inten- 
sive Pasteur treatment is administered . . . there occurs some 
involvement of the nervous system, with possible serious results. 
Therefore the intensive Pasteur treatment is not without danger, 
and warning should be given accordingly." 
The Journal of the American Medical Association, December 1, 1917, 
page 1873, contains an article by Robert L. Levy, M.D., John Hopkins 
Hospital, Baltimore, entitled "Facial Paralysis Following Pasteur Anti- 
raoic Treatment." Though expressing his belief in the treatment, the 
author admits the danger: 
". . . there are records of only 150 cases in which paralyses 
have followed its use. Of these patients, twenty-five died." 
Dr. Levy's own patient is described as a man thirty-seven years old, 
and of good general health. He received the Pasteur treatment at the 
State laboratory in Raleigh from August 31 to September 19, 1916. We 
quote from the article: 
"On the fourth day of treatment he began to have sensations 
of 'something crawling under his skin,' first in one place, then in 
another. In addition, there were 'neuralgic' pains in the lumbar 
region and in the muscles. . . . Two weeks before admission [to 
John Hopkins Hospital] he began to feel muscular twitchings, 
especially in the head, neck and legs. Six days before coming 
to Baltimore, a severe bitemporal headache appeared, and had 
not be relieved by sedatives. On rising in the morning, three 
days before admission to the hospital, he noticed that the left 
side of his face was paralyzed." 
.Symptoms of a distressing nature continued and 
"November 28. the entire side of the face was paralyzed, except 
for the right frontalis muscle, . . ." "December 4, the patient 
complained of numbness of both legs . . . and was much con- 
61 cemed about his condition. He left the hospital at his own re- 
quest." "A note from the patient's physician, June 25, 1917, 
stated that 'Mr. N. is not taking any treatment now. He is 
very little better, judging from the appearance of his face.' " 
Commenting upon this case, Dr. Levy says, 
"In spite of the fact that in the case here reported seventy- 
three days elapsed between the beginning of treatment and the 
onset of paralysis, there can be no reasonable doubt as to the 
direct relationship between the antirabic therapy and the facial 
diplegia. Symptoms began after the fourth injection and were 
similar to those described in other instances of 'treatment para- 
lysis.' " 
After referring to other cases of a similar nature, Dr. Levy con- 
cludes: 
"The etiology of these paralyses is still in doubt. The various 
theories as to their causation have recently been adequately dis- 
cussed by Fielder, who sums them up as follows: 'There is no 
doubt that in most of the cases, at least, the symptoms are 
caused, not by street virus infection, modified by the treatment, 
but by the treatment itself either through the medium of fixed 
virus infection or through the action of a toxin, or both. In any 
event there must be a special idiosyncracy on the part of the 
patient. Otherwise the cases would be enoromusly more fre- 
quent than they are.' " 
The following excerpts are from a book, "Accidents and Emergencies'' 
(1918), page 63, by Charles W. Dulles, M.D., Fellow of the College of 
Physicians and of the Academy of Surgery; Consulting Surgeon to the- 
Rush Hospital; formerly Surgeon to the Out-Door Department of the 
Hospital of the University of Pennsylvania and of the Presbyterian. 
Hospital in Philadelphia, etc., etc.: 
"Bites of Dogs, like those of cats or rats, may be followed by 
a local irritation. Besides this they cause a special terror to 
some persons, while others have little fear of them, though 
often bitten. If any one is bitten by a dog in good health, only 
the simplest treatment will be necessary. If the dog is sick, 
local inflammation or severe constitutional disturbance may 
follow. In case of reasonable suspicion, the wound may be 
thoroughly cleansed and an application of hartshorn made to it, 
in addition to energetic sucking, or soaking under hot water, 
to extract any irritating material which may have entered it. 
Dog bites should never be cauterized with lunar caustic (nitrate 
of silver). This is so generally done by druggists and at hos- 
pitals that the author must state that more than thirty years 
of exhaustive study of the subject and a large experience have 
convinced him that such cauterizations are worse than useless.. 
They never do good and often do harm. 
"Further, persons bitten by suspected dogs or cats should not 
be sent to so-called Pasteur Institutes.' 'For this there are 
several reasons. One is, that there is no trustworthy evidence 
that all such institutions are honestly conducted, while there is 
ground for the belief that some of them are arrant impostures; 
another is, that a large number of persons have come to their 
death from the treatment received in such institutions. And, 
finally, more persons have died of so-called hydrophbia, and of 
the laboratory disease caused by the so-called preventive inocu- 
lations, since Pasteur Institutes were founded, than died, in an 
equal time, before the introduction of this dangerous inno- 
vation." 
"Again, if one has been bitten, and there is a reasonable sus- 
62 picion that the dog was called 'mad/ let him not despair. Most, 
if not all, cases of so-called hydrophobia are not hydrophobia 
.at all. The author has studied this subject with great care for 
many years, and has become satisfied that the popular theory in 
regard to hydrophobia is utterly wrong. He also believes it will 
some day disappear, as the belief in witchcraft-which not long 
ago was supported by the most respectable medical, clerical, and 
popular authorities-has disappeared. In most of the reported 
cases the patients have been alarmed by what they thought, or 
frightened by what injudicious friends or timid doctors have 
said and done, until they died of sheer terror. So much nonsense 
is believed about hydrophobia by medical men who have not 
carefully studied the subject, and so much talk about it goes on 
among the laity, that it is no wonder it is much dreaded by old 
and young. Children learn about its horrors nearly as soon as 
they can walk, and no age is secure against a belief in it. But 
those who see the most dogs liable to be rabid have the least 
belief in hydrophobia. Keepers of public pounds, dog-catchers, 
and keepers of kennels in large cities, may be said to never de- 
velop hydrophobia though bitten innumerable times. So, in 
case of a bite from a supposed mad dog, let the things suggest- 
ed above be done; and let the bitten person reflect how common 
are dog bites and how very few are the cases of so-called hydro- 
phobia." 
In a foot-note Dr. Dulleb remarks: 
"So-called hydrophobia exists exactly in proportion to the 
common belief in it and the amount of public discussion it gets. 
It has almost disappeared since the epidemics of spinal mening- 
itis in this country several years ago, and since the present war 
has occupied men's minds." 
63 INFANTILE PARALYSIS 
Extracts from an article in The Journal of the American Medical 
Association, August 4, 1917, page 407, reviewing a report by H. Ulrich 
published in Boston Medical and Surgical Journal, July 19, 1917, con- 
cerning the specific treatment of Infantile Paralysis: 
"The 120 cases studied by Ulrich were divided into six groups, 
each group being treated in a different manner. Group I was 
treated with three intraspinal injections of immune serum; Group 
II was treated similarly with normal serum; cases of Group III 
were injected with their own spinal fluids (auto-therapy-Dun- 
can) ; Group IV comprised cases on which the effect of simple 
withdrawal of spinal fluid was tested; Group V received no 
specific treatment; Group VI includes cases of which one was of 
doubtful diagnosis, one died of pneumonia, and the others were 
moribund on admission. ... A comparison of the results ob- 
, tained shows that none of the measures used had any favorable 
influence whatever on the progress or outcome of a single case. 
Ulrich concludes, therefore, that not only must the various meas- 
> ures employed in this study be looked on as useless, at least after 
the onset of paralysis and under the conditions under which the 
investigation was carried out, but the manipulation of the suf- 
ferers necessarily attendant on lumbar puncture causes great 
pain, and would seem to be permanently harmful in view of the 
great need of rest during the early stages of the disease." 
From an editorial on Poliomyelitis, American Medicine, September, 
1917, page 608: 
"No new light has been thrown upon the conditions which must 
exist to cause an epidemic to arise nor has further definite know- 
ledge upon the relation of personal immunity to infection been 
presented. Certainly the further testimony of this year indicates 
that poliomyelitis, while infectious, is not highly contagious. 
"The sum total of results, as far as prevention and cure are 
concerned, that have arisen from a study of the paralytic pla- 
gue of 1916 amounts to very little." 
The Journal of the American Medical Association, October 13, 1917, 
page 1295 reviews an article by P. L. DuBois and J. B. Neal published 
in the Archives of Pediatrics, August, 1917. The article is entitled: 
"Seven Years of Clinical and Laboratory Experience with Meningitis in 
New York City." The following extracts are from this review: 
"Various methods of treating the acute stage of poliomyelitis 
[infantile paralysis] were tried during the summer of 1916, with- 
out very decisive results. The intraspinal injection of epinephrin 
was endorsed by only a few after it had been used for a short 
time. The injection of human-immune serum was quite extensive- 
ly tried. Injecting a foreign substance into the slightly inflamed 
meninges sets up in most instances an acute aseptic meningitis, 
as is shown both by changes in the spinal fluid, and clinically by 
an increased temperature, headache, vomiting and rigidity of the 
neck. It seems possible that this increased inflammatory re- 
action may tend to accentuate the inflammatory process already 
64 existing in the subjacent substance of the brain and cord. . . . 
While great improvement seemed to follow the administration of 
serum in certain cases, equally great improvement occurred with 
no serum in at least an equal number of cases. In view of these 
considerations the physicians of the meningitis division of the 
New York Department of Health feel that the best treatment of 
early cases is complete rest, with lumbar puncture for the relief 
of pressure symptoms, in addition, of course, to general sympto- 
matic and hygienic treatment." 
From a review of an article "Etiology of Epidemic Poliomyelitis," 
by E. T. H. Tsen, Journal of Experimental Medicine, Baltimore, The 
Journal of the American Medical Association, September 28, 1918: 
"An etiologic [causative] relation has not been established be- 
tween streptococci and poliomyelitis." 
In the same magazine, page 1091, is a review of an article, "Nuzum's 
Antipoliomyelitic Serum," by H. L. Amoss and F. Eberson, Journal of 
Experimental Medicine, Baltimore. The following is a quotation there- 
from: 
"The value, in general, of antistreptococcic serums in combat- 
ing streptococcus infections is unproved. . . . The experi- • 
mental and other evidence adduced by those who regard the 
streptococcus as playing an essential part in the pathology of 
epidemic poliomyelitis and the antistreptococcic serums as ex- 
hibiting therapeutic properties for man and monkeys is regarded 
by Amoss and Eberson as being imperfect and inconclusive." 
65 INFLUENZA 
Quotation from an article on Influenza, Health News, published by 
the New York State Department of Health, October, 1918: 
"Notwithstanding the reports in the daily press of the dis- 
covery of preventive 'serums' it may be definitely stated that no 
such serum exists or is likely to be discovered in the near future. 
Vaccines from killed influenza organisms are now being prepared 
in the State Department of Health laboratory and elsewhere and 
will be given a thorough trial as a means of prevention. At this 
writing no data, favorable or unfavorable, in regard to them are 
available." 
From an editorial in The Journal of the American Medical Associa- 
tion, October 12, 1918, page 1220: 
"The precise cause of the primary acute respiratory infection 
is not known-it may be the influenza bacillus; as yet definite 
proof is wanting-but the momentous peril so far is the develop- 
ment of pneumonia, and this appears to be associated with and 
] in all likelihood caused by different bacteria, of which the in- 
fluenza bacillus, hemolytic streptococci, and pneumococci are the 
most important." 
From an editorial on Influenza, the New York Medical Journal, 
October 12, 1918, page 645: 
"The causative organism of the disease still remains a matter 
of dispute, and European authorities particularly record the most 
divergent views as to the specific organism. ... It should be 
borne in mind, however, that the B. influenzae has not been uni- 
versally accepted as the specific cause of endemic influenza, or of 
the disease as it prevailed in 1890. From the point of view of 
possible prophylactic immunization, the settling of the question 
of the specificity or lack of it of the B. influenzae is a matter of 
the greatest importance." 
From an editorial entitled: "Serums and Vaccines in Influenza," The 
Journal of the American Medical Association, October 26, 1918, page 
1408: 
"With respect to serums and vaccines in influenza, there are 
certain simple facts and considerations that physicians will do 
well to keep in mind at this time. The main point to keep al- 
ways in sight is that unfortunately we as yet have no specific 
serum or other specific means for the cure of influenza, and no 
specific vaccine or vaccines for its prevention. Such is the fact, 
all claims and propagandist statements in the newspapers and 
/ elsewhere to the contrary notwithstanding. This being the case, 
efforts at treatment and prevention by serums and vaccines, 
now hurriedly undertaken, are simply experiments in a new field, 
and the true value of the results cannot be predicted by any one." 
"As to serum treatment, the only noteworthy new method so 
far is the injection in severe cases of influenzal pneumonia of the 
serum of patients who have recovered from such pneumonia. 
... It should be borne in mind, however, that McGuire and 
66 Redden made their observations in the declining phase of the 
epidemic when the organism or organisms concerned appeared to 
be losing virulence. For this and other reasons the expectations 
as to what may be accomplished by this method must be kept 
' within reasonable bounds. Influenza is a self-limited disease 
with variable complications and of variable severity in different 
places, thus offering great difficulties in the way of evaluation 
of different methods of treatment." 
"At least two kinds of vaccine are in use in the hope that they 
may have preventive effects. One consists solely of killed in- 
fluenza bacilli, and it is being extensively used in the East. 
. . . The other vaccine is a mixed vaccine of the more im- 
portant bacteria in the respiratory tract in influenza, principally 
pneumococci, streptococci and influenza bacilli. It appears that 
vaccines of this nature are in extensive use, but we have no evi- 
dence that any benefit will be derived from them. . . . How 
slender the basis for this anti-influenzal vaccination when it is 
considered that the real nature of influenza is still unknown!" 
. . it is probably safe to say that nothing on which to 
rely in the future can be learned from the indiscriminate vaccin- 
ation now going on. There is, therefore, no basis on which 
promise of protection from vaccines may be made. They may 
be harmless, and they may or may not be of preventive value." 
From an article on Influenza, by Royal S. Copeland, M.D., Commis- 
sioner of Health of the City of New York, New York Medical Journal, 
October 26, 1918, page 716: 
"Secondly, the production of a vaccine which would effectively 
protect persons against influenza, has not yet passed the ex- 
perimental stage, and its use on a large scale has been decried 
by some as tending to produce a special susceptibility to the 
disease during the negative phase which it produces. At all 
events, while those most competent to decide are not yet in 
accord with its value, it offers as yet only a measure of promise 
as an agent in the prevention of the spread of the disease." 
The following quotation is from an article entitled: "Vaccines Against 
influenza," U. S. Public Health Reports, November 1, 1918, page 1866: 
"In view of the exaggerated and in some respects misleading 
statements that have appeared in the public press regarding the 
value of bacterial vaccines in the prevention and treatment of 
influenza and the pneumonias which so often complicate it, 
the following statement is made: 
"The evidence that has been presented thus far does not war- 
rant the reposing of confidence in any influenza vaccine for 
either prophylactic or therapeutic purposes. 
"Several vaccine preparations made of the influenza bacillus, 
some from streptococci, some from various types of pneumococci 
and other organisms have been recommended and used in vari- 
ous localities, and evidence has been advanced which has been 
held to show that the number of persons attacked has been less 
and the deaths fewer among the vaccinated than among those 
who had not been treated. When, however, this evidence has 
been carefully analyzed it has been found that either there was 
no indication of protective or therapeutic value or there was no 
more than a suggestion that possibly some protection had been 
conferred." 
From The Journal of the American Medical Association, November 2, 
1918, page 1489: 
"The United States Public Health Service, having been be- 
sieged with inquiries regarding this and that method of treat- 
67 ment, has issued a special bulletin in which it is emphasized that 
there is no specific cure for influenza yet known and that the 
chief reliance must be placed on good hygiene, good nursing and 
symptomatic treatment." 
An editorial in the New York Medical Journal, November 2, 1918, 
after reviewing the history of the various methods of treating influenza 
in the past, says: 
"The value of the whole story is in not jumping to hasty con- 
clusions in therapeutics and being sure not to do any harm. . 
. . " "We cannot but commend," says the editorial, "the 
thoroughly conservative attitude of the United States Public 
Health Service with regard to the various remedies that have 
been recommended. There is much more likelihood that jump- 
ing to conclusions in the midst of an epidemic shall prove wrong 
rather than right and much more than a possibility that biolog- 
ical remedies of various kinds, except when employed under the 
most rigid control, may do ever so much more harm than good." 
From an article, "Notes on the Present Epidemic of Respiratory 
Disease," by Solomon Strouse, M.D., and Leon Bloch, M.D., Attending 
Physician and Associate Attending Physician, Michael Reese Hospital, 
Chicago, The Journal of the American Medical Association, November 
9, 1918, page 1570: 
"Prophylactic vaccination is as yet of unknown value. We 
know of at least three instances in which three doses of a vac- 
cine had been given and influenza subsequently developed, and of 
over twenty instances in which one or two doses had been given, 
followed later by typical attacks of influenza and pneumonia." 
We feel definitely that at present there is no special treatment." 
"The present epidemic of 'influenza' or 'influenzal broncho- 
pneumonia' or 'epidemic pneumonia' is as yet of unknown eti- 
ology [causation]." 
Referring to articles on influenza prepared by the British Medical Re- 
search Committee, an editorial in the same magazine says: 
"On the whole, the results of the work covered by the ab- 
stracts support the conclusion that we do not understand the 
true nature of the condition now being called epidemic influenza; 
that there is not sufficient evidence to regard any one of the dif- 
ferent forms of bacteria found in the respiratory tract in the 
cases of the disease as the primary cause, but that all the bac- 
teria, the influenza bacillus, as well as the so-called diplostrep- 
tococci and others, may be secondary invaders, transmissible 
from person to person with almost the same ease as the sup- 
posed, but unknown, primary cause." 
From "Current Comment," the same magazine, page 1583, "Value of 
Vaccination Against Influenza:" 
"There is no conclusive evidence that the Pfeiffer bacillus plays 
any greater role, if as great, in the present epidemic than any 
other bacteria found in the respiratory tract in this disease. 
This point emerges very clearly in the abstract of recent English 
and German literature and in the original contributions printed 
in this issue. . . . Again, we have no record of any pro- 
perly conducted and controlled experiments on human beings 
with influenza vaccines." "In this connection we give two ex- 
amples of so-called 'evidence' that appeared in newspapers, 
which seem to be the medium through which most of the evi- 
dence is appearing." The article gives quotations from this 
newspaper evidence, one of the "utterly misleading ' headings 
68 being "Vaccine Blots Out 'Flu'" and proceeds to analyze: "In 
the meantime, we should not forget that in its natural course, 
epidemic influenza is affecting different, even adjacent, com- 
munities with widely varying degrees of severity, and that vac- 
cination in an institution after the disease has appeared can have 
no value as an experiment because it may have been done in the 
wane of the epidemic. Finally we repeat: Vaccination against 
epidemic influenza is in a wholly experimental stage. Noth- 
ing can be learned as to its real value from indiscriminate vac- 
cination of the public." 
From a report on the epidemic of influenza at Camp Sherman, Ohio, 
The Journal of the American Medical Association, November 16, 1918, 
page 1652: 
"Bacillus influenzae (Pfeiffer) has not been demonstrated as 
the causative organism. The frequency of its detection has not 
exceeded the frequency of its existence under normal conditions." 
The following is from an article entitled: "The Failure of a Bacterial 
Vaccine as a Prophylactic Against Influenza," by G. W. McCoy, M.D., 
Director, Hygienic Laboratory, Washington, D. C.; V. B. Murray, M.D., 
Assistant Surgeon, United States Public Health Service; and A. L. 
Teeter, Intern, Stanford University Hospital, The Journal of the Ameri- 
can Medical Association, December 14, 1918, page 1997: 
"The bacterial vaccine used in the present investigation was 
kindly furnished by Dr. F. O. Tonney, Chief of the Laboratory of 
the Chicago Health Department." 
"The persons vaccinated were patients at a state institution 
for the insane." 
"In each ward of the hospital a list was made of all patients 
aged 41 or under, and each alternate patient was vaccinated, 
the remainder being considered as controls. Each group num- 
bered 390. The vaccination was completed November 15, and 
fortunately the institution remained free from influenza until 
November 26, when cases began to appear, . . . The cases 
were clinically like those that have been observed elsewhere, 
and there was the usual percentage of severe cases and of cases 
with serious pulmonary complications, some terminating fatally. 
"The accompanying tabulation shows the results in the two 
groups up to December 9, 1918. 
"Incidence of Influenza and Pneumonia in the Vaccinated 
and the Controls. 
Vaccinated Not Vaccinated 
Persons in group 
390 
390 
Number developing influenza 
119 
103 
Number developing pneumonia 
23 
17 
Deaths 
10 
7 
"It appears clear from the evidence afforded by these obser- 
vations that no protection was afforded by the vaccine." 
From The Journal of the American Medical Association, December 21, 
1918, page 2094: 
"At this time it may be said that the ase of vaccines in in- 
fluenza is at best in the experimental stage, and that carefully 
controlled experiments exist which indicate that neither of the 
two main types of vaccines now offered to the profession are 
efficacious in preventing the spread of the present epidemic." 
Same magazine, page 2100, quotation from the report of Col. Victor 
69 C. Vaughan's remarks at the annual meeting of the American Public 
Health Association: 
"We have tried with the greatest thoroughness the vaccines 
for influenza. We have used influenza vaccine in great quanti- 
ties, all they could make in the Army Laboratory, and have used 
all that Dr. McCoy could spare, and also have used that which 
Dr. Park has furnished us from the New York laboratory, and I 
do not hesitate to say that it has not done one bit of good." 
From an editorial, The Journal of the American Medical Association, 
December 28, 1918, page 2154: 
j "The primary cause of influenza, in accordance with the facts 
as we now have them, is an unknown agent that prepares the 
i way for secondary infections of the respiratory tract." 
From the New York Herald, January 31, 1919, reporting an address 
by Dr. G. W. McCoy: 
"There is no serum in existence which will prevent influenza 
or be of any use in the treatment of that disease, according to 
a statement made yesterday by Dr. G. W. McCoy, director of the 
hygienic laboratory of the Public Health Service, Washington, 
D. C., speaking at the twenty-ninth annual meeting of the Asso- 
ciation of Life Insurance Medical Directors at Newark." 
"In speaking of the study of preventives for influenza, Dr. 
McCoy said: 'Now, coming to the matter of vaccines. When this 
epidemic started in Europe, and perhaps after it struck us here 
in the United States, I suppose more or less of us were pretty 
well contented to believe that the so-called influenza bacillus, or 
influenza-pneumonia bacillus, was actually the cause of the dis- 
ease. We have even gone so far as to take a virulent culture 
of this influenza bacillus and spray it into the noses and mouths 
and upper air passages of a considerable number of volunteers. 
We have done this with not only one culture, but in the neighbor- 
hood of twenty, and we have altogether used some thirty or 
forty people who volunteered for this experiment. It, however, 
did not do any of them any harm; not one got influenza or ex- 
perienced the slightest harmful effects. 
" 'After we failed with the influenza bacillus to produce the dis- 
ease we went a step further and took material-that is mucus- 
from the posterior nasal pharynges of patients actually ill of in- 
fluenza and sprayed it into the throats and noses of healthy, 
people, using altogether twenty or thirty volunteers, and we 
never gave anybody influenza even by that process. 
" Tn Boston we went further, and actually took the volunteers 
to the bedsides of the influenza patients. We swabbed the mucus 
directly into their throats and noses, but we never were suc- 
cessful in producing influenza.' " 
"Results of vaccinations made on a wholesale scale at the naval 
training school at Pelham Bay and also at Camp Wheeler were 
given. According to Dr. McCoy, of 1,200 sailors at Pelham, half 
were vaccinated. Of these 1,200, those afflicted by influenza or 
influenza-pneumonia were as numerous in the vaccinated as in 
the unvaccinated groups. The same result appeared at Camp 
Wheeler." 
From an article on Influenza by Rupert Blue, Surgeon General, 
United States Public Health Service, published in the N. Y. Tribune, 
February 18, 1919: 
"In establishing a quarantine, it is first necessary to have some 
definite standard by which a disease can be readily recognized, 
70 either a clinical or a bacteriological standard. In the case of 
influenza we have neither. No sanitarian of standing will con- 
tend that the causative organism of influenza is known. Hence, 
there can be no determination of what is or what is not influenza 
by means of laboratory methods. As to the determination of the 
disease through clinical evidence, it is well known that influenza 
varies according to whether it is a mild or severe type, and that 
in the absence of an epidemic of the disease, many cases at the 
present time and in the past that have been diagnosed as in- 
fluenza would ordinarily have been diagnosed as a 'common 
cold," bronchitis, pneumonia or a case of influenza of the non- 
epidemic type." 
71 PNEUMONIA 
In The Canadian Medical Journal, July, 1915, page 596, Dr. J. C. 
Meakins, referring to the serum treatment of pnuemonia, says: 
"It is now over twenty years since patients were first treated 
by serum obtained from immune animals. The practical results 
were very disappointing." 
Editorial, The Journal of the American Medical Association, May 12, 
1917, "Prophylactic Inoculation Against Pneumococcal Infection." Re- 
ferring to the immunization of animals, the article says: 
"When we consider these experiments, it is obvious that if the 
problem had been the immunization of rabbits against pneu- 
mococcal infection, it could be said that the method has been 
put to the crucial test. ... In the instance of man, however, 
the results are not so striking." 
On page 365 New York State Journal of Medicine, August, 1917, Dr. 
Allen A. Jones, Buffalo, referring to the serum treatment of pneumonia, 
says: 
"I have been very much interested in carrying out in a small 
way the antipneumococcic serum treatment. Recently I had two 
cases which I treated with this serum. In one case we thought 
we had a complete recovery, because we saw the case early. 
We were very proud of the results in this case, but later the 
patient died." 
Dr. Rufus Cole of the Rockefeller Institute, in an article on the use 
of serum in the treatment of pneumonia, The Journal of the American 
Medical Association, August 18, 1917, page 505, refers to 
"the possibility of severe serum reactions" and advises against 
"the indiscriminate use of serum." 
He says: 
"they [the reactions] are unpleasant when they occur, and may 
cause some anxiety to the physician, especially if he be uncer- 
tain whether in the case being treated the serum can be of any 
value or not." 
"In administering large amounts of foreign serum, as it is 
necessary to do in this form of therapy, the patients may ex- 
hibit certain symptoms which are due entirely to the parenteral 
[by any other way than through the gastro-intestinal tract] in- 
jection of the foreign protein, and have no relation at all to the 
content of the serum in specific antibodies." "These so-called 
serum reactions are of several kinds. First, in patients who have 
previously received horse serum, or even occasionally in cases 
in which no history of the previous administration of horse serum 
can be obtained, there may occur, almost immediately follow- 
ing the injection, suffusion of the face, restlessness, increased 
heart rate, difficulty in breathing, urticaria, and rarely collapse. 
These symptoms may occur, however, after the administration of 
small doses of serum such as are employed in the treatment of 
72 diphtheria, as well as following large doses of serum such as 
are required in pneumonia." 
"The second form of serum reaction is more difficult to guard 
against. This possibly has nothing to do with anaphylaxis or 
previous sensitization, and may occur with repeated injections. 
The symptoms, however, are like those seen in anaphylactic 
shock, consisting of restlessness, tachycardia [excessive rapidity 
of the heart's action, suffusion of the fact, sweating and occa- 
sionally vomiting. They may appear during the administration 
of serum, or may be delayed for an hour or longer. High eleva- 
tion of temperature, with abrupt fall, may be a part of this non- 
specific serum intoxication. . . . It is the same kind of re- 
action which is seen after large injections of vaccines, which 
reactions have been claimed by some to have therapeutic effects. 
However, we do not believe that the beneficial effects of such re- 
actions have been demonstrated. So far as the present form 
of therapy is concerned, we believe that the occasional occur- 
rence of such reactions is a distinct drawback to the method, and 
we believe that such reactions should be presented so far as pos- 
sible. "At present they cannot be entirely avoided; . . 
"Finally, following serum treatment, patients may show a com- 
plex of symptoms which has been described as serum sickness. 
These symptoms consist of elevation of temperature, skin rashes, 
glandular enlargement, edema of the skin and joint pains. Mild 
symptoms, especially the skin rashes, may occur within a day or 
two after the serum injections. . . . The entire group of symp- 
toms most frequently occurs, however, seven to fourteen days 
following the administration of the serum. The attack may be 
repeated one or more times, or may be very irregular in its 
course. Mild symptoms occur in about half the treated cases, 
severe attacks only rarely." 
The author emphasizes that serum is, at best, of value in only one 
type of pneumonia, concerning which he says: 
"We cannot but feel hopeful that the treatment of this type of 
infection by immune serum is of distinct value. However good 
other kinds of evidence are, the final test must be as to whether 
patients with pneumonia are cured or not." 
Referring to experiments on dogs and smaller animals, Dr. Cole con- 
cludes : 
"In neither case, however, are the conditions identical with 
acute lobar pneumonia in man, and the final test of value must 
come from the observation of patients." 
In the "Abstract of Discussion," which follows Dr. Cole's article, Dr. 
Lawrence Litchfield of Pittsburgh, states that out of 134 cases of 
pneumonia in his district there had been fourteen cases of pneumococcic 
meningitis "diagnosed by lumbar puncture, . . Some of these mening- 
itis patients were treated by the repeated injection of the undiluted 
Rockefeller serum into the lumbar canal, . . The symptoms and progress 
of the meningitis were modfied in a noteworthy manner, but as yet we 
have had no recoveries." 
Subsequently Dr. Cole refers to these meningitis cases as 
"extraordinary" and is "interested to learn whether in any of 
these cases serum had been administered before the onset of 
the meningitis." 
Dr. Litchfield, continuing, states that: 
"Of the lype I cases of lobar pneumonia, [the only type for 
73 which benefit from serum treatment is claimed by the Rocke- 
feller authority], twelve patients were treated with the Rocke- 
feller serum, with five deaths ... in spite of the high mortal- 
ity, a study of the cases has made me very enthusiastic as re- 
gards this treatment." 
Dr. David Bovaird, New York, speaking of his observations at the 
Presbyterian Hospital, states: 
"There is a most remarkable variability in the mortality of 
the different groups of this disease [pneumonia] in different 
years, a variability for which we have at present no explanation. 
... It is, therefore, important to be careful in comparing mor- 
tality statistics." 
Excerpts from an article by Arthur Bloomfield, entitled: "The Effects 
of Serum Therapy in Acute Lobar Pneumonia," Bulletin of the Johns 
Hopkins Hospital, October, 1917: 
"Eleven cases were studied. They were all instances of 
frank lobar pneumonia, in which the Type I pneumococcus was 
demonstrated in the sputum or blood." Discussing the results 
of the serum treatment the author states: "There was no strik- 
ing change in the clinical course of the cases which could clearly 
be attributed to the serum. . . . No striking critical falls of 
temperature were observed after injections of serum, nor was 
there in any instance any sudden relief of symptoms. The total 
stay in the hospital was, however, much prolonged by the severe 
relapsing serum disease which occurred in most of the cases." 
"Without dwelling on the usual features of serum disease a few 
points of special interest may be noted. In two cases (about 20 
per cent.) a very alarming reactions followed immediately after 
the initial injection, although no indication of hypersusceptibil- 
ity had been furnished by the preliminary 'desensitizing' dose. 
The patients presented the picture of acute anaphylactic shock. 
. . .In five cases (45 per cent.) there were very severe late reac- 
tions. These were featured by long periods of high fever and 
prostration punctuated by various symptoms of serum disease." 
"The present series throws little light on the curative value of 
the serum." 
Extracts from an article by Henry Koplik, M.D., Mount Sinai Hospi- 
tal, The Journal of the American Medical Association, November 17, 
1917, page 1661: 
"Under normal conditions, pneumonia at any age is a self- 
limited disease of definite duration, and, barring complications, 
it has a definite tendency to recovery." ". . . there is a tend- 
ency to recovery no matter what treatment is employed . . . 
the ultimate outcome of all pneumonia depends mainly on the 
vitality of the patient and his powers of resistance." "In pneu- 
monia we have no specific, the early application of which would 
save." 
". . . I believe pneumonia to be a disease in which clinical 
experience must go hand in hand with good judgment, in order 
that the patient may not be injured while making the fight for 
recovery. As to serums or vaccines, they have been even less 
successful in the final results in children than in adults." 
The following extracts are from an article on "The Serum Treatment 
of Pneumonia," Weekly Bulletin of the Department of Health, City of 
New York, January 12, 1918. 
Though advocating the use of serum in lobar pneumonia of Type I, 
dangers therefrom are admitted, page 12: 
74 "One danger confronts the physician, viz., a sudden serum re- 
action evidenced by suffusion of the face, restlessness or uneasi- 
ness, increased pulse rate, difficulty in breathing, urticaria 
[hives] and more rarely serious collapse with the possibility of 
a fatal outcome." 
"A second form of serum reaction consisting of chilliness or 
a distinct chill and an abrupt rise and fall of temperature may 
come on during or after the injection. Some difficulty in breath- 
ing or cyanosis may also occur. This reaction is similar to that 
elicited by the intravenous injection of vaccines or other foreign 
proteins and cannot be adequately guarded against." 
"Seruni sickness will follow after some days or after a week 
or two in many cases. In most instances this will be nothing 
more severe than an uncomfortable urticaria. Oedema of the 
skin, joint pains and glandular enlargement and a rise in tem- 
perature may accompany the rash." 
The following excerpts are from an article on pneumonia, by S. Adol- 
phus Knopf, M.D., New York Medical Journal, January 26, 1918, page 
170: 
"Some clinicians and experimenters believe that it is perfectly 
safe to administer one dose of serum against Type I, prior to 
the determination of the type, and when the determination of 
the type is not feasible, two or .three doses. Prof. William H. 
Park is of the opinion that such procedure can only be beneficial. 
Dr. Cole is of the contrary opinion and says: 'The administra- 
tion of serum is frequently followed by general constitutional 
reactions and, if this method were employed, many patients in 
whom the serum could be of no possible value, would be sub- 
jected to such reactions.' " 
Extracts from an article on pneumonia under "Therapeutics," The 
Journal of the American Medical Association, February 9, 1918, page 
382: 
"Vaccines during acute pneumonia are of doubtful utility and 
perhaps sometimes absolutely harmful... They have been tried so 
extensively under favorable circumstances with such uncertain 
or unfavorable results that there seems no good reason for con- 
tinuing their use." 
"As has been stated, workers in the Rockefeller Institute 
have prepared antipneumococcus serums. . . . Commercial prep- 
arations of these serums are available and also polyvalent ser- 
ums. These polyvalent antipneumococcus serums are of ex- 
tremely doubtful value." 
"While cases caused by other types of pneumococci than Type 
I are not benefited by serum, it is quite likely that they may be 
harmed. The intravenous injection of a hundred or more cubic 
centimeters of horse serum can hardly be devoid of harm and is 
certainly not to be used except when very decided benefit may 
be expected to follow its use. ... If it is a Type I pneumococ- 
ccus, serum treatment may be undertaken. The value of the 
serum in the treatment of pneumonia is uncertain, but the re- 
sults reported are sufficiently convincing to warrant its further 
trial under suitable conditions. It should be used only when cor- 
rect diagnosis of the type of infecting organism has been deter- 
mined. Under present conditions this can hardly be done, of 
course, outside of a hospital or in a laboratory which has 
specially trained workers." 
"Even at best a limited number of cases are suitable for 
treatment with immune serum, a large proportion of lobar and 
the very large group of atypical and bronchopneumonias not be- 
ing susceptible of attack by these measures." 
75 The article concludes: 
"There is no specific cure for most cases of pneumonia." 
"As stated at the outset, a restful, quiet room, a sensible, 
efficient nurse, a sufficient amount of fresh air, and a suitable 
diet and proper care of the bowels will prevent high tempera- 
ture, heart failure, low blood pressure, insomnia, tympanites 
and toxemia in very many cases, and prevention is far better 
than the treatment of these serious conditions." 
The following quotations are from a report by Major Joseph L. Miller, 
Camp Dodge, Iowa, regarding pneumonia in that camp, published in The 
Journal of the American Medical Association, February 23, 1918, page 
564: 
"Up to last evening (February 12) 210 pneumonia patients 
were received in the base hospital at Camp Dodge." 
"At present, there has not been a single death from pneu- 
monia of Type I. Most of the cases have been of Type II or 
Type IV. The mortality in 200 cases of pneumonia up to date 
has been 10 per cent." 
''The method of treatment has been exceedingly simple. It 
consists in keeping the patient in bed, paying particular atten- 
tion to the diet, and giving him what was thought to be needed. 
He is given morphin enough to control pain and. to insure sleep. 
He is made as comfortable as possible by the administration of 
' a hypodermic of morphin. The only other medication is digitalis, 
3 minims, three times a day, and this being increased as the 
1 pulse increases in rapidity to 15 minims every three hours. The 
ward is well ventilated, but in case a patient becomes dyspneic 
[labored breathing], he is moved into the solarium or to a win- 
dow that is slightly open to give him all the fresh air possible 
and to take away the expired air." 
Extracts from "Classification and Results of Treatment of Pneumonia 
at Camp Upton," The Journal of the American Medical Association, 
March 9, 1918, page 728. 
Captain Russell L. Cecil is reported to have said: 
"Of the 100 cases of pneumonia, 75 were primary and 25 sec- 
ondary, 19 of the latter following measles. . . . For the treat- 
ment of the cases the government supplied a Type I serum and 
a polyvalent serum (Mulford)." 
Notice in our earlier quotations from Dr. Cole, of the Rocke- 
feller Institute, disapproval of polyvalent serum in pneumonia. 
"We have tried one or the other of these serums in nearly all of 
the pneumococcus pneumonias, the serum being employed in 77 
per cent, of all cases. ... Serum Sickness occurred in about 25 per 
cent, of the cases. There were two cases of acute anaphylaxis. 
There was a mortality of 15 out of 100 cases of pneumonia. . . ." 
Extracts from the report of a meeting of the New York Academy of 
Medicine, published in New York Medical Journal, May 25, 1918, page 
1003, under the heading: "Classifications and Results of Treatment of 
Pneumonia at Camp Upton." Dr. Russell L. Cecil is reported to have 
said: 
"Serum sickness occurred in about one fourth, manifesting it- 
self with rise in temperature, urticaria, acute arthritic pains, 
and a general feeling of discomfort; it lasted only twenty-four 
to forty-eight hours. There were two cases of acute anaphylaxis, 
one of which was fatal. They were Type HI, lobar pneumonia. 
The first patient showed no effect of the preliminary subcutan- 
eous injection of horse serum, the distressing symptoms follow- 
ing the intravenous injection of the serum and lasting twenty 
76 minutes before he went on to recovery. The preliminary injec- 
tion of horse serum had no effect on the second patient, and 
neither did the first dose of antipneumococcus serum, but he was 
given a second dose during a relapse two weeks after the first, 
which was too long an interval to intervene, and additional pre- 
cautions should have been taken against hypersensitiveness; he 
became cyanotic [bluish discoloration of the skin], exclaimed 
that he felt dizzy and could not breathe, pulse became rapid and 
thready, and he suddenly died." 
Compare these two reports from Camp Upton, where the serum treat- 
ment of pneumonia was used largely, to the report from Camp Dodge, 
where 
"the method of treatment has been exceedingly simple" the 
patients being "made as comfortable as possible," the final re- 
sult being a mortality of only 10 per cent. The Camp Upton 
report shows a mortality of 15 per cent, besides a 25 per cent, 
of serum sickness, two cases being very severe resulting in one 
death. 
From an article by E. A. Fennel, M.D., Washington, D. C., The 
Journal of the American Medical Association, December 28, 1918, page 
2115. Concerning the bacterial cause of bronchopneumonia, in the 
recent epidemic, Dr. Fennel says: 
"It is too early as yet to draw any definite conclusions as to 
the bacterial etiology of the disease. Apparently well founded 
opinions have been advanced by experienced investigators set- 
ting forth diametrically opposed views." 
From an article, "Pandemic 'Influenza' and Secondary Pneumonia at 
Camp Fremont, Calif." by Walter V. Brem, M.D.; George E. Bol- 
ling and Ervin J. Casper, Camp Fremont, Palo Alto, California, The 
Journal of the American Medical Association, December 28, 1918, page 
2138: 
"Polyvalent antipneumococcus serum was given in four un- 
selected cases early in the course of pneumonia. Two of these 
patients made rather rapid recoveries, one ran a moderately 
severe course but recovered, and one died. This did not seem 
to be a deviation from the natural course of the disease uninflu- 
enced by treatment, and since we did not consider the treatment 
immunologically hopeful we did not continue it.. \ - 
"Serum from five convalescent patients was pooled and 35 c.c. 
was given each of five selected dangerously ill patients, all of 
whom were spitting blood. Though the blood spitting practic- 
ally ceased in four cases and decreased in the fifth, all five 
patients died." 
"Antipneumococcus serum, Type I, was not used, as no Type I 
pneumococci were isolated. 
"Vaccines have not been used either prophylactically or in the ' u 
treatment of the epidemic cases, as it seemed to us that there 
was no reasonable hope of benefit to be derived from their 
administration." 
77 SMALLPOX 
In "The Life and Letters of Herbert Spencer," by David Duncan LL.D., 
(D. Appleton & Co., 1908), reference is made to Spencer's disapproval 
of undue "interferences with individual liberty either by the State or by 
local authorities or associations." 
"Scientific scepticism," says the author, "often came to the aid 
of political disapproval. Declining to sign a memorial regard- 
ing rabies in the spring of 1890 he [Spencer] expressed himself 
as 'sceptical with regard both to the present scare about rabies 
and the alleged specific for it.' So it was with regard to vac- 
cination. 'Compulsory vaccination I detest, and voluntary vac- 
cination I disapprove.'" (Page 405). 
In The Vaccination Inquirer, London April 1, 1912, a letter from 
Alfred Russel Wallace, the famous scientist, to the Anti-Vaccination 
League was published. The following is a quotation therefrom: 
| "I feel more and more every year that vaccination is the most 
unscientific, the most harmful and in every way the most wicked 
delusion of the nineteenth century." 
The following excerpts are from a letter by Professor Wallace to the 
same League and published in The Vaccination Inquirer, April 1, 1913: 
"It seems so absolutely impossible to get people to weigh the 
evidence fairly. One would have thought that our great test- 
case of Leicester, with those of our absolutely 'Protected' (! I) 
Army and Navy, should have been enough, but now we have 
had the new, the great, and the still more complete test-case of 
Japan-the most thoroughly vaccinated and re-vaccinated coun- 
try in the world, and that one which still has the greatest small- 
pox fatality!" 
Professor Wallace refers to these cases as showing, 
"not only the absolute uselessness, but the serious danger of 
vaccination-that it really increases smallpox-causes death; 
and is therefore a Crime! We demand therefore not abolition 
of compulsion, but total abolition of all legal and official recog- 
nition of vaccination in any way whatever." 
The following quotation is from the Petition sent to the Italian Parlia- 
ment by the International Anti-Vaccin.ation League, drawn and pre- 
sented by Professor Carlo Ruata, Professor of Materia Medica, Univers- 
ity of Perugia, and published in The Vaccination Inquirer, December 1, 
1913, page 219: 
"England abolished compulsory vaccination in 1898 and sub- 
stituted for it strict isolation. Yet England has less smallpox 
than Germany, where vaccination and re-vaccination are com- 
pulsory, although isolation is compulsory there too. 
"Austria has no compulsory vaccination and has less smallpox 
than Germany-112 deaths only in the five years 1906-1910. 
France has compulsory vaccination and has an appalling mor- 
tality. Japan vaccinates twice as much as Germany and as late 
as 1908 lost 5,837 of her people by smallpox. We will not 
78 speak of Italy, where we know we are all vaccinated, re-vaccin- 
ated and re-re-vaccinated to the highest degree, and yet suffer 
from epidemics that ought to publish our shame abroad. 
"It was these facts that caused John Burns, a member of the 
English Government, to use the following words at a sitting of 
the English Parliament, on April 12th, 1911: 'In the precise 
proportion as vaccination has diminished in England smallpox 
has diminished. During the time I have had the honour to cont- 
rol this department the smallpox mortality in London has been 
as follows-1906, no deaths; 1907, no deaths; 1908, no deaths; 
1909, two deaths; 1910, no deaths. Neither Germany nor Berlin 
can boast of a similar result.' " 
Excerpts from the Dissenting Report, 1913, of John Pitcairn, member 
■of the Pennsylvania State Vaccination Commission: 
"We find in the Final Report of the British Royal Commission 
the following admissions: 
"(Section 339) 'It is not open to doubt that there have been 
cases m which injury and cleath have resulted from vaccina- 
tion.' " 
"(Section 410) 'It is established that lympeh contains organ- 
isms, and may contain those which under certain circumstances 
would be productive of erysipelas.' " 
"(Section 417) 'It may, indeed, easily be the fact that vacci- 
nation . . . does occasionally serve as an exciting cause of a 
scrofulous outbreak.' " 
"In Section 413 we discover that vaccination may become 
exceptionally risky through special circumstances, such as the 
prevalence of disease in the neighborhood; and finally (Sections 
420 and 421), that though formerly denied, it was no longer 
open to doubt that 'it is possible to convey syphilis in the act 
of vaccination.' " 
Referring to the alleged protection afforded by vaccination, the re- 
jport says: 
"At first one vaccination was to protect for life; this claim was 
soon modified and two vaccinations were considered necessary 
to confer lifelong immunity. The obstinacy of smallpox in 
attacking persons so vaccinated then resulted in shortening the 
period of immunity to fourteen years; later it was reduced to 
seven years, then five, and in the Spanish-American War-as 
shown by the practice of our army surgeons-six weeks was 
considered the limit of immunity. What could better prove 
that vaccination never has provided immunity ? For if six 
weeks is now the limit of immunity, then it was likewise the 
limit when Jenner and the College of Physicians so confidently 
proclaimed immunity for life. But vaccination does not pro- 
vide immunity even foi' six weeks. This is proved by the stat- 
istics of our Philippine Army. During the five years from 1898 
to 1902, there were in that army 737 cases of smallpox, with 
261 deaths,-a mortality of over 35 per cent! And yet, refer- 
ring to these very cases, Chief Surgeon Lippincott reported that 
'vaccinations and re-vaccinations many times repeated, went on 
as systematically as the drills at a well-regulated post.' He 
added, 'I believe I can say that no army was ever so carefully 
looked after in the matter of vaccination as ours, and that the 
department commander, General Otis, fully alive to the neces- 
sity, did everything in his power to make our work possible 
and effective.' But the soldiers still took smallpox and died of 
it. Where, then, is the immunity even for six we^ks?" 
79 Referring to the decrease in smallpox, the report says: 
"This statement is true, but the suggestion that the decrease 
is due to vaccination is a mere assumption. It would be nearer 
the truth to say that the decrease is due to public sanitation, 
the betterment of living conditions and the enforcemnt of iso- 
lation. This is especially evident in the German Empire, where 
sanitary and quarantine measures are strictly enforced. Again, 
in Cuba, Panama and New Orleans, the scourge of yellow fever 
has been exterminated solely by hygienic measures and the pre- 
vention of mosquito inoculation." 
"Japan is a favorite example of the 'blessings' of vaccination. 
In Japan, under the law of 1874, strengthened in 1885, vaccina- 
tion is compulsory during the first six months of life, again at 
six years, still again at fourteen, and after this whenever small- 
pox occurs. For all males there is still further vaccination on 
entry to the army or navy. The law is strictly enforced and 
complied with, . . " "Nevertheless, the official statistics of the 
Sanitary Bureau of Tokyo, from 1889 to 1908, show that there 
were in Japan, 171,500 cases of smallpox, an average of over 
8,500 a year, with 48,000 deaths,-a mortality of 28 per cent. 
And in 1908, when the Empire should have been reaping the 
best fruits of its rigorous vaccination laws, the smallpox cases 
numbered 18,000,-a number not exceeded since 1897,-and the 
deaths were nearly 6,000, or over 32 per cent." 
"There is absolutely no explanation possible for the disatrous 
results of smallpox in Japan except the plain and obvious one 
that vaccination does not protect from smallpox, even when ad- 
ministered under the most improved scientific regulations." 
"In order that there may be no doubt that the present vaccine 
virus is composed of disease matter, we again refer to the testi- 
mony of Dr. William H. Welch, of Johns Hopkins University, 
where he states (Testimony, pages 2361-62): 'It [vaccine virus] 
is the contents of the vaccine vesicle, or pustule fluid, and, I 
think, very often mixed with it now, a certain amount of the solid 
contents of the vesicle, containing as its essential part the un- 
discovered but undoubted micro-organism of the disease vac- 
cinia. . . . The Specific substances [in vaccine virus] we cannot 
isolate chemically. The ordinary things we can isolate so they 
are the ordinary proteids-nothing peculiar about them-which 
you obtain in any ordinary inflammatory exudate.' " 
"Dr. Robert N. Willson, a pro-vaccinal authority, testified 
before the Commission that he had made a somewhat extensive 
bacteriological examination of the contents of vaccine virus, and 
when asked to state the kinds of organisms he found in the 
virus, he answered (Testimony, page 2123): 'All of the pus 
producing organisms, the streptococcus, the staphylococcus, the 
pneumococcus, etc.' It might be added that Dr. Willson found 
the above disease germs in vaccine virus that was ready for 
use when acquired by him for examination." 
"In another part of his testimony Dr. Willson says, speaking 
of the contents of vaccine virus (Testimony, page 2106-A55), 
'Many other [organisms] and nearly all of the pus producing 
organisms have been obtained [from vaccine virus] and isolat- 
ed.' On the question whether or not glycerine was any protec- 
tion against tetanus germs in vaccine virus, he said (Testimony, 
pages 2106-A68): 'Glycerine which is itself a powerful hypo- 
dermic irritant, would tend to accelerate rather than retard the 
action of the tetanus process.' This observation would seem 
finally to dispose of the contention that glycerine in vaccine vir- 
us is any protection whatever against the development of tetan- 
us from vaccination." 
"The Commission addressed letters to the proprietors of vari- 
80 ous vaccine farms in the United States, asking for the source of 
the virus manufactured on said farms. The Vaccine Laboratory 
of the Board of Health of the City of New York answered 
through Frank S. Fielder, M.D., Assistant Director of the Labor- 
atory, as follows (Testimony, pages 2872-74): 'The vaccine virus 
of this department is a mixture of various strains. Not all of 
the original sources are known, ... it has been our custom to 
rejuvenate our vaccine from time to time by vaccinating calves 
with seed virus obtained from the human being or from rab- 
bits. . . . The history of our virus, then, may be summed up 
as: calf-to human being-to rabbit-to calf-to general distri- 
bution? Dr. Fielder then adds that this 'virus' (page 2880) 
'is tested for potency, upon children, before it is issued.' . . . 
Dr. Fielder also states (Testimony, page 288 I a) that 'the 
glycerine acts as a preservative, but has no strong germicidal 
effect? Dr. Fielder, no doubt wishing to show the business 
economy necessary in the manufacure of vaccine, states also 
(Testimony, page 288 I b) that 'after calves have been killed, 
they are dressed and the veal is used for food? " 
"There was presented to the Commission much evidence show- 
ing that many of the most serious and fatal of diseases are 
caused by vaccination, such as tetanus, meningitis and small- 
pox itself. Accurate reports have been kept by the Registrar- 
General of England of all deaths in that country certified as 
being directly due to vaccination in that country. These re- 
ports show that the deaths certified in the Registrar-General's 
report as being directly due to vaccination, for the years 1905- 
10, inclusive, were 99, while the smallpox deaths during the 
same period were 199; and that, from 1900 to 1906, the deaths 
from smallpox were 19 per million population, while during the 
same period the deaths from vaccination were 34 per million 
vaccinated, showing a death rate of vaccination nearly twice 
that of smallpox." 
"The dangers, injuries and deaths following and caused by 
vaccination that have hitherto been spoken of in this Report, 
are only those officially reported or proven, but the countless 
numbers of persons who are diseased by vaccination, whose 
cases do not get into official reports, are still more impressive. 
The poisons admittedly contained in vaccine virus are insidious 
in their operation and are capable of producing many dangerous 
and even fatal diseases, frequently of slow development, includ- 
ing such diseases as paralysis and epilepsy, not to mention 
tuberculosis. . . . The infliction of such known and positive dis- 
eases as vaccine virus has been shown to produce, together with 
the unknown dangers admittedly connected with vaccination, 
take away every justification for any compulsory law for forc- 
ing it upon anyone, under any circumstances. Instead of com- 
pulsion for its enforcement, the conditions suggest its positive 
prohibition by the Legislature." 
"The way professional pro-vaccinal writers and authorities 
unjustifiably ignore the influence of sanitation and isolation in 
stamping out smallpox is well pointed out by Dr. Crookshank, 
who says: 'It is an extraordinary fact that in the text books of 
medicine no reference is made to the influence of all these Sani- 
tary Acts upon the existence of smallpox and its prevention. 
The student is taught that smallpox has declined since the intro- 
duction of vaccination, and there the matter is left!' Here, con- 
cisely stated, is the whole gist of the matter. By deliberately 
ignoring the large and dominating factor in the case, medical 
writers have given to vaccination an utterly false credit, 
which has enlisted the support of public sentiment, when un- 
enlightened." 
"Dr. Crookshank is unquestionably one of the greatest stu- 
81 dents of the subject of smallpox and vaccination in the world; 
his works have become classics and are the result of years of 
painstaking and impartial research on the subject. In closing 
his testimony before the British Royal Commission on December 
3d, 1890, he gives that eminent body, which was seeking advice 
for parliamentary action, the following solemn conclusion as to 
the only method by which smallpox can be extirpated: 'I ven- 
ture to think that the present system of notification and isola- 
tion, if uniformly carried out, is perfectly efficacious in stamp- 
ing out smallpox. ... I maintain that at the present day the 
chance of any person being infected with smallpox is infinites- 
imally small when notification and isolation are conscientiously- 
carried out. ... As regards vaccination, I would leave that 
question to the discretion of the individual, with liberty to take 
the advice of his medical adviser. Believing as I do that the 
stocks of vaccine lymph obtained from cow-pox, horse-pox, 
sheep-pox, cattle plague and even attenuated variola-vaccine, 
produce, if any, a very transient effect, I should leave it to the 
individual to weigh on the one hand the advantages (if they 
exist) of 'vaccination' and on the other the chances of infection 
with smallpox and the disadvantages and risks of 'vaccination.' 
A system of universal protective inoculation of healthy indi- 
viduals as a means of warding off communicable disease of man 
and animals has, in my opinion, had its day. ... In conclu- 
sion, I maintain that the State should protect the people from 
smallpox by a stamping-out system and by the encouragement 
of sanitary reforms, and not by any system of protective in- 
oculation... (Fourth Report of the British Royal Commission, 
page 123).'" 
"For the settlement of disputed questions, modern thought 
demands what are called 'control experiments,' by which all 
factors contributing to a general result are severally accounted 
for. Fortunately, there is one control experiment covering over 
thirty years in a large community where smallpox has been 
kept under subjection and prevented by isolation and sanitation, 
without vaccination. This experiment was made in the city of 
Leicester, England. Leicester is a city of about 250,000 popula- 
tion, a manufacturing centre in a district with considerable den- 
sity of population. It has 75,000 school children, nearly every- 
one unvaccinated. During the fifteen years from 1887 to 1901, 
out of 84,788 children bom in Leicester, only 2885 were vac- 
cinated, and yet during that period there were only 21 deaths 
from smallpox in Leicester, and there were no smallpox cases 
there from 1896 to 1900. During this whole period Leicester 
experienced many importation of smallpox,-the same kind of 
importations that produced epidemics in well-vaccinated towns 
like Sheffield and Warrington,-but Leicester, in spite of dire 
prophecies, had no serious epidemic from these importations, 
and in every instance completely controlled and stamped out 
smallpox though having to deal with it in an almost wholly un- 
vaccinated community." 
"Dr. C. Killick Millard, the able Officer of Health for Lei- 
cester, himself a believer in the efficacy of vaccination, has at 
the same time given first hand testimony against the efficacy of 
vaccination, and in favor of the stamping-out system, without 
vaccination. In a communication to the British Medical Journal 
for June 3, 1911, Dr. Millard writes of Leicester as follows: 'One 
important section of it, the school children, are, for all practi- 
cal purposes, entirely unvaccinated. Yet although school chil- 
dren have been repeatedly attacked whilst still attending school, 
the disease has never 'caught on' in a single school, nor have 
I ever had to close schools on account of it. A similar immun- 
82 ity of the school children was observed in the earlier epidemic 
of 1893."' 
"In an elaborate letter to the London Lancet, for July 22, 
1911, Dr. Millard gives a thorough review of the efficacy of the 
stamping-out system, without vaccination, as practiced in Lei- 
cester, with the view of enforcing the lessons which this great 
control experiment teaches. Dr. Millard says in his letter to 
the Lancet: 'The real question at issue is briefly this: It is 
obvious that infantile vaccination is falling more and more into 
disuse.-Does this fact and the existence of an increasing pro- 
portion of unvaccinated persons in a community necessarily in- 
volve, under present-day conditions in this country, an increas- 
ing risk of smallpox mortality? The orthodox answer of the 
medical profesion is, 'Most certainly, yes.' But the arguments 
upon which this answer is based are all of a more or less 
theoretical or indirect character, and I venture to submit that, 
convincing though they may seem, a priori, they ought not to 
have the same weight attached to them as to the definite re- 
sults of a crucial experiment, such as has been carried out in 
Leicester. We have in Leicester a large industrial town, with 
over 200,000 inhabitants, which has so completely set the vac- 
cination laws at defiance that in the past twenty-eight years, 
whilst there have been 155,880 births, only 19,562 vaccinations 
have been registered-i.e., 12.5 per cent. . . . Smallpox has 
been repeatedly introduced into the town. It has three times 
succeeded in establishing itself in epidemic form. . . . Yet the 
diease has never 'caught on' amongst the unvaccinated section 
of the community, nor has it ever been necessary during my 
term of office to close a school on account of smallpox. Surely 
such an experience would be impossible if orthodox theories 
about the danger of the spread of smallpox amongst unvacci- 
nated persons were correct. . . . The Leicester experiment is 
about as conclusive as the experience of any one town can be. 
It has now lasted for a quarter of a century. It is confirmed by 
the more recent experience of the country generally, where an 
increasing neglect of vaccination has not been followed by any 
evidence of an increase of smallpox mortality. I have thought 
about this question for a good many years, and I may claim to 
have had some little experience of the subject, having been in 
the Birmingham epidemic of 1893-94 before I came to Leicester. 
... Of this I feel certain, and I believe many others are coming 
to think the same, that as time goes on we shall come to depend 
more and more upon such measures as notification, isolation 
and supervision of contacts, etc., rather than upon infantile 
vaccination of the general population. The future lies with the 
Medical Officer of Health, rather than with the public vac- 
cinator.' " 
"The history of the control of smallpox in England is also 
the history of effective sanitary measures. When the British 
Parliament in 1898, and more completely in 1907, withdrew its 
powerful support from the compulsory features of the British 
law for enforcing vaccination, the advocates of vaccination 
uttered dire cries about the smallpox calamities that were to 
be visited upon the unvaccinated infants of England. But the 
substitution of sanitary measures for compulsory vaccination 
disappointed these prophets of evil. The results of the new 
system in England were triumphantly proclaimed by the Hon- 
orable John Bums, Minister of Health for England and Wales, 
in the House of Commons, on April 12, 1911, when he said: 
'Just in proportion as in recent years exemptions [from vac- 
cination] have gone up from 4 per cent, to 30 per cent., so 
deaths from smallpox have declined. . . . During the time that 
I have had the honor of being at the Local Government Board, 
83 the following have been the deaths from smallpox in a city of 
4,500,000 inhabitants: 1906, no death; 1907, no death; 1908, no 
death; 1909, 2 deaths; 1910, no deaths.'" 
"Dr. Charles Creighton, of London, the eminent pathologist 
and epidemiologist, whose contribution to the Encylopaedia 
Britannica has been referred to in the first part of this Report, 
came to America for the special purpose of giving testimony 
before the Commission based on his extensive historical and 
pathological study of vaccination." 
"Dr. Creighton testified before our Commission (Testimony, 
page 1783), that about 1885 he was visiting the smallpox hos- 
pitals of London, and in talking with several superintendents 
with whom he was accquainted he was informed by them that 
three-fourts of all their patients in the smallpox hospitals 
were vaccinated, and, Dr. Creighton says: 'This was the first 
scruple that I ever felt in regard to the efficacy of vaccination.' 
He stated before the Commission that in his opinion the practice 
had produced many evil results and is fraught with the gravest 
danger." 
The following quotations are from an address on Vaccination, by 
Mr. Porter F. Cope, Philadelphia, read at the International Anti-Vivi- 
section and Animal Protection Congress, Washington, D. C., December, 
1913. Mr. Cope has devoted many years to the study of the vaccina- 
tion question: 
"The fundamental error made by the medical profession in 
regard to vaccination is its assumption that vaccination consists 
of inoculation with the virus of cow-pox and nothing more. But 
the fact is that besides cow-pox many other diseases have been 
used for the purpose of starting strains of vaccine, including, 
chiefly, human smallpox, but also, sheep-smallpox, cattle- 
plague, horse-grease and horse-pox, and foot-and-mouth-dis- 
ease. In India, donkey-lymph and buffalo-lymph have been re- 
commended, and the latter, which has been described as having 
'an abominable odor,' has been extensively used in the Philip- 
pine Islands and elsewhere in the far East, where calves do not 
usually thrive. Dr. Montague R. Leverson, after devoting about 
twenty-years to investigating the pathology of vaccination, en- 
umerated sixty-four various matters used as 'vaccine virus,' but 
a complete enumeration would doubtless embrace more than 
a hundred." 
"The vaccinal sore of every-day practice always contains the 
germs of septic and pyaemic diseases, and no physician would 
be so rash as to make certain the absorption of these germs 
into his system by having the matter of such a sore injected 
beneath his skin." 
"Defenders of vaccination admit that even calf-lymph is con- 
taminated with pathogenic organisms other than tKose of vac- 
cinia, but they claim that these organisms are deprived of their 
virulence and rendered harmless by dilution of the lymph with 
glycerin. They lose sight of the fact, however, that living dis- 
ease-germs such as are contained in vaccine virus find in the * 
vaccinal sore a most favorable culture medium, in which they 
may resume their original malignant character." 
"Vaccine virus has been derived from sources so numerous, 
and frequently so unlike in nature, except in their common 
quality of putrescence, that it is impossible to form a definite 
conception of the extent of its disease-inducing possibilities. 
It may, however, be truthfully said that the assertion of vaccin- 
ators, that no untoward results ever follow true vaccination, is 
merely a theoretical assumption, while deformities, diseases 
and deaths caused by vaccination are attested facts. 
84 "During a personal investigation of vaccination, pursued for 
a period of twelve years, I have collected details of many hun- 
dreds of instances of its injurious and even fatal effects, includ- 
ing many cases of such agonizing diseases as tetanus and men- 
ingitis. Could all the people but see the portraits of the previ- 
ously healthy child-victims of this deadly rite, and read the 
story of the sufferings of the slaughtered innocents, a wave of 
indignation, horror and disgust would sweep vaccination off 
the face of the earth." 
"Experimentation has never contributed toward teaching the 
medical profession the really important truth, that smallpox 
is a disease which does not arise spontaneously in the Western 
Hemisphere and which would have been stamped out long ago 
by isolation and disinfection, in both Europe and America, had 
it not been kept alive by the sowing of the living germs of 
smallpox in the blood of the people, by means of inoculation 
with vaccine virus derived from or contaminated with small- 
pox. What is needed for the extirpation of smallpox is the 
total abolition of vaccination." 
From an article, "Why Are Modern Infectious Diseases Mild?" by 
H. W. Hill, M.B., M.D., D.P.H., Director, Institute of Public Health, 
London, Ont., The American Journal of Public Health, January, 1914, 
page 11: 
"Sometimes the explanation (of mild smallpox at least) is 
based on gradually acquired inherited immunity from artificial 
vaccination. That explanation has the merit-a limited merit it 
is true-that it does take into account the recent development 
of the mildness, although only for the one disease, smallpox. 
But this has its fallacies also. First, the mildness of present- 
day smallpox does not seem to have developed gradually since 
vaccination first came into use. It seems to be confined to the 
last twenty or thirty years, or even less. Second, the present 
mild smallpox is not confined to the much vaccinated races, but 
flourishes everywhere. Last, and most important of all, how 
is it possible to consistently conceive the development in one 
hundred years of inherited immunization from cowpox, which 
itself protects the vaccinated only five years, when the virile 
and long-life protection afforded by virulent smallpox had oper- 
ated in the race for thousands of years without any such effect 
at all?" 
Extracts from the London Letter, The Journal of the American 
Medical Association, February 7, 1914, page 469, "A New View on 
Vaccination." 
"Dr. C. K. Millard, health officer of Leicester, delivered the 
first of the three 'Chadwick Public Lectures' on 'The Vaccina- 
tion Question in the Light of Modern Experience.' The lecture 
was remarkable in that an entirely new position intermediate 
Between that of the antivaccinationists and the orthodox view 
was adopted by an authority on public health." 
"Dr. Millard explained his personal position in regard to vac- 
cination. When he first went to Leicester his views on the sub- 
ject were strictly orthodox, but in consequence of his experience 
with small-pox in Leicester and of the close study of the ques- 
tion he has been obliged to modify those views considerably." 
The letter quotes from Dr. Millard, and the following extracts are 
from these quotations: 
"I agree entirely with the provaccinationist that recent vac- 
cination confers on the individual protection against small-pox 
85 which for practical purposes is complete, though unfortunately 
only temporary." "On the other hand, I agree with the anti- 
vaccinationist in doubting the value to the community, at the 
present day, of infantile vaccination. An exaggerated view has 
been taken as to the effect of such vaccination in preventing 
the spread of small-pox, which is the real problem before us." 
"I agree with the antivaccinationist that sanitation, notifica- 
tion, isolation, surveillance of contacts, and other modern meas- 
ures which are becoming generally adopted have played a more 
important part in the abolition of small-pox from this country 
during the past thirty or forty years than infantile vaccination." 
"I think the antivaccinationist is right when he contends that 
the drawback to infantile vaccination, and the injuries to health 
caused by it, are not sufficiently recognized by the medical pro- 
fession, who, in their sincere anxiety to defend vaccination, have 
been inclined to minimize these drawbacks.'" 
"There is distinct evidence that small-pox is leaving this coun- 
try in spite of the increasing neglect of vaccination, and it 
seems probable that such neglect of vaccination will continue 
to increase until the great majority of the population has be- 
unvaccinated. I am inclined to believe that when this happens 
the problem of small-pox prevention will very possibly be 
simplified and made more easy rather than more difficult." 
"The great difficulty in controlling the spread of smallpox at 
the present day is the occurrence of very mild unrecognized 
cases which spread infection broadcast before precautions can 
be taken. They occur almost entirely among vaccinated per- 
sons and because they were so vaccinated. In other words, 
infantile vaccination, by its very success in mitigating small- 
pox after its power to protect from attack has worn out, may 
have a distinct tendency to encourage the spread of the disease." 
The letter states that Dr. Millard 
"showed a number of diagrams illustrating the fall in small-pox 
mortality and proving that this was specially marked since the 
'era of sanitation,' during which such measures as notification 
and isolation had come into operation. Diagrams showing that 
although the proportion of infants vaccinated had been declin- 
ing the smallpox mortality had been undergoing the same change 
were also produced. He considered that the universal vaccina- 
tion of the community was, therefore, much less important 
than had been supposed." 
Concerning the possible results from vaccination, the reader's atten- 
tion is called to a pamphlet published by James A Loyster, Cazenovia, 
N. Y., entitled, "Vaccination Results in New York State in 1914-Being 
a Study of Fifty-one Cases with Portraits and Certain Conclusions." We 
quote from Mr. Loyster's Introduction: 
"The object of this pamphlet is to publish the result of a 
painstaking inquiry into the effects of vaccination in the State 
of New York in 1914. 
"My immediate personal interest in the subject is due to the 
death of my only son as a result of vaccination. 
"I have been a believer in and advocate of vaccination. I was 
myself vaccinated in childhood by the arm-to-arm method with- 
out ill effects. It was in accordance with this belief and in an 
honest effort to comply with the law that I had my son vaccin- 
ated. Even his death did not entirely shake my faith in the 
practice, but it led me to make an investigation of the results of 
vaccination in New York State in 1914. Owing to the diffi- 
culty of making a canvass in the great cities, no effort was 
86 made to collect statistics in New York and Buffalo, and but 
little in Rochester, Syracuse or Albany. My investigations were, 
therefore, practically confined to the rural or semi-rural por- 
tions of the State. 
"The result has been the gathering of such an appalling story 
of death and illness as to completely shatter my belief in the 
wisdom of enforced vaccination." 
As a result of Mr. Loyster's investigation, he received 
"the names of twenty-seven children who had died subsequent 
to vaccination, also the names of nearly a hundred who had 
been seriously ill." 
"In each case a correspondence was entered into with par- 
ents, physicians or others conversant with the cases, so that no 
statements have been accepted without ample verification." 
"In no single instance was it possible to get information 
from; a hospital.'' Also "physicians were reluctant to give 
details." "Four newspapers were silent about cases of which 
they must have been fully informed; one deliberately falsified 
the facts. . . . Two parents whose children had died refused 
any but the most meagre details 'for fear the doctor would 
make them trouble.' " 
In his Conclusion the author says: 
"The cost in illness and destruction of child life is entirely 
out of proportion to the amount of protection against small- 
pox that is atttained or needed. There were but three deaths 
from smallpox in the entire state, including Greater New York, 
in 1914. In one rural district twenty miles in diameter, where 
four children died from vaccination, there had not been a 
single case of smallpox within the memory of any person now 
living." 
Extracts from an article by Walter R. Hadwen, M.D., The Abolition- 
ist, London, October 1, 1915, pages 304-305. Referring to the epidemic 
of smallpox in Gloucester in 1895-6 Dr. Hadwen says: 
"I was in and out of the small-pox stricken houses through- 
out the period . . . and I have attended personally every case 
of small-pox that has occurred since, and I therefore claim to 
know something about it." 
"The total number of persons attacked with small-pox was 
1,979. Of these, no less than 1,211-nearly two-thirds-had been 
successfully vaccinated. Of these 1,211 'protected' persons, 120 
died. 
"One hundred and ninety of those who suffered had been re- 
vaccinated. Several of them were vaccinated three times. Four- 
teen had been vaccinated twice. One man-a soldier-had 
been successfully vaccinated at different periods seven times, 
and yet he had a bad attack of small-pox. 
"There were eighty-nine cases which had been vaccinated 
within a fortnight of their falling ill with small-pox. There 
was no evidence that this recent vaccination exerted the slight- 
est modifying effect upon the disease." 
"As further proof that vaccination has no power to mitigate 
the severity of the disease, there were 29 successfully vaccina- 
ted persons who were attaacked with malignant small-pox and 
every one of them died. There were 223 successfully vaccinated 
persons who were attacked with confluent smallpox, and no less 
than 79 died. That is a total of 252 successfully vaccinated 
persons attacked with the worst types of small-pox, scoring the 
enormous fatality of 39.3 per cent.! 
"Throughout the worst period of small-pox in this country 
87 [England], namely, in the eighteenth century, when everybody 
was unvaccinated, the death-rate from small-pox did not exceed 
18 per cent., and yet, a century later, we have vaccinated per- 
sons dying at more than double the rate!" 
"An eighth part of the whole of that epidemic occurred in 
three narrow streets, where practically every house was devoid 
of flush boxes to the closets, where the drains were defective, 
and not a single sewer pipe (many of which ran under the floors 
of the houses) had either a cemented joint or a cemented base. 
In some of these slums there were as many as five, six, seven, 
eight, nine, eleven and even twelve cases of smallpox in a 
single house." Dr. Hadwen says that, "the first case of small- 
pox was in a vaccinated person, and right away on from May 
to September, 1895, not a single unvaccinated person caught 
the disease. It spread entirely among the vaccinated. At last 
it reached the insanitary schools I have described, and the very 
first person to be attacked in those schools was a young vaccin- 
ated teacher." 
"The epidemic reached its high water mark on April 9, 1896, 
and then began an almost abrupt decline and rapidly disap- 
peared. The outbreak had been preceded for months by the most 
serious drought Gloucester had known for many years; water 
was short, sewers and drains were unflushed, and then toward 
the end of March came copious showers of rain which cleansed 
the sewers! and washed the atmosphere, and away fled the 
smallpox as if by magic. The great epidemic of small-pox in 
Sheffield in 1888 (which, by-the-bye, was one of the best vac- 
cinated cities in England) disappeared in the same rapid man- 
ner consequent upon floods of rain." 
"The fact is smallpox is a filth disease. Get rid of the filth 
and we get rid of the disease. But to suppose you can protect 
a body from disease by polluting it with the products of a 
filthy cattle eruption is contrary both to science and common 
sense. The true protection against disease is health, and the 
true prophylactic against small-pox, as proved by history and 
experience, consists in personal and municipal cleanliness." 
From an editorial article, "Tetanus and Vaccination Again," in the 
New York Medical Journal, December 11, 1915, page 1200: 
"This has before now been a subject of comment in these 
columns, but recently reported cases in the daily press of tetan- 
us following vaccination in New York and its vicinity bring 
this matter once more forcibly to mind." "All available evid- 
ence . . . justifies the belief that infections of this kind are 
not due to the vaccine virus per se, but occur subsequently, 
and are attributable to later contaminations of the vaccination 
wound. In all justice, however, it must be admitted that experi- 
ence also teaches, despite all contrary evidence, that vaccina- 
tion wounds, at least in children of certain ages, are unduly 
prone to such infections. The reasons are not apparent." 
". . . however trivial the operation of vaccination may seem, 
we should always remember that it is a surgical procedure 
sometimes followed by severe and even fatal results." 
In the London Letter, page 1537, The Journal of the American Medi- 
cal Association, November 18, 1916, under the heading: "Decline of Vac- 
cination," is the following paragraph: 
"It may be assumed, says the annual report of the Local 
Government Board, that more than half the children now bom 
escape vaccination. By far the greater proportion unvaccin- 
88 ated are exempted by a declaration of conscientious objection 
made by their parents." 
In view of the fact that in England vaccination is not compulsory 
and that it is probably the least vaccinated country in the world, the 
following figures from the London Letter in The Journal of the Ameri- 
can Medical Association, April 20, 1918, page 1181, are peculiarly 
interesting: 
"So far outbreaks of smallpox in London have appeared in 
cycles, and one of these cycles was due last year, but not a 
single case was then reported in the whole of London. In 1916 
there was only 1 case; in 1915 there were 11, 10 of which oc- 
curred among Belgian refugees; in 1914 there was 1 case, 
in 1913 one, . ." 
From New York Medical Journal, April 15, 1916, page 761: 
"Pemphigoid Eruptions Following Vaccination.-W. H. Mook 
records six cases of pemphigoid dermatitis following vaccina- 
tion. He comes to the following conclusions: The cases may 
be divided into three groups: 1. Those which end in rapid 
recovery with or without constitutional disturbance. 2. The 
chronic recurrent cases with or without constitutional symp- 
toms, in which the local lesions are vesicles or blebs. 3. Those 
which terminate rapidly in death. . . . They may get completely 
well in a few weeks, or the lesions may recur over a period of 
months or years. The vaccination may or may not have been 
successful. In the several types we see vegetating and scar 
forming lesions. In these latter cases, there is a marked eleva- 
tion of temperature at the onset, or during the course of the 
disease. The lesions showed a predilection for certain areas, 
namely around the mouth, neck extremities and especially the 
joints; they appeared either as small vesicles resembling small- 
pox or chickenpox, as papulovesicles or pustular." 
Extracts from an article by John Hutchinson, M.D., Ex-President 
International Hahnemannian Association, Member American Institute 
of Homeopathy, Society Medical Jurisprudence, American Association 
for the Advancement of Science, entitled, "Vaccination as a Cause of 
Smallpox," published in Physical Culture, October, 1917, page 75: 
"Sanitation is the first intelligent step in the control of filth 
diseases today, yet it is easier for certain minds to look upon 
it as unimportant, relatively, just as it is hard for those minds 
to realize that flies must be bred before they can be swatted. 
The will to swat is strong." "While provided with all the 
accessories for physical cleanliness and well-being, it is a mon- 
strous calamity for a community to be induced to receive into 
its individual lives the contamination of a foreign element 
which by any possibility may produce ill effects. It matters 
not at all how eloquently it be urged that this poison will neut- 
ralize in advance the toxin of possible diseases. That is wholly 
speculative. The virus or the antitoxin will not overcome a 
toxin that is not present." 
"A fundamental objection to the vaccine antitoxin, serum, or 
other such products is its violence. When it is remembered 
that the vital machinery of our make-up is poised most delic- 
ately in ways that wTe may study but never fully learn, what 
shall be said of brutal coercion of that machinery ? Can any 
man calculate what he has done when he has forced into the 
circulation a substance of unknown potentiality within that 
identical circulation? If the substance were introduced into 
the stomach, some redress might be possible. The stomach is 
89 empowered to reject what is unfit. Not so the circulation. It 
must distribute and deposit its unwelcome burden where it dis- 
turbs and may become unbearable." 
"The human organism is too wonderful, too beautiful, and 
too sacred to be barbarously invaded by materialistic, destruc- 
tive elements." 
Referring to tetanus, "so frequently reported as following vaccina- 
tion," Dr. Hutchinson remarks'. 
"Why a 'scientific' operation [vaccination] should be followed 
by tetanic infection, when children with bare legs and arms go 
about much of the year generously scratched and bruised with- 
out any infection at all, is at least suggestive." 
90 TETANUS 
Review of an article, "Anaphylaxis Following Administration of 
Tetanus Antitoxin," in Washington Medical Annals, The Journal of the 
A/merican Medical Association, February 6, 1915, page 544. 
Although in the case reported, the patient ultimately recov- 
ered the report describes very severe symptoms following the 
injection of the serum, such as "joint infection, accompanied by 
fever, pain, swelling, prostration and delirium, lasting a week, 
making a total of twenty-seven days after injection. The series 
of symptoms started in nine days after the time of injection 
and lasted until the twenty-seventh." 
In the same magazine, page 549, "Intoxication After Antitetanus 
Serum," a case is reported where the man inoculated suffered from such 
■''intolerable" itching over the entire body that he "had to be given 
morphin." 
Quotation from a review of an article, "Tetanus at Cracow," in a 
Vienna medical journal, The Journal of the American Medical Associa- 
tion, February 6, 1915, page 551: 
"Arzt says that in the sixty-five cases of tetanus among the 
26,600 wounded in hospitals at Cracow, only eleven of the 
tetanus patients recovered, and all of these had been given anti- 
tetanus serum. Forty-six others had been given the antitetan- 
us serum also, among those who died from it." 
Review of an article by C. Ritter in Berliner klinische Wochenschrift, 
"Prophylaxis of Tetanus," The Journal of the American Medical Asso- 
ciation, March 13, 1915, page 947: 
"Ritter quotes some recent statistics which show that of the 
60,000 wounded in Bavaria up to the time of writing, 0.7 per 
cent, had died and 0.4 per cent, from tetanus. The experiences 
with various forms of treatment of tetanus have all been dis- 
appointing; . . . Even prophylactic injections are not always 
able to ward off the disease." 
In an article, "Medical Notes from the Front," the New York Medi- 
cal Journal, August 4, 1917, page 224, speaking of tetanus and the 
use of prophylactic serum, says: 
"In these fifty-four patients who had received a preventive 
injection, and in whom, nevertheless, the diease developed, tris- 
mus was absent in fifteen; in thirteen it occurred late in the 
progress of the affection or was greatly attenuated, while in 
twenty-six cases this cardinal symptom was present from the 
beginning with quite the same intensity as in a case in which 
no prophylactic injection had been administered." 
In the light of the following quotations it is interesting to note the 
statements of Dr. W. W. Keen of Philadelphia, who is reported, in the 
editorial section of the New York World, March 24, 1918, to have said 
that as a result of antitetanic serum, 
91 "tetanus has been almost wiped off the slate. . . . All the 
surgeons on both sides concur in saying that tetanus, while it 
still occurs here and there, has been practically conquered." 
Dr. Keen's exaggerated remarks would seem to indicate that enthus- 
iasm had overpowered his discretion. 
Excerpts from an editorial, The Lancet, January 20, 1917, page 114: 
"In the home military hospitals during the year ending July 
31st, 1916, we know from Sir David Bruce's analysis . . . that 
195 cases of tetanus were received, of which 96 died. . . . No 
obvious falling off occurred during the year, and there is at the 
present moment some evidence to hand of an increasing number 
of cases, some of them being of the fulminant variety so tragic- 
ally common in the ranks of all the combatants during the early 
months of the war." 
"As a prophylactic injection of protective serum is now a 
routine measure at the front in every case of gunshot wound, it 
is evident that the protection afforded by a single injection is 
not complete." 
As to repetition of the serum injection advised by some, the article 
says: 
"Possibly the fear of harmful effects from repeated injections 
of horse serum may have acted as a deterrent, for 'serum dis- 
ease,' as it may still conveniently be called, may be a very seri- 
ous matter when it occurs-witness the rapid death from 
anaphylactic shock of animals injected with foreign protein 
appropriately dosed and spaced." 
The article suggests that the danger of anaphylactic shock is "neg- 
ligible" when the amount of horse serum injected is 3 c.c. 
"The case is somewhat different in regard to the massive 
doses demanded in curative treatment after symptoms of tox- 
aemia have already shown themselves. The large doses of 
horse protein which necessarily accompany the requisite num- 
ber of antitoxic units may be a source of inconvenience or 
danger." 
From an article on tetanus, by Sir William B. Leishman, C.B.> F.R.S., 
F.R.C.P., LL.D., K.H.P., Colonel, Army Medical Service; and A. B. 
Smallman, D.S.O., M.D., D.P.H., Major, Royal Army Medical Corps, 
The Lancet, January 27, 1917: 
The writers refer to 'the specific treatment of tetanus, upon 
which there exist wide differences of view, both as to the use- 
fulness of antitoxin at all and, admitting its value, as to the 
system of its employment which may be expected to yield the 
best results." 
"Although since the days of the battle of the Aisne, strict 
orders exist that every wounded man should receive a prophy- 
lactic injection of tetanus antitoxin, and it is exceedingly rare 
that this is for any reason omitted, still it is well recognized 
that this cannot confer absolute protection." 
"The present analysis is based upon 160 cases which occurred 
in hospitals in France between July 1st and Oct. 31, 1916. Of 
these cases 118 died and 42 recovered, a case-mortality of 73.7 
per cent. This mortality may be contrasted with that of the 
group of cases, already alluded to, examined by one of us in 
the spring of 1915. In that series, among 179 cases there were 
140 deaths, a case-mortality of 78.2 per cent. This, as far as 
it goes, does not disclose any considerable degree of improve- 
ment in the treatment employed." 
92 The same magazine, page 141, from an article on tetanus, by H. Bur- 
rows, M.B., B. S. Lond., F.R.C.S. Eng., Captain, R.A.M.C. Referring 
to the use of antitetanus serum, the writer says: 
"Moreover, as shown above, general tetanus may sometimes 
follow in spite of the proved use of prophylactic treatment." 
"What dangers are to be feared from anaphylaxis? Person- 
ally, I believe that unless precautions are taken there is a real 
danger-in the case of intravenous injections, at any rate, of 
causing anaphylactic shock by secondary doses. I believe cases 
of sudden death to be examples of anaphylactic shock and to 
indicate that the secondary injection of antitoxin into a vein, 
in the presence of anaphylaxis, is a dangerous procedure unless 
certain precautions be taken." 
From an editorial in the same number of The Lancet, page 157: 
"It is incontestably proved that a prophylactic dose of tetanus 
antitoxin has a really wonderful effect in reducing the incid- 
ence of the disease; but from the very fact that through the 
use of the antitoxin an attack of tetanus is prevented arises 
a great difficulty in deciding in what proportion of cases the 
disease has been prevented by the antitoxin and in what pro- 
portion of cases the disease would not have occurred, even 
though no antitoxin had been given." 
The suggestion contained in the last part of the preceding paragraph 
applies with equal force to all prophylactic inoculations. It is impossible 
to affirm that the inoculation has prevented a person from contracting 
a disease as it is well within probabilities that he would not have con- 
tracted such disease in any case. 
From an article on tetanus, by H. R. Dean, M.D. Oxon., F.R.C.P. 
Lond., The Lancet, May 5, 1917, page 678: 
"Concerning anaphylaxis, much has been written and little 
is known. ... It has been ascertained that different species of 
animals differ widely from one another both in their suscep- 
tibility to anaphylaxis and the symptoms which they exhibit 
during the attack. Interesting and valuable as many of these 
observations are. they do not as yet provide all the data re- 
quired for the elucidation of the problem of anaphylaxis as it 
occurs in man." 
"All, however, who have carried out experiments on anaphy- 
laxis are aware that animals differ enormously in their in- 
dividual susceptibility, and even under laboratory conditions 
the peculiarities of individual animals render attempts at 
generalisation very difficult." 
Same magazine, page 681, from an article by Sir David Bruce: 
". . . there is a great difference between tetanus in man and 
in an experimental monkey." 
Same magazine, page 682, from an article by F. W. Andrewes, M.D. 
Oxon., F.R.C.P. Lond., F.R.S.: 
"There are six routes by which tetanus antitoxin may be 
given in curative treatment ... at the present time opinions 
are still widely divided as to the relative advantages of these." 
"Failure, no less than success, is apt to occur whatever be the 
route chosen, and thus chance comes to play some part in one's 
preference. ... It is probable that a large proportion of these 
milder cases would recover whatever the route of administra- 
tion of the serum, or even without serum at all." 
"As a rule, more than one route is employed in any given 
case, and the widest discrepancies exist not only as to choice 
93 of route but as to dosage of serum, while different cases of 
tetanus present extreme variations in severity. It does not 
seem legitimate to draw any conclusions from the heterogen- 
eous mass of data at present available." 
"Neverthless, everything that we know about anaphylaxis 
from the experimental side points to the intravenous as the 
most certain route for producing shock, except perhaps the 
intracerebral. There is, further, plenty of clinical evidence that 
the danger is a real one in man; fatal cases, for instance, have 
been reported lately from the intravenous injection of anti- 
dysenteric serum." 
From an editorial in the same magazine, page 691: 
"It is only a few weeks since Emil von Behring passed away, 
and even a cursory view of his life-work reveals the fact that 
the discovery of antitoxin, which seemed at first sight to afford 
a simple solution of the treatment of bacterial disease, was but 
the fortunate prologue of a drama which was to become more 
and more intricate in the later acts." "The statistician expres- 
ses doubt on the value of the analysis of clinical results, alleg- 
ing that the figures when examined do not admit of any clear 
conclusions being drawn. The clinician questions the deduc- 
tions of the experimenter who deals with animal conditions 
not necessarily applicable to man. The experimenter cannot 
accept the statistician's conclusions at his own value, and queries 
the necessity of elaborate analysis where convincing ocular 
demonstration lies ready to hand. The outside observer notes; 
with interest how long such questions as the value of the anti- 
toxin treatment of tetanus may remain in doubt. A generation 
ago the late Professor Kanthack impressed on his pupils the 
division of cases of tetanus into three groups: the hopeless 
cases with short incubation period, those long in incubating 
which recovered whatever the nature of the treatment, and a 
small intermediate group on which alone the value of treatment 
could be demonstrated." 
Referring to tetanus antitoxin, Dr. Rufus I. Cole of the Rockefeller 
Institute, is reported in the New York State Journal of Medicine, Aug- 
ust, 1917, page 349, to have said: 
"There have been certain experimental difficulties in the way 
of the solution of the problems concerned, one of the chief 
being that tetanus in animals differs somewhat from that in 
man, in the former case the symptoms being at first localized 
in the muscles nearest the point of lesion and spreading from 
here, so-called tetanus ascendans, and in the case of man the 
neYves almost invariably first attacked being those of the face 
and jaw. . . ." 
"During the present war, in the hospitals in England, though 
the treatment has not ben carried out in a strictly ideal way, 
of 231 cases treated during the first year of the war, there was 
a mortality of 57.7 per cent., and the second year, among 195 
cases, a mortality of 49.2 per cent." 
On page 714, New York Medical Journal, October 13, 1917, Dr. Rufus 
I. Cole is reported to have said: 
"The lack of necessary time to analyze carefully the evidence 
leads many to use agents of the biological type which have 
little or no established value. This is promoted by the zeal of 
manufacturers to market their products, which leads them to 
make claims for them which are often grossly exaggerated and 
94 not based upon established facts. ... In the case of tetanus 
antitoxin as a curative agent, much still remains to be learned 
and its position is very uncertain." 
"The use of antistreptococcus serum is entirely empirical and 
its efficacy is very uncertain. . . . 'Finally the various forms of 
nonspecific serum therapy, including the new method of Swift 
and Ellis, and the nonspecific protein reactions are all still in 
the experimental stage." 
Extracts from an article, "Cases of Tetanus Treated in Home Milit- 
ary Hospitals," by Sir David Bruce, Surgeon-General, Army Medical 
Service, The Lancet, December 22nd, 1917: 
"The mortality has been reduced to 19 per cent, for the last 
hundred cases, but whether this has been due to the specific 
treatment, or to which of the several factors which come in, it 
is impossible at present to say. Whatever is the cause-the 
prophylactic dose of serum, better surgical treatment, quicker 
diagnosis, more thorough therapeutic treatment, &c.-the result 
is gratifying. It is difficult to apportion the proper awards." 
'In regard to the therapeutic effect of antitoxin serum the 
evidence is still inconclusive." 
From "An Analysis of Recent Tetanus Statistics," by F. Golla, M.B., 
B. Ch. Oxon., Captain, R.A.M.C. Member of the War Office Committee 
for the Study of Tetanus, The Lancet, December 29, 1917: 
"The tetanus statistics under consideration deal with the 
period of 1916 and early part of 1917. 640 cases occurring in 
British Hospitals in England and France have been reviewed. 
The cases occurring in England were collected by Sir David 
Bruce and those in France by Sir William Leishman. The total 
mortality is 50.8 per cent. . . ." 
Referring to the improvement in tetanus conditions in the wounded, 
the London Letter, The Journal of the American Medical Association, 
January 5, 1918, page 45, says: 
"Sir David Bruce refrains from expressing an opinion as to 
whether the great improvement is due to the specific treatment 
[antitoxin] or to one of the several other factors involved. 
Referring to surgical treatment, he points out that if this could 
be made entirely successful, by the cleansing and sterilization 
of wounds at the outset, there would be no more cases of 
tetanus; but while there is some evidence of an improvement 
in surgical technic, much remains to be done." 
From "Peripheral Nerve Lesions After Antitetanic Serum," by S. C. 
Dyke, L.M.S.S.A. London, Captain R.A.M.C., The Lancet, April 20, 1918, 
page 570: 
"Gunner C- was wounded in the left arm on Dec. 13th, 1917. 
He received antitetanic serum as follows:-Dec. 13th, 750 units 
into the right breast; 14th, 750 units into the anterior surface 
of the right upper arm; 24th, 500 units into the same place. 
On the 28th he experienced pain and stiffness in the right arm 
and shoulder, which he states was diagnosed as due to tetanus. 
On the 29th he was given 16,000 units of antitetanus serum 
into the abdomen, and on Dec. 30th another 16.000 into the 
thighs. Apart from the record of the injections no reference 
to tetanus appears on his medical history sheets. The pain 
passed off in a few days, but the patient then found that he 
was unable to raise his right arm above his shoulder. 
"He was first seen by me on March 9th, 1918. The wound in 
the left arm was then completely healed and function of the 
95 limb perfect. The right deltoid and supra and infra-spinati 
showed wasting, and their power was completely lacking." 
"The point of interest seems to be whether this paraylsis was 
due to the toxin of tetanus or to the antitetanic serum. Its 
occurrence in the proximity of the site of three consecutive in- 
jections of serum is suggestive." 
The London Letter, The Journal of the American Medical Association, 
April 27, 1918, page 1247, after referring to previous reports by Sir 
David Bruce concerning tetanus, treated in the home military hospitals, 
says: 
"He has now published an analysis of 100 further cases. The 
death rate was 29 per cent, as against 19 in the previous analy- 
sis, which was by far the lowest of the series. Sir David Bruce 
thinks that the present mortality is little more than can be 
expected from the prophylactic and therapeutic use of antitet- 
anic serum, and that it now remains with the surgeons to do 
the rest." 
Excerpts from an editorial, "Recent Studies on Tetanus," New York 
Medical Journal, April 27, 1918, page 800: 
"Almost thirty years ago Von Behring gave tetanus anti- 
toxin to the world and from then down to the present efforts 
have been made to establish the value of this agent, both 
as a prophylactic and a curative measure. . . ." 
"The Lancet for December 22nd and 29th, 1917, contains a ser- 
ies of very valuable and interesting papers bearing on this 
subject." 
"A careful study of the investigation reported in these sev- 
eral communications throws some light on the problem, but 
still leaves us very far from any final decision on either the 
prophylactic or the curative value of antitoxin, or the relative 
merits of the different modes by which it can be administered." 
From "The Therapeutics of Tetanus," by Hermann B. Gessner, M.D., 
New Orleans, read at the Sixty-ninth Annual Session of the American 
Medical Association, June, 1918, The Journal of the American Medical 
Association, September 14, 1918, page 867: 
"In order to form a just estimate of the relative value of the 
several methods of treatment of this disease in civil practice, I 
have studied 427 case reports from the records of the Charity 
Hospital of Louisiana located in New Orleans." 
After eliminating certain cases because of several complicating 
factors, Dr. Gessner continues: 
"Thus 368 case reports were' available, a number which seemed 
sufficient to justify comparisons of some value as between rival 
methods of cure. 
"As a preliminary to the detailed study of these cases, I 
have thought it of interest to compare the mortality by decades, 
going back to the earliest records available. These records, as 
shown by Table I, give a mortality of 68.7 per cent, in the de- 
cade from 1840 to 1849, varying up and down through a maxi- 
mun of 83.9 per cent, in the period from 1880 to 1889, then 
coming steadily down to 68.5 per cent, in the period from 1910 
to 1917, the current period. Comparing decades, we find the 
gross undifferentiated mortality about the same now as it was 
seventy years ago." "We must admit that we have progressed 
but little in the treatment of this disease and that strenuous 
efforts must be made to correct our errors and lessen the 
heavy mortality rate." 
96 "Taking up the question of prophylaxis, in our 368 authentic 
cases of tetanus reported during a period of twelve years, we 
find twelve patients, each of whom received a preventive dose 
of serum, of whom four died-a mortality of 33Va per cent." 
. . we do not know positively the best way to treat tetan- 
us." "Every one can recall cases of recovery from tetanus under 
individual methods of treatment. The question is, What method 
offers the best prospect of cure?" 
Reviewing an article in the London Lancet, on "Tetanus in British 
Armies in France," The Journal of the American Medical Association, 
March 29, 1919, page 964, says: 
"Of the 376 cases analyzed by Cummins and Gibson, 252 
patients died and 124 recovered, a mortality of 67 per cent. Of 
the total deaths, 13 were from causes other than tenanus" [after 
the tetanus symptoms has subsided]. . . . "Operative interfer- 
ence was resorted to after the appearance of tetanic symptoms 
in 27 cases. Of these, 22 died, a mortality of 81.48 per cent." 
"Nearly one fifth of the total number of cases occurred among 
persons to whom no inoculation had been given. Of the 376 
cases, all but four . . . were treated with antitoxin administered 
by the intrathecal, the intravenous, the subcutaneous, and the 
intramuscular method. ... As to the value of antitoxin treat- 
ment in tetanus, a steady fall in mortality has undoubtedly 
taken place, but it is urged that the greatest caution should be 
exercised in attempting to draw definite conclusions as to how 
this improvement has been brought about." 
97 TUBERCULOSIS 
From an editorial article, The Journal of the American Medical Asso- 
ciation, September 28, 1912, page 1195: 
". . . the Public Health Service maintains a tuberculosis 
sanitorium at Fort Stanton, N. Mex. This institution is con- 
ducted for the benefit of tuberculous seamen and other bene- 
ficiaries of the federal marine hospitals. From its foundation 
in 1899 to June 30, 1912, a total of 1,937 patients had been dis- 
charged." 
"In treating active tuberculosis, -the only curative measures 
employed are rest, fresh air and good food. Drugs are used, 
however, as indicated by acute symptoms. The use of tuberculin 
has been entirely discontinued, as its effect is believed to be 
limited chiefly to the results of its administration on the mental 
condition of the patient." 
From an editorial in the New York Medical Journal, March 15, 1913, 
page 562: 
"The unsavory performance now going on in New York with 
a revival of a twenty year old method of attacking tuberculosis 
leads naturally to the thought whether the white plague will 
ever be cured by tuberculins, serums, Immun-Korper, cultures, 
or any similar preparation. The history of these so-called 
specifics of which high hopes have been entertained is no more 
encouraging than that of many other supposed remedies for 
tuberculosis; they have all flashed up like rocket and come 
down like the stick, as far as the pulmonary form of tuberculosis 
is concerned-and it is the pulmonary form w'hich interests 
both physician and patient ... no cure of phthisis is on re- 
cord which cannot fairly be attributed to the diet, fresh air, 
and other agencies which are successful when used apart 
from any specific. . . . That tuberculosis is eminently a self 
limited disease is well known. Futhermore, it is the custom 
in hospitals to select cases for treatment by tuberculin; cases 
usually which progress slowly, which do not exhibit high tem- 
perature, etc. Could not the cognoscenti tell many a story of 
hemoptysis [the spitting of blood from the larnyx, trachea, 
bronchi, or lungs], obstinate febrile reaction, or other grave 
accident following an injection? 
"From the serums of Maragliano, Marmorek, Lannelongue, 
Achard, Gaillard, Vallee, Jousset, Arloing, and others, what 
results have been obtained outside a few isolated surgical 
cases? Renon and Guimard, Calmette himself, all firm believ- 
ers at one time, have lost confidence." 
"As a matter of fact, pulmonary tuberculosis is itself still a 
mystery . . . which varies in its manifestations with the in- 
dividual attacked. . . . The disease seems to be Nature's pro- 
test at dirt, darkness, and starvation, which open the door to 
infection, and the solid and trustworthy results we have ob- 
tained in its treatment are due mainly to combating these 
conditions by cleanliness, sunlight, and good food. It is im- 
portant to put the patient's stomach in order, to inflate his 
lungs, to get him sleep and rest. When we see the patient 
98 early enough disease fades away before these simple measures. 
What therapeutic agents we have are beneficial only as they 
help digestion and put on flesh." 
"Education is bound to tell in the long run, and even the lay- 
man can be taught that no disease which comes from ages of 
neglect on the part of his ancestors, together with carelessness 
on his own, is going to yield to a few unaided shots from a 
hypodermic syringe." 
"If physiology and chemistry are some day to give us a 
genuine specific for pulmonary tuberculosis, we believe it will 
be along the lines of chemotherapy. ... It will not act as an 
entire cure in itself, but will always demand the cooperation 
of the great forces of Nature, together with a good nurse and 
a good cook." 
From an article, "The Present Status of Tuberculin," The Journal of 
the American Medical Association, March 14, 1914, page 873: 
"In the Transactions of the British National Association for 
the Prevention of Consumption and Other Forms of Tuber- 
culosis (Great Britain), appears the report of a symposium on 
tuberculin held at the fifth annual conference of the association." 
The Journal reviews the report and the following quotations are from 
its article: 
"It is a remarkable fact that notwithstanding the great 
scientific genius of its discover, tuberculin has never been 
placed on a scientific basis through satisfactory experimental 
results. This has been pointed out by Batty-Shaw . . . and is 
confirmed by Rabinowitsch and Mackenzie." 
"Rabinowitsch also made the important discovery that tuber- 
culin sufficient to produce a general reaction causes virulent 
tubercle bacilli to enter the blood and thus tends to disseminate 
the disease. This finding is confirmed by the observations of 
Bachmeister on human subjects. In four out of fifteen cases, 
blood taken from patients at the height of the feverish reaction 
lollowing the diagnostic use of tuberculin, produced tuberculosis 
in animals injected with it. The blood of each of the four pa- 
tients taken before the use of tuberculin gave negative results 
when injected. It is evident that much caution should be used in 
the employment of tuberculin even for diagnostic purposes." 
"The determination of the clinical usefulness of tuberculin has 
proved especially difficult. Mackenzie, after a considerable ex- 
perience, still feels uncertain as to its value. In his opinion it is 
still on trial. He says, 'When all is said and done, we have to 
acknowledge that the results of it are not brilliant, certainly not 
convincing.' " 
The article quotes Bardswell as having said: 
"Tuberculin cannot be looked on as a means whereby an un- 
favorable case can be converted into a favorable one, or as likely 
to turn the scale in the patient's favor when his progress is 
hesitating or definitely retrogressive. More often than not it 
will do harm." 
"Rist says that he has 'never seen a patient doing well under 
tuberculin without remaining in doubt whether he would not 
have done as well without tuberculin.' " 
"Dr. Gebser says, 'A great number of tuberculin successes 
sem"1 to ' e +o be exnlica 'e by psychologic processes.'" 
"Schudt. Henssen, Wolff and Brauer take a skeptical attitude 
as to the therapeutic value of tuberculin." 
99 "Thomson reports a most discouraging experience with this 
remedy in laryngeal tuberculosis." Thomson is quoted as say- 
ing of tuberculin: "It is often referred to as a remedy by those 
of little understanding. We know it is no remedy." 
"The susceptibility of various individuals to tuberculin varies, 
according to White, to such an extent that to produce the same 
effect in two individuals may require two hundred times as much 
tuberculin in one case as in the other. There are many cases in 
which it is distinctly contra-indicated." 
"Rist insists that one must first exclude patients who are in 
a febrile condition. This class includes the great majority of 
the progressive cases. Rist has had no success with tuberculin 
in the non-febrile progressive cases in which he has used it." 
"Rist points out that tuberculin acts favorably on certain skin 
lesions, but is of little use in tuberculosis of the lungs." 
"In an appendix to the report Pannwitz, secretary of the In- 
ternational Antituberculosis Association, presents a summary of 
the views of prominent German specialists. According to Pann- 
witz, tuberculin is extensively used in Germany and is popular. 
He points out, however, that the number of doubters is increas- 
ing, and in evidence of this fact he notes that the search for new 
tuberculin preparations never ceases." 
"From reading these papers the following impressions are 
gained: 
"Tuberculin is not holding the position which was accorded to 
it after its recovery from the depression due to its early in- 
cautious use." "The potency of tuberculin for harm is recog- 
nized by all." 
The Journal of the American Medical Association, August 8, 1914, 
page 512, reviewing an article on "Pulmonary Tuberculosis Treated 
with Tuberculin," by N. Bardswell in the Bristol Medico-Chirurgical 
Journal, London, says: 
"Bardswell's experience is that tuberculin is not a remedial 
agent which can be depended on to revolutionize either sani- 
torium results or the outlook for the average tuberculous. 
Tuberculin has not proved itself to be a remedy in the ordinary 
sense of the term, and no immediate or striking results are 
to be expected from it, even in the most favorable cases." 
"Bardswell's experience has been that the administration of 
tuberculin is quite unsuitable as a routine method of treatment 
of pulmonary tuberculosis, and that its indiscriminate and care- 
less use on a large scale can only end in harm." 
The Journal of the American Medical Association, August 22, 1914, 
page 708, reviews an article on Tuberculin in Treatment of Tubercu- 
losis, by G. V. Stockdale and R. Hodson, published in the British Medical 
Journal. We quote therefrom: 
"As many cases as possible of pulmonary tuberculosis (the 
criterion for which was the presence of tubercle bacilli in the 
sputum) were collected by Stockdale and Hodson and paired off 
■ in such a way that a febrile patient was paired with another 
febrile, while an afebrile was paired with an afebrile. Then by 
lot it was decided which should be given tuberculin, so that 
there should be no suggestion as to picking cases. Further, as 
fresh patients were admitted into the hospital, it was decided by 
lot which should be given tuberculin and which should act as 
controls [those not treated with tuberculin but used for com- 
parison] ." 
"Tuberculin was apparently harmful to the intermittently 
100 febrile patients, who formed the bulk of the series. Tuberculin 
had no apparent influence in increasing the weight or in im- 
proving the general condition, and in both these cases the bal- 
ance of improvement is on the side of the controls." 
From an article, "The Present Situation in Tuberculosis," by Freder- 
ick Tice, M.D., Chicago, New York Medical Journal, November 14, 1914, 
page 971: 
"No other disease has required nor received more serious 
clinical, laboratory, and experimental study, nor, strange to say, 
continues to present so many complex, unsolved problems." 
"Perhaps one of the most essential considerations is the matter 
of an early diagnosis. With the announcement of the discovery 
of the bacillus, and later, that of tuberculin, there was just 
foundation to hope that not only a definite means of diagnosis 
had been found, but also a cure. A few years sufficed com- 
pletely to shatter all such hopes. It was found that bacillus 
determination was no safe criterion on which to base a diag- 
nosis. . . . As for tuberculin, both as a diagnostic and thera- 
peutic agent, it soon fell into almost complete disrepute." 
"During recent years the work of Pirquet (2), Wolff-Eisner 
(3), Calmette (4), and Wright (5) revived interest in tubercu- 
lin; an agent once practically discarded, again came into al- 
most universal use. It seems that sufficient time has elapsed 
since its revival to enable us to arrive at some fair conclusions." 
The author quotes from the expressed opinions in reference to the 
diagnostic use of tuberculin as given at the Fifth Annual Conference of 
the National Association for the Prevention of Consumption, held in 
London, August, 1913. Dr. Hector W. J. Mackenzie is reported to have 
said: 
"I strongly deprecate the indiscriminate use of tuberculin as 
an ordinary means of diagnosis." 
"Professor H. Sahli considered that 'the use of tuberculin for 
diagnostic purposes ought to be condemned. It is unreliable, 
both positively and negatively. Diagnostic injections are dan- 
gerous.' " 
"Dr. Noel D. Bardswell observed that 'it is now generally re- 
cognized that the production of a local reaction at the seat of 
inoculation, and the raising of the temperature as the result 
of a tuberculin injection, afford no useful information.' " 
"Dr. Henssen, of Sonnenberg, told how 'for many years tuber- 
culin has been used in this sanitorium as an aid to diagnosis in 
almost all cases where no tubercle bacilli were found in the ex- 
pectorations. The experiences recorded cover many thousands of 
cases: 1, Pirquet's reaction is perfectly useless in adults; 2, the 
ophthalmoreaction is useless and dangerous. We have repeat- 
edly seen cases of tuberculosis of tfie eye arise; 3, the subcu- 
taneous reaction is useful for diagnosis only in very rare cases, 
practically only when there is a reaction at the tuberculous 
centre in the lung. It is not without danger, and may on occasion 
stimulate an inactive centre. We have observed undoubted harm 
done by it and we ascribe a case of death from meningitis to it. 
On the basis of these experiences we are about to give up the 
use of tuberculin for diagnostic purposes.' " 
Dr. Rabinowitsch-Kempner is quoted as having said: 
"Since through the diagnostic use of tuberculin, virulent 
tubercle bacilli may be caused to enter the blood stream it be- 
hooves us to proceed cautiously with its administration." 
101 Referring to the therapeutic use of tuberculin and vaccines, Dr. Tice 
says: 
"With the renewed interest in tuberculin, almost innumer- 
able new preparations have appeared, a rather sure indication 
of lack of confidence in the previous tuberculins. Not only has 
the number of tuberculins increased, but various stock and auto- 
genous vaccines have been employed. ..." 
"Recently, Webb and Williams have employed living virulent 
bovine bacilli in the protective vaccination of children also in 
treating human tuberculosis. More recently, supposedly atten- 
uated, nonvirulent modified living bacilli, so-called turtle bacilli, 
have been employed, vigorously advocated, advertised, and 
handsomely disposed of financially by Friedmann. Finally, as in 
other diseases, when medicinal therapy has been tried and found 
wanting, an appeal has been made to surgery and as a result, we 
are again in the midst of an artificial pneumothorax epidemic." 
"Sir James K. Fowler observed: 'Some of the conclusions at 
which I have arrived are as follows: (a) The use of tuberculin 
in any form in the treatment of pulmonary tuberculosis is 
not free from danger. Even with exceedingly small doses which 
are gradually increased the limit of tolerance may be suddenly 
reached and a reaction may occur, (b) Its use is absolutely 
inadmissible in any case in which there is fever.' " 
"Hofrat Doctor Wolff announced: 'We always have certain pa- 
tients with whom, generally at the request of their home doctors, 
we employ tuberculin therapeutically, but this does not make 
; more than one to two per cent of the inmates if all tuberculin 
treated patients are counted. For diagnostic purposes tuber- 
culin is practically never used.' " 
Professor L. Brauer is reported to have said: 
" ... in general my attitude [regarding tuberculin] is 
skeptical and I believe we are in a hopeless impasse." 
In his summary Dr. Tice says: 
"Tuberculin reactions, either positive or negative, are of no 
material assistance in diagnosis." 
"Tuberculin as a therapeutic agent is rapidly losing in repute, 
and, the indications justify the prediction that it will soon be 
quite generally discarded." 
From an editorial article, American Medicine, February, 1915, page 
72: 
"The popularity of tuberculin is diminishing according to Dr. 
Frederick Tice of Chicago (N. Y. Medical Journal, Nov. 14, 
1914) who has carefully reviewed the recent literature of the 
subject. The results reported by the world's foremost workers, 
have led him to the conclusion that tuberculin reactions are of 
no material assistance in diagnosis. . . . Tice says that the de- 
gree of sensitiveness to tuberculin is no measure of the acti- 
vity or latency of the tuberculous infection, . . ." 
| "The denial of the therapeutic value of tuberculin is the dis- 
heartening part of Tice's conclusions. He says that it is not 
only losing in repute but that the indications justify the pre- 
diction that it will soon be quite generally discarded. We hope 
he is wrong, for the profession seems to have been looking upon 
tuberculin in some form, as a possible solution of the whole 
tuberculosis problem. ... It is therefore a great shock to learn 
that we might have been wrong. Still, the history of medicine 
102 is a long series of such reversals of opinion ... of course the 
whole profession has been in error more than once." 
The following excerpts are from an article entitled: "Possible Tuber- 
culin Reaction in the Breast-Fed Child After Diagnostic Dose to the 
Mother," by George Thomas Palmer, M.D., Director of Springfield Open 
Air Colony and Medical Director of the Springfield Tuberculosis Dis- 
pensary, Springfield, Illinois, The Journal of the American Medical As- 
sociation, April 17, 1915, page 1312: 
"The following case is interesting in that it suggests one of 
two things: That, possibly, greater care should be exercised in 
the use of tuberculin in diagnostic dose in the nursing mother, or 
that the element of coincidence should be taken fully into con- 
sideration in interpreting unfortunate complications which may 
occur after tuberculin has been used." 
"F. L. P., aged 6 months, was the apparently healthy child 
of F. P., a man aged 30, suffering from open pulmonary tubercu- 
losis, and of M. L. P., a woman aged 30, who had been in poor 
health since the child's birth. 
"Physical examination of the mother elicited nothing on which 
a definite diagnosis could be based; . ." 
"In view of the necessity for removing the child from the 
breast in case the mother was tuberculous, a tuberculin test 
was decided on. A 1 per cent, dilution of old tuberculin, amount- 
ing to 1 mg., was given intradermally. This was followed by 
marked local reaction with some slight systemic reaction. 
"A day later, the nursing child, who was under the care of 
the family physician, was reported to have developed bron- 
chitis or bronchopneumonia and, about a week after the injec- 
tion of the mother, there were reported definite meningeal symp- 
toms. 
"When I visited the infant, on the invitation of the family 
physician, I found evidence of extensive pulmonary involve- 
ment and of meningitis." 
"The child died about ten days after the test had been given 
to the mother." 
The author concludes that 
"it seems highly probable that the relationship of the test and 
the child's acute illness was purely one of coincidence." 
"While there is no question but that toxins as well as immune 
substances may be transmitted through the milk, it seems hardly 
probable that, in this case,, sufficient! tuberculin could have 
reached the child to cause the slightest disturbance." 
"However, in our present incomplete knowledge of the action 
of tuberculin and its possible far-reaching effects, every case 
which may suggest further study and the employment of greater 
caution is worthy of serious consideration." 
In an article on Infantile Paralysis, published in the North Ameri- 
can Journal of Homeopathy, September, 1916, Dr. Stuart Close, Brook- 
lyn, N. Y. makes the following observations: 
"Bacteria act in the living organism, not by their mere me- 
chanical presence, but chemically and dynamically by their se- 
cretions or toxins-whether dead or alive. Dead bacilli have 
a pathogenic action as well as live bacilli, through their toxins or 
ptomaines. . . . The venom of a rattlesnake, half dead, or even 
wholly dead, but not destroyed, is as deadly as the venom of 
a live reptile." 
103 Referring to tuberculin tested cows, Dr. Close says: 
"The reaction to the tuberculin test represents the actual set- 
ting up of an acute, even if mild, tubercular process. The 
animal is actually infected by the inoculation. In a strong 
young animal the disease may, and often does, subside and be- 
come latent for a long period; but the milk cannot be regarded 
as free from taint." 
Quotations from, "Bacterial Vaccines in Treatment of Pulmonary 
Tuberculosis," by S. G. Bonney, M.D., Denver, Col. (Read before the 
American Climatological Association at the Annual Meeting, May 10, 
1916). The Journal of the American Medical Aassociation, October 21, 
1916, page 1223: 
Dr. Bonney states that he has had opportunity to note the effect of 
vaccine treatment of tuberculous patients "in a large number of cases." 
The following conclusions are from his article: 
"Vaccine therapy should by no means be permitted as a rou- 
tine measure in the treatment of tuberculosis." 
"As 'a routine method of treatment in pulmonary tubercu- 
losis it cannot be too strongly condemned." 
"The number of pulmonary invalids for whom vaccines are 
properly applicable is comparatively small." 
"The results obtained are very uncertain." 
"The proportion of those exhibiting improvement is disap- 
pointing." 
"Vaccines not infrequently are shown to possess vast possi- 
bilities of injury." 
" . . . the foregoing statements seem to be true, to a certain 
extent at least, of tuberculin therapy." 
"A Plea for Greater Simplicity in Diagnostic Technic," is the title 
of an article by Dr. Hardee Johnston, Alabama, published in American 
Medicine, February, 1917. Referring to various laboratory tests Dr. 
Johnston remarks: 
"The more we know of most of these tests, the less certain 
do we feel as to their infallibility." 
He calls attention to Tuberculin as follows: 
"When the different tuberculin reactions were heralded abroad, 
the inference was that the physical signs of the disease, as 
elicited through examination of the chest, would be entirely 
superseded by these more certain tests. We now know the 
absurdity of this. During one of my services in the Hillman Hos- 
pital, as an experiment, we administered the tuberculin skin 
test,-Von Pirquet-to the nurses and interns. As well as I 
remember, about three-fourths of them gave a very positive 
reaction. They were as healthy a lot as one would wish to 
see. Even the Wassermann reaction admits of many errors, 
and is by no means as certain as we once believed." 
Quotation from an article by Wilfred H. Manwaring, Arthur R. Mein- 
hard, and Yoshio Kusama, Leland Stanford University, New York Medi- 
cal Journal, August 25, 1917, page 348: 
"In spite of repeated false hopes, serum treatment of tuber- 
culosis is without practical results." 
New York Medical Journal, November 2, 1918, page 770: 
"A. Jousset (Presse medicale, August 5, 1918) states that, 
among tuberculous patients, normal equine or bovine serums 
104 give rise to the same kinds of untoward reactions and in the 
same proportion of cases as do active antituberculous serums. 
. . . They [general reactions] often occur after the first injection 
of serum, without any preparatory inoculation. They arise 
merely from special susceptibility of the subject to the ma- 
terial injected. . . . The most serious reactions attending serum 
injections are those constituting the Arthus phenomenom, in 
which after repeated injections there develops locally what ap- 
pears to be a suppurative hematoma [tumor]. This may prove 
so painful that the patient will refuse further treatment. In 
this instance, however, large, frequently repeated doses proved 
less dangerous than small doses. . . . Intravenous serum injec- 
tions should not be used." 
105 TYPHOID FEVER 
(For further light on this subject see the League's pamphlets on 
Antityphoid Inoculation) 
In an article entitled, "Antityphoid Vaccination," The Journal of the 
American Medical Association, February 24, 1912, page 539, Dr. D. J. 
Davis, Laboratory of St. Luke's Hospital, utters a word of warning. 
He says: 
" . . . the vaccine has heretofore been given chiefly to young 
and healthy army men who have passed a thorough physical 
examination. We should remember that any substance that 
will, in a healthy individual, cause headache, nausea, insomnia 
and an increase of temperature of two or sometimes three de- 
grees, etc., as the typhoid vaccine may do in the doses used, 
must be considered a powerful toxin. Consequently it is reason- 
able to assume that certain changes such as myocardial [heart] 
degeneration, vascular changes, kidney degenerations, etc., might 
easily result, though they may be manifested only at a much 
later period of life. And perhaps the consequences might be 
much more severe should the vaccine be injected into an indi- 
vidual who was at the time suffering from renal [kidney], 
cardiac [heart] or other lesions. At any rate, it would seem in- 
advisable to use the vaccine previous to a careful physical ex- 
amination." 
Government, State and City Medical officials, as well as physicians in 
private practice, not only urge antityphoid vaccination upon the general 
public but declare it to be "a sure and harmless preventive," although 
the Surgeon General of the U. S. Army said, in italics, in Circular No. 7, 
April 24, 1912, that: 
"No person should be immunized who is not perfectly healthy 
and free from fever at the time." 
Dr. M. P. Ravenel in The Journal of the American Medical Associa- 
tion, June 22, 1912, page 1970, referring to antityphoid vaccination 
says: 
"Injections should only be made in those who are healthy and 
free from fever." 
In The Journal of the American Medical Association, Oct. 12, 1912, 
page 1363, Dr. F. F. Russell under, "Use of the Typhoid Prophylactic" 
states that the general reaction from the vaccine, 
"when present, gives rise to a headache and malaise and some- 
times to fever, chills and occasionally to nausea, vomiting or 
diarrhea." He also admits that severe reactions, although ex- 
ceptional, do occur, and adds, "We have always insisted that 
only the healthy should be vaccinated, since a severe reaction 
in one weakened by disease might do harm." 
From the New York Medical Journal, March 29, 1913, page 667, 
Editorial, "Typhoid Eradication:" 
106 "It is no longer necessary to adduce evidence to prove that 
typhoid fever is a thoroughly preventable disease. For a long 
time it has been conceded that milk and water borne typhoid 
epidemics depend upon factors which are entirely within our 
control. More recently it is becoming apparent that it is both 
theoretically and practically possible to reducel the flybome 
cases to almost the vanishing point. The health authorities 
in Jacksonville, by the enforcement of a sanitary privy ordin- 
ance and a concerted action against the fly and his breeding 
places, reduced the morbidity from typhoid fever in 1911 to a 
little less than one-half of the figures for the previous year." 
The Journal of the American Medical Association, May 3, 1913, page 
1364, editorially says: 
"Typhoid, of course, is mostly a disease which communities 
elect to give themselves in payment for a comfortable amount 
of sloth and filth, and the curative aspects are much less im- 
portant than the preventive." 
An editorial article, "Compulsory Inoculation of Troops," The Medi- 
cal Times, January 16, 1915, refers to a meeting held for the purpose 
of discussing "Preventive Inoculation," at which, according to the art- 
icle, only doctors from one side (those in favor of compulsory inocula- 
tion) were permitted to speak. We quote from the editorial: 
"One after another they jumped up like khaki marionnettes, 
all saying the same thing, more or less, and indulging in 
similar derision or denunication of their opponents. One began 
to understand what Mr. H. G. Wells meant by saying that half 
the medical men he met betrayed 'totally untrained minds.' " 
"That there should have been vigorous manifestations of dis- 
sent and even disgust when the meeting was told by Colonel 
Sir William Leishman that if he could get at the people who 
do not agree with him in this matter of inoculation he could 
excel in atrocities those witnessed in Belgium, is not to be 
wondered at." 
"It will, we are sure, be admitted by everyone that it is 
impossible to arrive at a sound conclusion in this or any other 
matter without hearing both sides, and carefully weighing the 
evidence. Truth is great, and it will prevail ultimately, but it 
will not be hastened by burking discussion or threatening those 
seeking truth with pains and penalties outclassing the atrocities 
perpetrated by the Germans in Belgium. Personally we are 
inclined to the view that antityphoid inoculation is still in the 
experimental stage, and, whilst we raise no objection to the 
experiments being continued in the case of those anxious or 
willing to be experimented upon, we are strongly of opinion 
that there is a better way of dealing with typhoid, and all other 
filth epidemic diseases, and for that reason we deprecate the 
compulsory inoculation of gallant men who are perfectly willing 
to face the all too evident dangers of the field of battle, but are 
unwilling to submit to the hidden dangers of antityphoid 
inoculation." 
The Mew York Times, March 28, 1915, published a review of an article 
by Dr. M. L. Ogan, Chief of the Division of Typhoid Fever of the 
Bureau of Infectious Diseases of the Department of Health, New York, 
dealing with the epidemic of typhoid fever at the Sloane Hospital, 
and the influence of artificial immunization in the form of antityphoid 
vaccination, in preventing infection among the nurses and doctors con- 
nected with the institution. The Times says: 
107 "If one may judge from the figures given, it is evident that 
antityphoid vaccination in the case of this particular epidemic 
made a poor showing, for several of those supposed to be either 
completely or partially immunized fell ill of typhoid fever." 
The review quotes Dr. Ogan as follows: 
"In January and February of the current year [1915], an out- 
break of typhoid fever took place in the Sloane Hospital for 
women, involving twenty-five cases, chiefly among the physi- 
cians, nurses, and subordinate employees. As a number of the 
doctors and nurses had been immunized against typhoid fever 
at various times, an opportunity was afforded for a limited but 
fairly defined study of the effects of this preventive measure." 
"The immunity analysis will then refer only to the seventy- 
three nurses and eight physicians, among whom thirty-seven 
nurses and seven physicians had received three doses previous 
to the outbreak, some of them as far back as three and four 
years ago. In this group, there were seven of the cases under 
consideration. One was immunized in 1911, two in 1912, three 
in 1913, and one 1914." 
"Two nurses were partially immunized with two doses each, 
in 1912. One of them came down during the outbreak and died 
in the third week. Five nurses gave a previous history of 
typhoid fever and escaped infection. Twenty-nine nurses and 
one physician had no artificially or naturally acquired immunity; 
among these, there were six cases. There were then in all 
fourteen cases; eight among the forty-six immunized, six among 
the thirty non-immunized, none among the five giving a pre- 
vious history." 
Quotation from the Paris Letter, The Journal of the American Medi- 
cal Association, September 9, 1916, page 824: 
"Dr. Lian has reported to the Reunion medicale de la IV-e 
Armee two accidents resulting from mixed antityphoid and 
antiparathyroid vaccination. There was a general syndrome 
[complex of symptoms] of an acute suprarenal insufficiency, 
namely, fever, headache, vomiting, profound depression, vertigo, 
faintness, very low arterial pressure, the 'white line' of Ser- 
gent, and in the graver one, hiccup, epigastric and lumbar pain, 
oliguria and albuminuria. These troubles disappeared in four 
days in one patient, and in twelve in another." 
Quotations from a review of an article in Progres Medicale, The 
Journal of the American Medical Association, October 14, 1916, page 
1189: 
"Balmelle reviews his eighteen months of experience in the 
typhoid ward of the Marseilles military- hospital. Among the 
600 typhoid patients, 14 per cent had been supposedly effect- 
ually vaccinated and the typhoid averaged no milder in these 
than in the 86 per cent who had not been vaccinated." 
Under the heading: "Inoculation Against Typhoid Fever in the 
Army," the London Letter, The Journal of the American Medical Asso- 
ciation, November 18, 1916, page 1537, reports as follows: 
"The following are the latest official figures on this subjeet: 
Up to Aug. 25, 1916, 1,501 cases were finally diagnosed as 
typhoid fever among the British troops in France, 903 among 
inoculated men and 508 among uninoculated men. There were 166 
deaths, 47 of which were among the inoculated and 119 among 
the uninoculated. To the same date there were 2,118 cases of 
108 paratyphoid fever, 1,968 among inoculated men, and 150 among 
men who had not been inoculated. There were 29 deaths, 22 
of which were among the inoculated and 7 among the unin- 
oculated." 
Extracts from "Vaccination Shock and Its Treatment," Paris Letter, 
The Journal of the American Medical Association, April 28, 1917, page 
1275: 
"Under the name of 'choc vaccinal', Mery and Halle have 
described a syndrome [a complex of symptoms] which is some- 
times produced by antityphoid and antiparatyphoid vaccina- 
tion. The onset of this condition is sudden and severe, consist- 
ing of a distinct chill, marked prostration and a considerable 
elevation of temperature. The symptoms may be divided into 
two distinct groups, occurring in periods. The first group of 
symptoms embraces the gastro-intestinal manifestations (vomi- 
ting, sometimes intractable, diarrhea, often severe, and particu- 
larly fetid and watery) and always extreme asthenia [absence of 
strength] with circulatory collapse (cyanosis, deafening of the 
heart sounds, fetal rhythm, weak radial pulse, sometimes im- 
perceptible, hypotension, and mental torpor not unlike the 
meningeal state), to which are frequently added renal [kidney] 
symptoms . . . and sometimes incontinence of bowel and blad- 
der. In exceptional cases there are symptoms of involvement 
of the liver and spleen. The symptoms of the second period 
often are not clear and may be inconstant, if treatment of the 
case is instituted early. They consist of hypothermia [sub- 
normal temperature], a persistence of the circulatory collapse 
phenomena and sometimes renal symptoms, especially anuria 
[suppression of the urine]. 
Excerpts from an article, "Untoward Results of Prophylactic Typhoid 
Immunization," by William Lintz, M.D., Professor of Bacteriology, Long 
Island College Hospital; Associate Visiting Physician, Brooklyn Jewish 
Hospital, published in The Journal of the American Medical Association, 
May 5, 1917, page 1319: 
" . . . I believe it is wise to bear in mind that untoward re- 
sults may follow typhoid inoculation, as in the case herewith 
reported, with the idea, not of paralyzing activities in this direc- 
tion, but that it is necessary to take proper precautions with 
patients who are inoculated with typhoid vaccine. I believe that 
patients who receive the vaccine should be instructed to go home 
and not to their vocations, where the sudden appearance of cer- 
tain mental and nervous symptoms would jeopardize their lives." 
Report of the case follows, the man being described as twenty-four 
years of age, 
"one of thirty-three senior students who presented themselves 
on the morning of October 28, 1916, for the routine typhoid vac- 
cination. He received the same as the other students, 500 mil- 
lion bacilli of the U. S. army strain, nonsensitized, and prepared 
in the usual manner. ..." 
"The patient, . . . presented the following rather unusual 
symptoms: 
"Twenty minutes after the subcutaneous injection of the vac- 
cine he felt weak all over the body, especially m the lower ex- 
tremities. A sensation of chilliness and a dull headache set in. 
The symptoms were progressively becoming more severe, until 
one hour after the injection the patient began to shake vio- 
lently over the whole body, and he had an unbearable throbbing 
109 headache. Then the rather unusual symptom of continuous 
vomiting set in. The vomitus was at first slimy mucus, and 
then mucus and blood, which was bright red. The soreness all 
over the body became extreme and the joints exceedingly pain- 
ful. The temperature was 103, pulse 100 (normal 60). The 
vomiting, the painful joints and soreness all over the body per- 
sisted for forty-eight hours. He remained apathetic for forty- 
eight hours, during which time anorexia [aversion to food] and 
polydipsia [excessive thirst] were marked. The stools were 
yellow and watery. The urine was red and contained blood. 
At the height of the illness the patient was in extreme col- 
lapse. The temperature continued high for seventy-two hours 
with slight morning remissions; . . . The glands in the neck, 
axilla and groin were decidedly enlarged; those in the axilla 
were very tender. The convalesence lasted one week, the 
patient complaining of dull headache and severe pain in the 
bones of the legs." 
"If the patient had suffered from a regular course of typhoid 
he could not have fallen away more or looked worse. He was 
exceedingly feeble." "In view of the severity of the reaction, 
... it is hardly necessary for me to say that I did not give 
the patient the second and third injections." 
"The previous history of the patient was absolutely negative. 
He never had typhoid or any other disease. . . . He has. never 
before received typhoid vaccine. From the foregoing it is there- 
fore difficult to determine what has sensitized him against the 
protein of the typhoid bacillus. I do not doubt for a moment 
that sensitization or anaphylaxis was responsible for the symp- 
toms." 
The Weekly Bulletin of the Department of Health, the City of New 
York, May, 5, 1917, page 141, under the title, "Typhoid Fever in a 
Patient Twice Vaccinated Against the Disease," says: 
" ... we are forced to conclude either that the immuniza- 
tions were not effective or that they were incomplete and have 
not remained permanent." 
Under the heading, "Serious Disturbances After Vaccination Against 
Typhoid." The Journal of the American Medical Association, June 2, 
1917, page 1671, reviews an article by Stefansky published in Russkiy 
Vrach, from which the following quotation is taken: 
"Stefansky reports an especially serious case of disturbances 
after injection of antistreptococcus vaccine for an old chronic 
streptococcus affection. The first and second injections were 
borne without mishap, but a few hours after the third a ser- 
ious condition developed suddenly, with cyanosis [a bluish dis- 
coloration of the skin caused by circulatory disturbances], almost 
inperceptible pulse, about 160, temperature 105 at times, and in- 
tense pains in the left flank, compelling morphin. This serious 
condition kept up for nearly three days and then subsided except 
for the pains, which persisted for several days. These exces- 
sive reactions in his experience always occurred in apparently 
entirely healthy persons. The intense neuralgic pains and vas- 
cular disturbances in his last case seem to point to bacterial 
anaphylaxis." 
The Journal of the American Medical Association, September 1, 1917, 
page 760, reviews an article published in Progres Medicale, Paris, July 
14, 1917: 
"In two cases" according to the review "there was hemoptysis 
110 [spitting of blood] after antityphoid vaccination, and a typical 
tuberculous pneumonia developed. ..." 
Extracts from an article entitled: "Bacterial Vaccine Therapy," by 
James P. Leake, M.D. Passed Assistant Surgeon, United States Public 
Health Service, Washington, D. C., published in The Journal of the 
American Medical Association, August 25, 1917: 
"It is obvious that the tendency is to report favorable results, 
while the series of non-successful cases are less likely to be 
published." " . . . practice" says Dr. Leake "has jumped far 
ahead of knowledge, ..." "The uncertainties due to enthu- 
siasm for any rather new treatment are obvious, but in the case 
of vaccine therapy our vision is particularly clouded." '. . . 
a great part of the unqualifiedly favorable communications on 
vaccine therapy, reporting uniform benefit without severe re- 
action, bear internal evidence of lack of careful control, and as 
a rule the more favorable, the greater is this evidence." "On 
the other hand, we had some very carefully controlled reports. 
Last year Captain Whittington of the Royal Army Medical Corps 
reported 230 cases of typhoid fever, selected to conform to rigid 
standards of diagnosis and classified as to relative severity, and 
divided them into two lots, so that each vaccine-treated case was 
accurately checked with a nonvaccine-treated case in the same 
state of prophylactic vaccination, of the same severity, occur- 
ring in the same season, climate and locality, of the same sex, 
of about the same age and previous .health, and receiving the 
same general treatment as to nursing, dieting, etc. Captain 
Whittington had the advice of Sil' William Leishman on the ear- 
lier cases, so that there should be little to criticise as to dosage 
and time between doses. Such a series, though small, is far 
more valuable than thousands of cases collated from different 
observers without proper controls, with the chance favorable 
results in many instances acting as a spur to publication. 
Whittington's results are recorded in the accompanying table. 
"Comparative Results From the Use of Vaccines in Two 
Hundred and Thirty Typhoid Fever Cases. 
Vaccine Treated 
Mortality 
per cent. 
Average 
Days Fever 
Relapsed 
Cases- 
per cent. 
Cases with Com- 
plications or 
Sequelae per cent. 
Cases 
25 
29.2 
10.4 
49.5 
Controls 
21 
26.1 
7.8 
46. 
"A comparison of these results shows that the controls did a 
little better than the vaccine-treated cases. Moreover, from 
the promptness with which some of the hemorrhages followed 
a vaccine injection, there was a decided suspicion, that the 
vaccine might have induced this complication." 
"To a laboratory worker it would seem that, with our present 
Knowledge, no patient is unjustly treated in having this so-called 
specific treatment withheld." 
Dr. Leake refers to 
"One other small but well controlled series" of treatments 
of whooping cough "recently reported by a group of workers 
under Dr. Park, of the Bureau of Laboratories of the New York 
City Health Department." 
"These authors also, even up to the time the results were 
tabulated, believed that the vaccine (pertussis in this case) was 
111 of specific benefit. ... Yet when the data were assembled, no 
matter what the grouping, whether according to intensity of 
onset, stage of disease, duration of disease, or intensity of para- 
oxysms, the result was the same. The pertussis vaccine showed 
no superiority over the nonspecific treatments." 
Referring to Dr. Frank Billings of Chicago, he says: 
"After years of trial, especially in chronic disorders which 
should offer the most favorable field, Dr. Billings says that a 
personal and general hygienic management will accomplish 
quite as much without as with vaccines; and that vaccines with- 
out proper attention to a hygienic management are more likely 
to be harmful than helpful." 
"The bulk of vaccine therapy, if it is to become generally avail- 
able, must be on the stock basis. Autogenous vaccines are often 
as ludicrously abused as stock vaccines." "The case in general 
is not proved, and doubt is increasing. Many keen observers 
believe that specific bacterial therapy is a failure." 
New York Medical Journal, August 25, 1917, page 379: 
"Abortive Treatment of Typhoid Fever.-A. Maute (Presse 
medicale, June 21, 1917) expresses doubts as to the specificity 
of antityphoid vaccine, given intravenously for curative pur- 
poses, since similar reactions can be provoked by colon bacillus 
injections and various proteins. In view of the severe circula- 
tory depression which sometimes follows intravenous typhoid 
vaccine injections, he deems such treatment inadvisable, ..." 
Speaking of his use of vaccines, Dr. Thomas W. Jenkins, Albany, 
N. Y., is reported in the New York State Journal of Medicine, August, 
1917, page 367, to have said: 
"Three unusual complications were observed; one, the lighting 
up of a chronic appendicitis on the day following the adminis- 
tration of a staphylococcus vaccine for pustular acne; second, 
with the same organism and disease, after several injections, 
the patient, a woman, had symptoms of peritonitis, and when 
operated upon an abscess in a constricted portion of the omen- 
tum was observed. Third, in the treatment of a case of typhoid, 
after one injection of the typhoid vaccine the patient had an 
internal hemorrhage the next day." 
The Journal of the American Medical Association, September 1, 1917, 
page 760, reviews an article on Pulmonary Tuberculosis and the War, 
by R. Morichau-Beauchant, published in Progres Medical, Paris. Ac- 
cording to this article: 
"In two cases there was hemoptysis [spitting of blood] after 
antityphoid vaccination, and a typical tuberculous pneumonia 
developed. ..." 
The London Letter, The Journal of the American Medical Association, 
September 1, 1917, page 748, summarizes the report of the medical offi- 
cer of health of London County Council for the year 1916, as follows: 
"There were 461 cases of typhoid fever reported, as compared 
with 607 in 1915, but the figures are not strictly comparable, as 
the practice relating to inclusion of military cases was not the 
same as in the two preceding years. The great decline of re- 
cent years in prevalence of typhoid fever has proceeded practi- 
cally pari passu with the abandonment of the consumption of ' 
112 shellfish and fish from polluted sources, and, with removal of 
laying, etc., to a distance from sewer outfalls." 
From the Paris Letter, The Journal of the American Medical Asso- 
ciation, December 1, 1917, page 1897, "Appendicitis in the Armies in 
the Field." 
"At one of the recent meetings of the Societe de chirurgie de 
Paris, Dr. Walther, Assistant Professor on the Faculte de 
medicine de Paris, and Surgeon of the Hospitals, presented a 
memoir on this subject by Dr. Rouhier. Rouhier has been aston- 
ished at the unusual number of cases of appendicitis occurring 
in the armies in the field; appendicitis occurs more frequently 
here than among civilians of the same age. This may be ex- 
plained by the conditions of life at the front. . . . Rouhier has 
also been struck by the particular gravity of the attacks he has 
observed, perhaps the result of overexertion* which lowers the 
resistance to the infection." 
In this connection see page 28 of our Antityphoid Pamphlet, No. 2, 
which quotes from The Journal's review of an article in The Canadian 
Medical Association Journal, May, 1915 and cites two instances of ap- 
pendicitis following as a direct effect of antityphoid inoculation. Notice 
also the statement on the same page that, 
"In some cases the inoculation appears to have picked out a 
previous weak spot." 
From Vaccination Inquirer, London, January 1, 1918, page 4: 
"The latest typhoid returns for our Army [the British Army] 
in France were extorted by Mr. Chancellor [M. P.] from Mr. 
Macpherson (Under Secretary for War) in the House of Com- 
mons (on November 7th). It was not stated to what date ex- 
actly they were taken, but the previous batch given out last 
March 1st by Mr. Foster only brought us up to November 1st, 
1916. That total was 4,571 for 'the typhoid group of diseases.' 
and included, besides 1,684 true typhoid, 2,534 paratyphoid and 
353 indefinite cases. It is interesting to speculate about those 
indefinite cases, but there is no such class recognized in the 
present batch of returns, which are divided into typhoid and 
paratyphoid only. Thus:- 
Cases 
Deaths 
Typhoid 
... 2,321 
184 
(62 inoculated) 
Paratyphoid 
... 3,871 
48 
(39 inoculated) 
Totals.... 
.... 6,192 
232 
(101 inoculated)" 
From the United States Naval Medical Bulletin, January, 1918, page 
1: "The Dangers of Intravenous Injection of Antityphoid Vaccine," by 
G. D. Hale, Passed Assistant Surgeon, and F. W. Hartman, Assistant 
Surgeon, United States Navy. In this article reference is made to the 
case of a man suffering from arthritis who was treated by a "local 
physician" with antityphoid vaccine, which treatment resulted in the 
death of the patient: 
"The treatment he instituted and which he acknowledged was 
in the way of an experiment, although he gave as authority an 
article appearing in The Journal of the American Medical Asso- 
ciation, was as follows: About June 15, the patient was given 
one-half c.c. of standard antityphoid vaccine intravenously 
(diluted), followed by marked reaction of short duration the 
principal feature of which was high fever. On the afternoon 
113 of June 23, 1917, a second injection was given, of a slightly in- 
creased amount, also diluted. Two hours later the woman in 
charge of the rooming house found the patient very ill, vomit- 
ing, and with a high fever. She called the physician in charge, 
hut before his arrival, two hours later, the patient was dead, 
his death having occurred some four hours after the injection. 
Autopsy showed a markedly dilated right heart and congestion 
of both lungs. Although 'dilatation acute cardiac' was given 
as the cause of death it is believed that some more scientific 
explanation could be found." 
"Since 1914 the intravenous injection of killed typhoid bacilli 
has been extensively used in the treatment of typhoid fever, 
and more recently as one of the agents in the nonspecific pro- 
tein treatment of various conditions, especially gonorrheal 
rheumatism. 
"The reaction as described by Gay, Miller, Scully, and others 
consists of a severe chill, accompanied by headache, nausea, and 
vomiting, followed by high fever and a leucocytosis ranging 
from 15,000 to 100,000. The usual dosage in a debilitated 
patient or a large dose administered accidentally produce the 
more severe symptoms of anaphylactic shock, namely, urticaria, 
hemorrhages from the mucous membranes, dyspnea, cyanosis, 
rigor, dilatation of the heart, and general collapse." 
"This method of treatment, though regarded as harmless by 
most workers, has been considered dangerous by Sladek and 
Kotlowski, and numerous alarming reactions of short duration 
have been reported. Scully reports one case of death in an 
alcoholic three and one-half days after a small dose of typhoid 
vaccine intravenously, and advises us of two other cases dying 
after antimeningococcus serum; one, an arthritic, died from 
acute dilatation of the stomach, and the second, a typhoid case, 
from epistaxis [hemorrhage from the nose] and intestinal hem- 
orrhage. Sladek and Kotlowski, Eggerth, and Biedl report four 
cases of death from intestinal hemorrhage and uncontrollable 
epistaxis after comparatively small doses of intravenous 
typhoid vaccine." 
"This case plainly shows that the treatment is dangerous...." 
The Journal of the American Medical Association, February 9, 1918, 
page 415, reviewing an article by E. Rist on "Acute Contagious Diseases 
in French Army," says: 
"From Jan. 1, 1915, to Dec. 31, 1916, there were only 193 
deaths from dysentery. There has not been a single case of 
typhus or cholera in the French army in spite of the fact that 
these diseases are endemic in Morocco and Corfu where many 
of the French troops have come." 
No doubt if there had been a routine system of inoculation 
against these diseases, as there is against typhoid, the credit 
would have been given to "scientific medicine." 
"When the war began, a small number of soldiers actually in 
training had been vaccinated against typhoid. . . . But by the 
end of 1915 more than 80 per cent, of the army had been vac- 
cinated. At the same time, other prophylactic measures had 
been taken: The drinking water problem had been solved, the 
disposal of fecal matter had been provided for, the general san- 
itary condition of the trenches and cantonments had been much 
improved. . . . The combined effect of those measures with 
vaccination was that considerable decrease of cases from 5,587.8 
monthly to 1,041.1, or, to put it more strikingly, from 13,993 in 
.January, 1915, to 323 in December, 1916." 
114 Quotations from a review in The Journal of the American Medical 
.Association, February 23, 1918, page 578 of an article in Progres Medi- 
cal, Paris: 
"Ginestous reports two cases in which vision declined after 
antityphoid vaccination and the men incriminated the vaccina- 
tion. Furthei' investigation, however, revealed preexisting 
albuminuric retinitis in one case and in the other toxic am- 
blyopia from abuse of tobacco to which the man was not ac- 
customed. A third case realized the possibility mentioned re- 
cently by several writers that the temperature reaction to the 
vaccination might induce a febrile herpes [acute inflammatory 
condition of skin or membrane], and that this herpes might 
settle on the cornea [the transparent anterior portion of the 
eyeball]. This was what occurred in this case; two days after 
the fourth injection double keratoconjunctivitis developed. In 
less than a month there were miliary abscesses in the right 
cornea and a large ulceration in the left cornea with perfora- 
tion. The lesions healed leaving perfect vision in the right 
eye, but in the left there is central leukoma [an opacity of the 
cornea presenting an appearance of ground glass] and vision is 
only 1:50. These herpetic complications are rare, but their 
connection with the antityphoid vaccination can be accepted, he 
says." 
From an article by Ernest E. Irons, M.D. and David Marine, M.D., 
Majors M. R. C., U. S. Army, Camp Custer, Battle Creek, Mich.-The 
Journal of the American Medical Association, March 9, 1918, page 687: 
"We have recently had opportunity to study the incidence 
and symptoms of streptococcal infections following measles, 
tonsillitis and other conditions associated with lowered resist- 
ance in soldiers. . . ." 
"Our experience with these streptococcal infections suggests 
that while measles is an important predisposing factor, other 
infections, as bronchitis, tonsillitis, diphtheria, and other condi- 
tions, such as exposure and excessive fatigue, must be included 
-in short, anything that may reduce resistance to infection 
by an organism quite generally distributed during the epidemic 
of colds and bronchitis, in the noses and throats of the appar- 
ently healthy as well as the sick." 
It seems pertinent, here, to suggest that it has been pointed out, more 
than once, by those competent to judge in these matters, that inoculation 
with vaccines produces, temporarily at least, a decreased bodily resist- 
ance. The deduction is obvious. 
The following figures are from the sixth annual report regarding 
"Typhoid in the Large Cities of the United States in 1917," The 
Journal of the American Medical Association, March 16, 1918, page 779. 
"Typhoid Death Rate per 100,000 [in 57 cities] 
1910 19.59 
1911 15.74 
1912 12.56 
1913 12.77 
1914 10.38 
1915 8.71 
1916 7.61 
1917 6.65" 
On page 780, the same magazine, an editorial, comments as follows: 
115 "It is of great interest to note the remarkable decline in the 
total average typhoid rate that has occurred in the large cities 
of this country since 1910. . . . The 1917 typhoid death rate in 
a population of approximately 25,000,000 will bear comparison 
with the rate in a similar population anywhere in the world." 
The editorial gives the credit for this improvement in the typhoid 
death rate chiefly to sanitary science. 
Excerpts from an article entitled: "Typhoid in a Company of Immu- 
nized Soldiers," by Samuel Bradbury, M. D., (New York) First Lieu- 
tenant, M. R. C., U. S. Army, France, The Journal of the American 
Medical Association, August 17, 1918, page 532: 
"The occurrence of four cases of typhoid fever in a company 
of 175 men (Company F, Eleventh Engineers, (Ry.), A. E. F.), 
who had been immunized but five months before the occurrence 
of the infection, is of enough interest to warrant a brief report 
... it is hoped to emphasize the fact that, while an effort has 
been made to protect our soldiers from typhoid group infection 
by immunizing them, the six injections they received are not 
a guarantee that they will not contract one of these diseases." 
". . . no soldier should abuse his immunity." 
"There were during the same period, the last three weeks of 
November, several other cases with fever of undetermined origin; 
one especially was clinically typical typhoid as reported from 
the hospital. These undetermined cases have not been included, 
as all attempts at isolation of typhoid group bacilli from blood, 
urine or feces failed." 
Referring to the four cases of typhoid described by him, the author 
says: 
"At any rate, each man had the usual amount of each vaccine 
that is thought sufficient to render him immune to either of 
these diseases." 
Dr. Bradbury refers to Rist's statements in regard to typhoid in the 
French army: 
"By the end of 1915 more than 80 per cent, had been inocu- 
lated, and during the same period the drinking water problem 
had been solved, fecal matter properly disposed of, better sani- 
tary arrangements made in the cantonments and trenches, and 
carriers had been searched for and isolated. ... in December, 
1916, there were only 323 cases." 
Review of book by Frederick P. Gay, "Typhoid Fever Considered as a 
Problem of Scientific Medicine," The Journal of the American Medical 
Association, September 7, 1918, page 847: 
"Public health workers may wish to take exception to a few 
statements in the earlier part of the book, such as that on page 
10 in which the author declares it will 'be evident that all sig- 
nificant information concerning the nature of the disease it- 
self and its method of dissemination, as well as all effective 
means that have been devised to prevent and cure it . . . have 
depended on laboratory data and are based on the recognition 
of the single bacterial causative factor.' This statement ap- 
pears to overlook the fact that much of the epidemiologic work 
on the relation of typhoid to sewage-contaminated drinking 
water has been carried out, and in the nature of the case must 
be carried out without ever finding or attempting to find the 
typhoid bacillus. The evidence that causes an investigator to 
116 attribute a typhoid epidemic to a particular milk supply does 
not, as a rule, depend on laboratory data." 
Review of an article, "Tardy Relapse of Meningitis," by E. de Mas- 
sary and L. Tockmann in Bulletins de la Societe Medicale des Hopitaux, 
Paris-The Journal of the American Medical Association, October 12, 
1918, page 1254: 
"The relapse occurred four months after defervescence, but 
the man had not felt well in the interim. The relapse occurred 
after antityphoid inoculation, and the case suggests that men 
who have had meningitis should be spared the antityphoid in- 
oculations. During his convalescence he presented the symp- 
toms and aspect of general paresis, and recovery was very slow. 
He was finally discharged as unfit for duty." 
From a review of an article published in Bulletins de la Societe Med. 
des Hopitaux, Paris, The Journal of the American Medical Association, 
October 19, 1918, page 1349: 
"Netter says that among 350 meningitis patients, 1.14 per 
cent, had a relapse in from one to nearly three months after 
apparent recovery. . . . Some of his and others' cases suggest 
that antityphoid vaccination may produce a reaction in the 
organism which might favor the proliferation of otherwise 
harmless meningococci slumbering in the nasopharynx. In 
certain exceptional cases, the reaction to an antityphoid injec- 
tion may simulate meningitis. . . . Sainton reported syncope 
[fainting] after an intravenous injection of antimeningococcus 
serum, which required artificial respiration to revive the 
patient." 
In an article on Cerebro-Spinal Fever, The British Medical Journal, 
November 9, 1918, page 509, Captain J. A. Glover, M.D., D.P.H., R. A. 
M. C., gives among other 
"etiological factors producing military outbreaks of cerebro- 
spinal fever" antityphoid inoculation. Under his No. 4 are 
"Causes temporarily lowering resistance, such as antityphoid 
inoculation, fatigue, strenuous training, nostalgia. . . 
The following excerpts are from the report of a meeting, November 8, 
1918, of the Section of Epidemiology and State Medicine, Royal Society 
of Medicine, under the heading: "Outbreak of Typhoid Fever Among 
Inoculated Soldiers," The Lancet, London, November 16, 1918, page 669: 
"Captain Fred. M. Meader, U.S.M.C., gave an account of the 
epidemiology of the outbreak" which occurred at an American 
rest camp. According to Dr. Meader's report, the American 
unit, "arrived at Liverpool, July 10. After disembarkation the 
organization proceeded to . At Liverpool 3 cases were left at 
the Red Cross Hospital, and it is reported that 2 other cases were 
left at some station en route. At the American rest camp 40 
soldiers were found ill and transferred to a base hospital, 
where a diagosis of typhoid fever was made on 38 of them. . . . 
The organization left the American rest camp before the 
diagnosis of typhoid fever had been established, and it had 
since been learned that 57 other cases developed; this made a 
total of 95 cases of typhoid fever out of a company of 248 men. 
. . . All of the above-mentioned cases had been inoculated with 
either typhoid vaccine and paratyphoid vaccine or triple typhoid 
vaccine, or both. Many of them had received several doses 
117 in excess of the required number. Also, the men were inocu- 
lated at widely different posts and at different times . . . 
bacteriological tests proved the organism to be that of typhoid;"' 
"Captain Clinton B. Hawn, U.S.M.C., gave an account of the 
clinical aspects of the outbreak, which included an account of 
each of the 40 cases mentioned by Captain Meader. . . . III. 
Clinical course of disease: 1. The average duration of fever was 
35 days: (a) Severe high grade typhoid, 70 per cent. 2. Compli- 
cations: (a) Lobar pneumonia occurred in 1 case; (b) terminal 
pneumonia in one case; (c) broncho-pneumonia in 2 cases; (d) 
haemorrhage in 3 cases; (e) perforation in 1 case; (f) phlebitis 
in 1 case. IV. The mortality was 13.15 per cent." 
"Captain J. G. Hopkins, U.S.M.C., said that of the 40 patients 
in this series admitted to Hursley Hospital as typhoid suspects, 
the laboratory findings were positive in 25. ... In the remain- 
ing 14 cases all laboratory tests were negative, although 13 
were clinically cases of typhoid. . . . Vaccination records show- 
ed that the men were vaccinated at several different camps and 
at different times, so the possibility that a faulty specimen of 
vaccine was employed might be excluded. The laboratory find- 
ings offered no explanation of the infection of these men." 
"Surgeon-General Sir W. B. Leishman said that what struck 
him most was the remarkable severity of the disease, the num- 
ber of men attacked, that the infection did not extend to other 
units, and that though the men were inoculated they still got 
the fever." 
An article by Edgar M. Medlar, M.D., First Lieutenant, Medical 
Corps, U. S. Army, The Journal of the American Medical Association? 
December 28, 1918, page 2146, calls attention to the fact that there iff 
a difference of opinion in regard to the effect of antityphoid inoculation 
upon the individuals so treated: 
"From time to time," says Dr. Medlar, "since the use of 
typhoid vaccine as a prophylactic in the control of typhoid fever, 
there have been objections on the part of medical officers to its 
use, the main one being that it predisposes the individual to 
infection with other diseases." 
From an editorial article entitled: "Typhoid Vaccines a Possible- 
Factor in Appendicitis," New York Medical Journal, April 26, 1919: 
"Colonel McKenna [who, in spite of "its incidental dangers" 
the article says does not wish to be considered as opposed to 
antityphoid inoculation] has begun a study of the possible 
relationship between inoculation with triple typhoid vaccine 
and the onset of appendicitis, and the data so far collected, 
covering fifty cases, show that in a majority of cases a marked 
relationship between inoculation with triple typhoid vaccine 
and that this reaction seems to be a predisposing factor in caus- 
ing an attack of appendicitis, particularly in the case of patients 
with a previous history of that disease. It is suggested that 
this reaction possibly causes some pathological change in the 
lymphoid tissues of the body, as many patients show an acute 
adenopathy [any disease of the glands], in various parts of the 
anatomy, while some manifest marked tenderness in the Mc- 
Burney region." 
Quotations from an article entitled, "Typhoid Fever Occurring After 
Prophylactic Inoculation," by Claude P. Brown, M.D., Major M. C., U. S. 
Army; Francis W. Palfrey, M.D., Major M. C., U. S. Army; Leonard 
Hart, M.D., Captain M. C., U. S. Army, Camp Greene, Charlotte, N. C.„ 
The Journal of the American Medical Association, February 15, 1919: 
118 "Typhoid fever of recent years in our army has been con- 
spicuous by its rarity. It is our purpose here, however, to show 
that while rare it cannot be considered as nonexistent; that in 
cases of continued fever it is still to be suspected, and, even more 
important, that the protection of prophylactic inoculations, great 
as has been their sendee, cannot be taken as absolute to such 
an extent that sanitary precautions can be neglected." 
"Yet in spite of sanitary precautions and vaccination, oc- 
casional cases of typhoid fever, like those herein reported, 
have occurred. Bradbury has reported four cases, and others, 
in addition to those studied by us, have been included in army 
reports of contagious diseases." 
"In the latter part of June, 1918, cases began to appear at 
the base hospital at Camp Greene, N. C., which from their grad- 
ual onsets, climbing temperatures, without evidence of local 
inflammatory disease, enlarged spleens, rose spots and leuko- 
penia presented the clinical picture of tyhpoid fever. Cultures 
from blood stools, and urine resulted in isolation of the typhoid 
bacillus. ... It was beyond dispute, therefore, that we were 
dealing with a miniature epidemic of typhoid fever." 
Then follows a report of the cases, eighteen in all, two only of whom 
had received no prophylactic inoculations, two had received one dose 
and two two doses. 
"The question then arose whether there may not have been 
some defect in the preparation or fault in the administration 
of the vaccine. In each of our cases this point was therefore 
investigated. It was found, as shown by the histories, that all 
had had the regular prophylactic injections within a year at 
proper intervals, as attested both by the soldiers' statements 
and by their service records. It was not possible to trace the 
preparations of vaccines used, but the fact that these soldiers 
had received their preventive inoculations at different times 
and at different camps, together with the known care with 
which the Army vaccine is prepared, renders it unlikely that the 
failure of immunity was due to failure to receive the standard 
vaccine in standard doses." ". . . no conclusive source of infec- 
tion was proved. . . ." 
"It is to be concluded, therefore, that occasional cases occur 
in which the usual preventive inoculations against typhoid fever 
fail to protect against the disease. ... To eliminate such oc- 
currences, sanitary precautions should prevail;" Referring to 
certain sanitary precautions, the authors say: "No false sense 
of security from typhoid vaccination should be permitted to 
relax vigilance in this direction." 
From the New York Times, February 27, 1919: 
"Washington, Feb. 26. Illness among the American Expedi- 
tionary Forces showed considerable increase during the week 
ended Feb. 6. There were 132 new cases of typhoid fever, set- 
ting a new high rate for this disease." 
Excerpts from an editorial article, "Typhoid Vaccination Not A 
Substitute For Sanitary Precautions," The Journal of the American 
Medical Association, May 3, 1919, page 1298: 
"As in certain other diseases, the sense of security imparted 
by typhoid vaccination has led some persons to disregard sani- 
tary precautions which might otherwise have been taken. A 
little knowledge is a dangerous thing. The man who believes 
that he is protected against typhoid by vaccination may take 
chances in drinking water from contaminated sources that 
otherwise he would have avoided. . . . One instance is given of 
119 a replacement unit of 248 men reaching England from Camp 
Cody with nearly 40 per cent, of the men suffering from typhoid. 
Investigation was thought to indicate that the men were ex- 
posed to infection by contaminated drinking water while en 
route to the port of embarkation in the United States. Other 
small but relatively severe epidemics have occurred in various 
units in France. In November, typhoid began to appear more 
extensively in the expeditionary forces. According to Soper, 
from September 27 to February 13 there were 821 cases of 
typhoid and 190 of paratyphoid in the American Expeditionary 
Forces in France. Apparently a large portion of these were 
due to the drinking of contaminated water during the fighting 
in the Argonne. The memorandum by Colonel McCaw, chief 
surgeon of the American Expeditionary Forces, points out the 
importance of water contamination and carrier infection in the 
spread of typhoid fever under the conditions prevailing in 
France. It is emphasized that vaccination should be regarded 
only as a partial protection, and should always be reinforced 
by sanitary measures. In a word, valuable as typhoid vaccina- 
tion has proved to be, its efficiency does not warrant any relaxa- 
tion of sanitary precautions." 
The following quotation is from the "New York Medical Journal,'* 
July 12, 1919: 
"Typhoid and Paratyphoid in the Vaccinated and Unvac- 
cinated.-Cesare Pezzi (La Riforma Medica, April 19, 1919) 
finds from a study of statistics in Italy that vaccination has 
no favorable effect on the mortality rate from typhoid. The 
mortality in the vaccinated in 1918 was eighteen per cent, 
and in the unvaccinated 14.7 per cent., while for the two years 
1917-18 the mortality in the vaccinated was 21.7 per cent, and 
in the unvaccinated twenty per cent." 
120 WASSERMANN TEST AND LUETIN TEST 
From Editorial Comment, American Medicine, May, 1915, page 265: 
"Contradictory Findings in the Wassermann Test.-We are 
beginning to have serious doubts of the infallibility of the 
Wassermann test. Indeed, confusion has been' growing for 
some time in the minds of not a few of our leading specialists 
as a result of the contradictory reports from serologists con- 
cerning the findings from the serum of the same patients taken 
at the same time and submitted to different laboratories. As 
a result patients have often been subjected to specific treatment 
notwithstanding a negative history of lues, and made to suffer, 
if not permanent injury, at least great mental anguish. So 
common have these contradictory findings become among com- 
petent syphilographers, that in not a few instances the test 
has been greatly discredited, and in many cases abandoned as 
practically useless. Why the laboratory findings of presumably 
equally expert serologists frequently vary so widely cannot be 
* explained." "It cannot be that our technicians are alone to 
blame, for we find in consulting a report on 'A Further Clinical 
Study of the Contradictory Findings in the Wassermann Test' 
by Dr. Abr. L. Wolbarst, of New York City, (Interstate Medi- 
cal Journal, Vol. XIX, No. 2) that the same difficulties exist 
in Germany. Dr. Wolbarst quotes Wossidlo as making a study 
of twenty cases in seven different serologic institutes in Berlin, 
of which seven agreed and thirteen disagreed. 
"Dr. Wolbarst further reports thirty-three cases in his own 
experience in which absolute contradictions were found. In 
comparing two series of cases he found the following interest- 
ing figures: three serologists examined 85 cases; in 4:2 per cent, 
of these the findings agreed, in 19 per cent, they differed and 
in 39 per cent, they were contradictory." 
In a discussion of the Wassermann test, The Journal of the American 
Medical Association, February 17, 1917, page 520, Dr. Wolbarst, New 
York, is reported to have said: • 
"It has been my experience that you can go into any labora- 
tory in this country and take your choice as to whether you 
are going to get a positive or a negative report on any serum 
submitted. Some laboratories will give you a positive and some 
a negative report on the same serum taken at the same time 
and presented under the same conditions." 
Dr. Leland Boogher, St. Louis, is reported to have said, page 521: 
"I have no faith in the Wassermann test being infallible. 
A minus Wassermann does not necessarily mean no syphilis." 
Quotation from Monthly Bulletin of the Department of Health, City 
of New York, April, 1917, Vol. VII, No. 4, page 37, article on the 
Wassermann Reaction: 
"From the point of view of the physician submitting 
samples of blood for the Wassermann reaction, there are two 
121 principle reasons for occasional dissatisfaction with the results 
obtained. The first is that two portions of the same specimen 
sent to two different laboratories are sometimes reported with 
absolutely contradictory results, and the second is, that incon- 
sistent results are sometimes obtained from the same laboratory 
from week to week." 
Quotation from an article, "A 'Luetin' Reaction in Syphilis Produced 
by Agar," by John H. Stokes, M.D., Rochester, Minn., The Journal of 
the American Medical Association, April 14, 1917, page 1092: 
"The enthusiasm with which cutaneous tests for diagnostic 
purposes have been incorporated into clinical practice is a strik- 
ing tribute to the uncritical frame of mind in which we are 
prone to receive what promises to present the golden combina- 
tion of simplicity and usefulness. Few better illustrations of 
this ready acceptance of the plausible as gospel could be found 
than the reception accorded the luetin reaction." 
From an editorial entitled, "Value of the Luetin Test," The Journal of 
the American Medical Association, June 19, 1915: 
"The luetin test for syphilis, described by Noguchi in 1911, 
seems to have fallen into disuse after a rather brief trial." 
"It [the luetin test] is sometimes strongly positive when the 
Wassermann reaction is repeatedly negative." "Recently the 
specificity of the luetin reaction has been questioned, since other 
substances injected intradermally may give a local reaction 
which cannot be distinguished from the luetin reaction." 
The reader's attention is called to the fact that in an article by Dr. 
Noguchi, of the Rockefeller Institute, published in The Journal of Ex- 
perimental Medicine, December 1, 1911, Dr. Noguchi, describing his 
experiments with Luetin-which consisted of inoculations with a pre- 
paration made from the germs of syphilis-states that he used for 
these experiments, 
"46 normal individuals, chiefly children between the ages of 
two and eighteen years, and 100 individuals suffering from 
various diseases of non-syphilitic nature." 
Extracts from The Journal of the American Medical Association,,. 
February 2, 1918, page 279: 
"The Value of the Wassermann Reaction, as Indicated by 
Postmortem Investigation in Three Hundred and Thirty-One 
Cases at Bellevue Hospital," by Douglas Symmers, M.D., and 
Charles G. Darlington, M.D., with the Collaboration of Helen 
Bittman, New York. (From the pathologic laboratories of 
Bellevue and Allied Hospitals): 
"When the Wassermann reaction was introduced, it was 
widely embraced as marking the end of all diagnostic diffi- 
culties in syphilis. ... As time progressed, instances began to 
multiply in which the reliability of the reaction was brought 
into question . . . there seems to be a growing tendency to 
moderate those views which once were attacked only on a 
charge of heresy. 
"In the pathologic laboratories at Bellevue Hospital we have 
used the Wassermann reaction in the diagnosis of syphilis for 
a period of nearly seven years, during which time about 75,000 
serums have been examined, representing a total of nearly a 
hundred thousand reactions, . . . From the outset the Wasser- 
mann laboratory has been under the supervision of patho- 
logists who, with their assistants, have been specially trained 
122 in serologic work. Every effort has been made to safeguard 
the accuracy of the reports. In view of the doubt concerning 
its reliability as a diagnostic sign of syphilis, not only in our 
own laboratory but elsewhere, we have attempted to corre- 
late the results of the Wassermann reaction with postmortem 
findings, . . ." 
"There were 331 cases in which the result of the Wassermann 
reaction were correlated with the anatomic findings in the same 
subjects investigated postmortem. In 204 cases no anatomic 
signs of syphilis were detected at necropsy, and the Wasser- 
mann reaction during life was negative, or was reported as 
'weakly positive' or 'doubtful.' ... In a considerable number 
of cases, as will be shown later, no syphilis was demonstrable 
at necropsy, and yet the Wassermann reaction during life was 
positive." 
"The Wassermann reaction, on the other hand, is a biologic 
phenomenon which occurs in certain syphilitic subjects and, in 
these circumstances, it is a symptom of value. It is not a 
specific reaction, however, but occurs in conditions other than 
syphilis, and it does not always occur in syphilis." 
The authors refer to certain clinical signs 
"any one or any combination of which, as the case may be, is 
less apt to lead one astray than the results of a Wassermann 
reaction. These and like signs were sought by the clinicians 
of the generation that passed with Delafield and the elder Jane- 
way; but the generation that holds the responsibility of the 
future is being inculcated with an almost reverential respect 
for artificial methods that neither clinician nor pathologist can 
explain or control." 
The authors' conclusions are: 
"1. Depending on the antigen employed, the Wassermann re- 
action in the living patient, as carried out at Bellevue Hospital, 
gives a negative result in from 31 to 56 per cent, of cases in 
which the characteristic anatomic signs of syphilis are demon- 
strable at necropsy. 2. The Wassermann reaction in the living 
patient is positive in at least 30 per cent, of cases in which it is 
not possible to demonstrate any of the anatomic lesions of 
syphilis at necropsy." 
Extract from the Evening Globe, February 8, 1918 (Dispatch from 
Cleveland, Ohio): 
"Commenting today on the article in the current Journal of 
the American Medical Association, in which the Wasserman 
test for syphilis is cast in doubt, Dr. John H. Quayle, the well- 
known authority, said: 'The article entitled 'The Value of the 
Wassermann Reaction,' by Douglas Symmers and collaborators 
in The Journal of the American Medical Association of Feb- 
ruary 2, bears out the claims that I have made for the last 
four or five years in regard to the value of this test in the 
diagnosis of syphilis. Their work was carried out in a very 
careful and scientific manner. The conclusions drawn by the 
writers of the article cannot fail to convince a mind that is 
open on this subject, and are well known among the best 
diagnosticians.' " 
" 'It was very unfortunate that when the Wassermann re- 
action was introduced in the United States it was hailed and 
accepted as an infallible test for syphilis by some members of 
123 the medical profession and pseudo-medical men, and this quickly 
spread to the laity. . . .' " 
" 'The laity should also know that one dose of Salvarsan 
does not cure syphilis, and they should have a full under- 
standing that other remedies must be administered in conjunc- 
tion with Salvarsan before they can be cured.' " 
" 'I believe the Wassermann reaction, as carried out by the 
average laboratory is valueless in the diagnosis of syphilis and 
have proved this to my own satisfaction.' " 
Quotation from a letter by Douglas Symmers, M.D., New York, Act- 
ing Director of Laboratories, Bellevue and Allied Hospitals-The Jour- 
nal of the American Medical Association, August 17, 1918, page 592: 
"Nor has the Wassermann reaction aided materially in the 
all-important determination of the incidence of syphilis. While 
a positive Wassermann reaction is a highly suggestive indica- 
tion of syphilis, it is now almost universally admitted that the 
reaction has its limitations-an occasional enthusiast to the 
contrary-and that it sometimes occurs in conditions other than 
syphilis and that it does not always occur in syphilis. 
"All things being taken into consideration, it would seem 
that the most dependable signs of syphilis still are those which 
pathologic anatomists and properly trained clinicians have long 
known. . . 
From The Journal of the American Medical Association, February 1, 
1919, page 381, a review of an article, "The Misdeeds of the Wasser- 
mann Reaction," by G. Thibierge, Presse Medicale, Paris: 
"Thibierge warns against undue reliance on the Wassermann 
reaction. Even competent and experienced biologists may ob- 
tain contradictory findings at times. It is not a chemical reac- 
tion but a test of the properties of certain substances of 
unknown composition, existing in unknown and certainly vari- 
able amounts, and the test is made by means of other sub- 
stances of equally unknown nature present in the reagent 
also in unknown proportions, and associated in the reagent 
with a crowd of other substances, equally unknown and in pro- 
portions independent of those which are concerned in the reac- 
tion. Besides all these uncertainties is the personal equation, 
one observer regarding as positive what another would class as 
dubious or negative. . . . He warns further of laboratories 
which play into fakers' hands, reporting the reaction as always 
positive. ... He declares further that the seroreaction is nega- 
tive in about 10 per cent, of syphilitics with active manifesta- 
tions of the disease. The reaction is liable to occur also in 
certain skin diseases in nonsyphilitics, . . . This fact has mis- 
led some into assuming a syphilitic origin for some of these skin 
and other affections, including Paget's osteitis deformans." 
"In conclusion he warns against breeding or fostering syphilo- 
phobia in impressionable subjects who ascribe exaggerated im- 
portance to the Wassermann test. The physician must be 
extremely careful in examining and in what he says in regard 
to the Wassermann test to easily unbalanced persons who 
have been exposed to syphilis. An imprudent word or the dic- 
tum of some irresponsible laboratory will convince nonsyphilitic 
men of this type that they have syphilis, and they then fall a 
prey to fakers of all kinds." 
Excerpts from an article, "Serologic Cure (?) In the Light of In- 
creasingly Sensitive Wassermann Tests," by Udo J. Wile, A.B., M.D., 
Professor of Dermatology and Syphilology, University of Michigan 
124 Medical School and Clyde K. Hasley, A.B., M.D., Instructor in Derma- 
tology and Syphilology, University of Michigan Medical School, The 
Journal of the American Medical Association, May 24, 1919. 
Although approving of the Wassermann test as an aid in diagnosing 
syphilis the authors' own conclusions seem to indicate its lack of efficacy: 
"When one compares the relative sensitiveness of older tests 
with those employed to-day, and the ever increasing refine- 
ments, it becomes apparent that at best our laboratory methods 
are crude means to detect chemical and physicochemical changes 
taking place in the cells of the body after infection." 
"We are convinced that in the presence of an intensive ther- 
apy, a positive test does not necessarily mean living spirochetes 
and potential syphilis any more than a positive tuberculin test 
in an individual who has had tuberculosis would indicate the 
presence of living tubercle bacilli. 
"With the ever increasing discrepancies reported with each 
refinement of the Wassermann test; with the ever increasing 
number of permanently positive cases, previously regarded neg- 
ative, it appears to us that as a guide to therapeusis, the Was- 
sermann reaction does not have a leg to stand on. 
"We stand to-day, with regard to the criteria of the treat- 
ment and cure of syphilis, as did the syphilologists of the pre- 
Wassermann day." 
"In the light of our real ignorance of the nature of the re- 
action, particularly in the interpretation of late persistent tests, 
we submit that serologic and clinical cure are not necessarily 
parallel. Energy of treatment directed toward the end of at- 
tempting to make a persistent positive react negatively may 
well be not only useless but misdirected." 
125 WHOOPING COUGH 
The following extracts are from an editorial in The Journal of the 
American Medical Association, October 14, 1916, page 1163, "The Eradi- 
cation of Whooping Cough": 
"In the last generation the death rate from whooping cough 
in the former city of New York (Manhattan and Bronx) has 
steadily decreased from 25.5 per hundred thousand population 
to about 7. It is interesting to note that it went up as high as 
58.82 and that it was frequently four to five times its present 
rate. The lowest rate was 4.71 in 1908. . . . The steady lower- 
ing of the death rate is probably due to the general increase 
in knowledge and observation of public and personal hygiene." 
"One cannot refrain, says Luttinger, who compiled the facts 
here reported, from comparing this lowering of the pertussis 
[whooping cough] death rate with that of diphtheria. Although 
no specific therapy had been used in whooping cough until re- 
cently [and then not successfully as is shown in an article in 
The Journal of the American Medical Association, May 19,1917], 
it compares favorably with the diphtheria curve influenced by 
antitoxin." 
Extracts from an article, "The Therapeutic Value of Pertussis Vac- 
cine in Whooping Cough" (From the Bureau of Laboratories, 
New York City Health Department), The Journal of the American 
Medical Association, May, 19, 1917, page 1451: 
"Grouping together, as did Dr. Luttinger and Dr. Hoag, all 
our patients treated with pertussis vaccine (136), we find that 
the whoop averaged thirty-two days. In those treated with the 
influenza vaccine (94), the whoop averaged thirty-five days. 
In the controls [those not treated with vaccines for purposes 
of comparison] treated with highly diluted milk injections or 
terpin hydrate medication (34), the whoop averaged twenty-six 
day." 
"If we were to make our deductions of the values of the 
vaccines in these comparatively few cases, from the first ar- 
rangement of averages, we would have to infer that there was 
not much choice between pertussis and influenza vaccine, and 
that terpin hydrate by mouth or dilute milk injections were 
superior in curative effect to either." 
". . . the mothers' reports do not make out a case for per- 
tussis vaccine. In the mild cases, in which water ^nade slightly 
turbid with milk, and thought at the time to be a vaccine by 
both doctor and parent of the child, was injected before the 
whoop or paroxysmal cough developed or during the first week 
of the whoop, the trouble terminated in less time than in cases 
treated with either pertussis or influenza vaccine." 
In their summary the writers say: 
"Of all the cases, the shortest course was run in our nonvac- 
cinated controls and those receiving inert, milk-colored water." 
"More observations and more critical observations with con- 
trols for comparison must be made before the case can be 
126 considered made out for the curative and prophylactic value' of 
a specific pertussis vaccine." 
The New York Medical Journal, June 16, 1917, page 1164, reporting 
the remarks of Dr. E. J. Huenekens, Minneapolis, at the Annual Meeting 
of the American Medical Association, June, 1917, in regard to the pro- 
phylactic use of pertussis [whooping cough] vaccine says: 
"He made prophylactic injections in young children in doses, 
varying from 100,000,000 to 2,000,000,000, and after vtwo weeks' 
testing for the presence of antibodies ... in none of the cases 
were the antibodies against the bacillus of Bordet and Gengou 
found to be present. The conclusion to be drawn was that pro- 
phylactic injections of pertussis vaccine has no specific value 
in preventing pertussis." 
"Dr. J. A. Foote, of Washington, D. C., reported that the small 
dose used by him had afforded no protection, did not alleviate 
, the symptoms nor shorten the period of disease." 
127 COLDS 
DYSENTERY 
HAY FEVER 
LUMBAR PUNCTURE 
RATTLESNAKE VENOM 
SKIN DISEASES 
TYPHUS 
Dr. Hill Hastings, Los Angeles, The Journal of the American Medical 
Association, December 2, 1916, states: 
'The use of vaccines, much lauded in various quarters to pre- 
vent 'colds,' has not proved of value in the experience of those 
qualified to pass judgment on this point." 
The Journal of the American Medical Association, November 10, 1917, 
page 1642, in answer to a letter of inquiry as to mixed vaccines for 
colds, bronchitis etc., says: 
"We know of no investigation which demonstrates that the 
use of the commercial mixed vaccines are of value in the pre- 
vention or treatment of 'common colds' or of similar affections. 
The Council on Pharmacy and Chemistry accepts for New and 
Nonofficial Remedies mixed vaccines only on condition that 
their usefulness has been established by acceptable clinical evi- 
dence; so far it has not admitted any of the 'influenza' or 
'catarrahal' mixed vaccines." 
From the report of an address given by Dr. William H. Park, review- 
ing results of the 'treatment of diseases occurring in the army, New 
York Medical Journal, November 2, 1918, page 794: 
"There was no specific treatment to prevent infection in 
dysentery. The ordinary precautions used against intestinal 
infections were employed as thoroughly as possible. The vac- 
cines so far prepared from the various strains of dysentery 
baccilli had been too toxic to be much used. The use of 
specific serum and bacillus mixtures, sensitized vaccine, was 
still in the experimental stage. There had been no vaccine 
developed which was effective in producing immunity against 
infections due to the ameba." 
From an article on "Hay-Fever: Its Cause and Prevention," by 
William Scheppegrell, A.M., M.D., President, American Hay-Fever-Pre- 
vention Association, The Journal of the American Medical Association, 
March 4, 1916, page 710: 
"A careful study of medical literature indicates very clearly 
that the treatment of hay-fever, except as far as temporary 
128 alleviation of the symptoms is concerned, has not been a credit 
to the medical profession. Polantin, which was heralded as a 
cure some years ago, has been successful in my hands in so 
few cases that I have long since discontinued to recommend it, 
and this has appeared to be the general opinion of the medical 
profession. 
"The treatment by gradual immunization with the specific 
pollen inhalation before) the season of the usual attack, which 
I introduced in 1908, proved successful in a considerable num- 
ber of cases, but the effects were not prolonged over a single 
season, and, as the majority of patients feared to prolong their 
hay-fever attack without the assurance of permanent relief, 
and promises to the contrary could not be conscientiously given, 
it was gradually discontinued. 
"Serum and vaccine therapy have been advocated in hay-fever 
as in the majority of other diseases, but the general results 
have been unsatisfactory, and the majority of patients decline 
this severe treatment without a reasonable guarantee of per- 
manent benefit." 
From an article on "Hay Fever," by Solomon Strouse, M.D. and Ira 
Frank, M. D., page 712, The Journal of the American Medical Asso- 
ciation, March 4, 1916: 
"To obtain results of value [in therapeutic experiments], one 
must not attempt to prove anything, especially when the proof 
will depend to a great extent on statistics. In collecting statis- 
tics, some cases are thrown out from one series while similar 
cases are left in the control, and other errors creep in despite 
the most honest efforts of the investigator." 
"Patients are anxious to be cured, and are willing to try 
almost anything. As a result of this feeling, sincere efforts 
of scientific investigators are prematurely pushed on the pro- 
fession by commercial houses, . . . The results of scientific in- 
vestigations and the promises of the commercial literature on 
specific therapy of hay-fever can hardly be said to correspond; 
scientifically speaking, the whole subject must still be con- 
sidered in an experimental stage." 
From Medical Record, March 18, 1911, page 487, "Sudden Death Fol- 
lowing Spinal Puncture for Diagnosis," by Edward M. Colie, M.D., 
New York: 
"I do not think that there can be any reasonable doubt that 
the immediate cause or occasion of the death was the spinal 
puncture. The interval of time (five minutes at the very great- 
est estimate) between the puncture and the onset of the ter- 
minal phenomena is too short to permit of other views." 
That the lumbar puncture connected with the serum treatment of 
several diseases, is not free from serious consequences would seem to be 
indicated by the following quotation from The Journal of the American 
Medical Association, September 16, 1916, page 914. Under the heading: 
"The Dangers of Lumbar Puncture," The Journal reviews an article 
published in Hygiea, Stockholm: 
"A recent compilation by Schonbeck," says the paper, "lists 
seventy-one cases of sudden death after lumbar puncture, . . ." 
From a review of an article on "Lumbar Puncture," by J. H. Barach, 
the New York Medical Journal, September 21, 1918, page 524: 
"Lumbar puncture should seldom or never be performed in 
the dispensary or office. The average patient usually has 
129 .several uncomfortable days after the procedure. Patients with 
various nervous symptoms are apt to show the more severe 
after-effects. A delayed reaction may come on after forty- 
eight to seventy-two hours." 
Quotation from an editorial comment on "The Rattlesnake-Venom 
Treatment of Epilepsy," The Journal of the American Medical Associa- 
tion, June 7, 1913, page 1811: 
"Except that the subject is one of less general interest, its 
sensational publicity has been on a par with that of Shafer's 
Phylacogens and Friedmann's tuberculosis treatment. Through 
it, victims of incurable epilepsy have been led to submit them- 
selves to a method of therapeutic experiment wholly empiric 
and fraught with just such dangers as our editorial [March 
29-1913] indicated." 
Under, "Treatment of Epilepsy With Rattlesnake Venom," The Jour- 
nal of the American Medical Association, March 27, 1915, page 1096, 
answering a correspondent, says: 
"This treatment has been discussed several times, and con- 
demned, in The Journal. Articles have been published showing 
that it does not diminish the number of attacks, and in certain 
cases it has proved dangerous." 
Excerpts from an answer to a letter asking for information concern- 
ing the "Di-Crotalin Treatment of Epilepsy," The Journal of the Ameri- 
can Medical Association, August 17, 1918, page 592: 
"Di-Crotalin is a rattlesnake venom preparation sold by the 
Swan-Myers Company of Indianapolis as a 'Treatment for 
Epilepsy, Chorea, Bronchial Asthma, Chronic or Hereditary 
Nervous Headache, Nervous Prostration Incident to Change of 
Life, Hysteria-Mania, Insomnia, Neurasthenia, etc.' Dr. Thomas 
J. Mays of Philadelphia advocated the use of rattlesnake venom 
for tuberculosis. Later his former assistant, Dr. R. H. Spang- 
ler, used the same material in the treatment of epilepsy. That 
any measure of success sufficient to justify the adoption of the 
rattlesnake venom or crotalin treatment for epilepsy has 
resulted is not to be concluded from the available reports. . . . 
There are a number of good reasons why a cautious physician 
will shun the administration of this treatment and advise 
against it. J. F. Anderson, working in the hygienic laboratory 
of the United States Public Health Service, reported a death 
from the crotalin treatment in consequence of infection, and 
reports that the market supply of crotalin solution and crotalin 
tablets is highly contaminated." 
The Journal of the American Medical Association, April 10, 1915, 
page 1228 contains an article by M. L. Ravitch, M.D., Louisville, Ken- 
tucky entitled: "What is the Present Status of Autoserum in Skin Dis- 
eases?" The following extracts are from Dr. Ravitch's article: 
"Having been an enthusiastic follower of autoserum therapy 
in skin diseases, and having given it a thorough and impartial 
trial, I regret to acknowledge my belief that autoserum therapy 
will prove another 'therapeutic fiasco.' " He speaks of him- 
self as having been accused of "being too much imbued with 
nihilistic views in regard to therapy of diseases," after having 
read a paper before the American Medical Association in 
1913: "In this paper" he says, "I stated that for lack of know- 
ledge of the etiology [the causation] of the majority of dis- 
130 eases, we physicians are always ready to adopt and exalt any 
new remedy or method that may have some promising feature. 
How any thinking physician can, in the present developmental 
era, not become a therapeutic nihilist, is rather an enigma to 
me." Concerning the serum treatment of skin diseases he 
says: "The serum treatment, after being almost abandoned 
in the old country in 1912, was revived in this country in 
1913. . . ." 
"No method," says Dr. Ravitch, "can be called rational and 
scientific until its action can be interpreted. Since we are un- 
able to understand the action of human serum in the treatment 
of diseases, why the withdrawal of blood, the separation of its 
serum, and return of this serum to the body should have 
caused any change in this serum which could cause reactions 
in the organism, and how such a change, if it does take place, 
does really affect the organism, we cannot put this method in 
the class of rational remedial agents. Although improvment has 
followed its employment in certain cases of psoriasis, how can we 
credit the improvement to the autoserum in the face of the 
fact that its action is useless without employment of chrysa- 
robin, the most important and most active remedy in psoriasis." 
As to apparent results he says: 
"In fact, any new method, pushed with enthusiastic persist- 
ence and arousing psychic influence in the patient, will be met 
with temporary good results. Had I published my experi- 
ments with other methods, I could have also given glowing 
results at the time of the beginning of the administration of 
these methods; but as time goes on, my ardor and enthusiasm 
had to give way to real, cold facts and disappointments." 
As to autoserum, Dr. Ravitch gives some objections to its use: 
"Intravenous injection is rather a dangerous procedure. . . ." 
"The technic is not simple or absolutely void of infection, no 
matter how cautious we may be, and the fact that I had no 
infection in my many cases I attribute as much to good luck 
as to my extreme care to maintain asepsis." "We are in total 
ignorance of its action, and of the dangers that may accompany 
such action." Moreover "Investigators fail to state the real 
percentage of cures." 
In summing up, he says: 
"The autoserum is not an ideal or an effective remedy." "In 
psoriasis none of the serums made any impression on the dis- 
ease without the use of chrysarobin." "Urticaria and pruritus 
were not materially benefited by serum of any kind." "A 
judicial and careful use of chrysarobin externally, with the 
employment of a suitable drug internally, is as efficient as the 
autoserum therapy. It is rather a peculiar fact in my experi- 
ence with autoserum in psoriasis that my first cases seemingly 
improved more rapidly than the subsequent ones. Whether 
this was due to the waning of my enthusiasm and the resultant 
lessened confidence on the part of the patient diminishing the 
psychic factor, I do not know, but my method has been the same 
throughout my work, while the results have become more un- 
favorable." 
Harold H. Fox, M.D. in an article entitled: "Vaccine Therapy and 
Other Treatment in Acne Vulgaris and Furunculosis [skin diseases]," 
131 published in The Journal of the American Medical Association, June 24, 
1916, sums up the results of the vaccine treatment as follows: 
"Our investigation would seem to demonstrate, first, the im- 
portant part played by personal hygiene in the cause, preven- 
tion, and treatment of acne vulgaris and furunculosis; second, 
the superiority of well-known therapeutic measures over vac- 
cine therapy in the conditions studied; and third, the value of 
following up the cases to ascertain the number of permanent 
improvements, since experience has shown that the results 
attained during the time of treatment are no criteria of the 
changes to be seen in the eruption at a later date. 
"As T. J. Horder (Lancet, London, January 31, 1914, p. 310) 
has well said: 'The failures of vaccine therapy are probably 
more numerous than its successes.' " 
Extracts from an article on the epidemic of typhus in Roumania, 
by Gideon Wells, M.D., Chicago, and Roger G. Perkins, M.D., Cleveland, 
members of the American Red Cross Commission to Roumania, The 
Journal of the American Medical Association, March 16, 1918, page 
743: 
"To check typhus the only material needs are baths, petrol- 
eum, hair cutters, fire and clean clothes;" 
"Apparently nothing of great value was discovered in respect 
to treatment, which was necessarily symptomatic. . . . Because 
of the immunity of convalescents to typhus, several attempts 
have been made to treat severe cases with the serum of con- 
valescents; but the evidence for the value of this procedure is 
not convincing, although its logic entitles it to a thorough trial.'* , 
132 ADDENDA 
From an editorial on "Prophylactic Inoculation Against Influenza," 
The Journal of the American Medical Association, January 4, 1919: 
"Any one familiar with the history of the numerous attempts 
made in the past twenty years to use specific and nonspecific 
serums and vaccines knows of the countless wrecks of well 
meant endeavor and patient industry that lie high, dry and 
forgotten on the rocks of facts. . . ." 
"The trouble with so much of the 'evidence' on the use of 
vaccines for the prevention of influenza-as stated in the 
recent report of the Committee of the American Public Health 
Association-is not that it is 'contradictory and irreconcilable,' 
but that it is not evidence at all; the pertinent facts are not col- 
lected and evaluated in such a way as to constitute solid 
grounds for either a favorable or unfavorable opinion." 
"Positive results are certainly more gratifying to the average 
investigator than negative; all the more reason, therefore, why 
he should hold himself a little stiffly and be ever on his guard 
against an uncritical acceptance of a desired fact." 
Excerpts from a review of an article on the "Use of Influenza Vaccine 
as a Prophylactic," The Journal of the American Medical Association, 
May 24, 1919, page 1573: 
"An experimental study was conducted by the Massachusetts 
State Department of Health to show the necessity of properly 
controlled experiments to determine the value of a prophylactic 
remedy during an epidemic. A report of this work is made by 
Hinton and Kane. The vaccine used consisted of two strains of 
influenza bacilli, obtained during the present epidemic, one 
strain being recovered at necropsy and the other from the nose 
of an infected patient. . . . The work was done in an institu- 
tion in which influenza had not yet made its appearance, the 
Monson State Hospital for Epileptics, representing a small 
colony of individuals ideally suited for the purposes of this 
experiment. Approximately half of the patients were vaccina- 
ted, and as far as possible this was done by vaccinating a 
patient in every other bed of a ward or room. Careful records 
were kept on 225 patients aged from 4 to 70 years, as to the 
local and constitutional reactions of the vaccine. No reaction 
was noted in 184; twenty-six had headache and vertigo; fifteen 
had cough and coryza ["cold in the head"]. In addition to the 
forty-one patients who gave reaction, eight gave severe reac- 
tions with all of these symptoms. . . . Forty-one patients 
showed mild constitutional symptoms of influenza, consisting 
of rise in temperature or nausea or vomiting or coryza or head- 
ache. The duration of symptoms was for twenty-four hours 
or less, t . . Among the tuberculous patients, the constitutional 
effects of the vaccine, as far as could be noted, differed in no 
way from those without this pulmonary complication. In tab- 
ulating the results of the epidemic, it was noted that some of 
133 the patients having the severest reactions from the vaccination 
developed influenza, although the interval was from four to 
thirty-six days after receiving the vaccine. . . . neither did 
vaccination have any demonstrable effect on the course of the 
disease. ... In addition to the experimental study carried on 
in Monson State Hospital, the same influenza vaccine was used 
for prophylaxis in other state institutions. For one reason or 
another, no conclusive proof as to the value of the vaccine as a 
prophylactic could be obtained in any of them." 
From an article entitled: "Pitfalls in Determining the Prophylactic 
or Curative Value of Bacterial Vaccines, with special reference to In- 
fluenza," by G. W. McCoy, Director, Hygienic Laboratory, United. 
State Public Health Service, United States Public Health Reports, May 
30, 1919: 
"During the prevalence of the epidemic of influenza and 
pneumonia from which the country is just emerging, the writer 
had an opportunity to examine data on the value of certain bac- 
terial vaccines designed for prophylactic or curative use against 
the infection. 
"The inadequacy of the evidence adduced to support the claims 
of certain preparations has been very striking. . . ." 
"Perhaps the commonest source of error is that due to the 
employment of a vaccine in an institution, or in a group not in an 
institution, after cases of the disease have appeared. Influenza 
develops among the persons in a given group, prophylactic 
vaccinations are undertaken more or less promptly, and no cases 
may occur after the inoculations have been completed. The 
results appear most impressive when the number of cases 
among vaccinated and unvaccinated is presented; but when 
closer examination reveals the fact that so large a proportion 
of the personnel involved has developed the disease before the 
vaccinations were done, that in all probability the remainder 
would not sicken, whether vaccinated or not, the figures lose 
their significance. . . ." 
"A second source of error occurs in vaccinating all persons 
in a group, large or small, and interpreting failure of the dis- 
ease to appear or to spread as evidence of protection. One has 
but to study the data with regard to certain institutions, where, 
without vaccinations, the disease has been excluded or has 
spread but slightly, to realize how fallacious are such argu- 
ments. Thus, the writer is acquainted with a large group, 
where vaccinations have been done and where a rigid quaran- 
tine has been in force, which has remained free from the dis- 
ease; and he is acquainted with a number of institutions where 
the same result has been obtained by quarantine alone. 
"The third, and perhaps commonest, pitfall is the drawing 
of conclusions from too meager data. Thus, one observer as- 
sured me that he had been exposed to influenza patients many 
times and had taken no precautions beyond being vaccinated 
and he had not developed the disease. Evidence of this sort 
should be given no consideration, as many of us, the majority, 
indeed, have escaped the disease without having taken any par- 
ticular means to prevent it. 
"We hear of numerous examples of the cure of cases by 
means of vaccine. I have heard related the most astonishing 
examples of apparent great benefit from vaccines in the pneu- 
monia that follows influenza. When the records were scrutin- 
ized, however, it was found that these remarkable cases could be 
duplicated by others that had done equally well without vaccine. 
134 "In the only examples with which I am familiar jn which a 
vaccine was used on alternate cases, no better results were 
secured in the vaccinated than in the control group. 
"The writer suspects that those who have used vaccines most 
commonly have been more facile in making the diagnosis of a 
complicating pneumonia than have others. The author has ex- 
amined numerous clinical records submitted to support the value 
of vaccines in pneumonia, and many of the cases, judged by the 
evidence presented, most certainly would not ordinarily have 
been regarded as pneumonia." 
VIVISECTION INVESTIGATION LEAGUE 
Room 411, United Charities Building, 
105 East 22nd Street 
New York City, N. Y. 
135