I 
PHYSICIAN'S MANUAL 
of VACCINE THERAPY 
G. H. SHERMAN, M. D. 
By 
BACTERIOLOGICAL LABORATORIES oj 
Press of the 
G. H. SHERMAN, M. D. 
Detroit Priced at One Dollar 
COPTMIOHTED 1914 Preface 
THIS little book purports to give in a 
concise, comprehensive manner such facts 
and data as are pertinent to the application 
of Bacterial Vaccine Therapy in the prophy- 
laxis and treatment of infectious disease. 
In order to make the data conveniently 
available for reference, it has been arranged 
alphabetically and titled according to disease. 
The facts and data given are the result of 
seventeen years of study and specialized 
effort in addition to a great deal of research 
work and also clinical investigation carried 
on in hospitals, sanitoria, etc. 
Great credit is due the men who have co- 
operated in this work and who, in a large 
measure, made this authentic information 
possible. 
As the title indicates, it is a manual and 
most necessarily then should be concise, 
convenient and practical. The section on 
Bacteriology does not intend to give com- 
plete information on the subject, but it does 
give that information which the practitioner 
may require at the moment in the application of this important therapy. There are many 
complete works on Bacteriology which can 
be consulted for more complete information 
on the subject. 
Necessarily in a manual of this nature con- 
siderable repetition is unavoidable and advisa- 
ble to provide at the point of reference the 
general information sought for on the point 
in question; otherwise considerable back 
reference would be necessary and would in 
a measure defeat the purpose of the book. 
The Appendix proposes to present from 
the literature such material chosen at random 
as may be of general interest to the reader 
using this form of therapy as an adjunct in 
his practice. Much more could be added 
but it would hardly add materially to the 
usefulness of the book when considered as a 
manual. 
In brief, if this book provides concise, 
comprehensive and practical data on the 
application of Bacterial Vaccine Therapy in 
the prophylaxis and treatment of infectious 
disease, it will serve its purpose. There is a Difference in Vaccines 
DURING the past seventeen years in addition to our own research 
and investigations on the subject of bacterial vaccine therapy and 
allied subjects we have made a most careful study of the literature on 
vaccine therapy. We have not only studied the reports which dealt 
favorably with the subject, but have made it a particular point to read 
and study the reports in which vaccine therapy was criticized. Coming 
in contact with thousands of physicians, we have of necessity heard 
not only favorable comment but also almost every conceivable objection. 
Consequently we believe we can speak authoritatively on the subject 
of vaccine therapy. 
Our observations have convinced us that many of the criticisms 
adverse to bacterial vaccines have in a large measure been justified. 
There are certain cardinal conditions necessary to obtain results with 
vaccines and unless all the conditions are fulfilled, nothing but mediocre 
success or failure is possible. 
Many of the vaccines which were used were lacking in antigenic 
qualities; they were not standardized so that uniform results whether 
good or bad could be obtained. Formulae were selected without regard 
to the actual bacterial flora in the infection to be combated. The value of 
collateral or nonspecific immunity was ignored in the single organism 
vaccines and the specificity of the immunizing mechanism was ignored 
by those who could only see the non-specific reaction with the result 
that they used vaccines entirely unrelated to the actual infecting organ- 
isms. 
The dosage used and interval of inoculation were based on theoretical 
consideration rather than on ascertained clinical fact. 
The fear of adding more toxic material to a patient already overtaxed 
with toxic substance was the stumbling block to a rational dosage. It 
became almost an axiom that the more acute the infection the smaller 
the dose and the longer the interval. Experience has shown that the 
proper procedure is to give larger doses at shorter intervals in acute 
toxic infections. 
Under the circumstances many unfavorable reports on the use of 
vaccines emanated from men who used formulae and dosage with which 
no experienced vaccine therapeutist would expect to obtain results. Why 
so many good men should try methods which have repeatedly ended in 
failure and not at least investigate the methods used by those who are 
obtaining results is beyond comprehension. 
5 6 
A Physician's Manual 
One more word as to the reason for the failures in vaccine therapy: 
The question of efficient vaccines. 
Bacteria are particularly susceptible to the type of culture media on 
which they grow. If grown on plain agar or bouillon the streptococcus, 
pneumococcus and some other organisms lose their virulence quite 
rapidly. In addition to losing their virulence they undoubtedly also 
lose some of their bio-chemical characteristics. There has been much 
said about the individual variations in the different strains of streptococci. 
We are of the opinion that the variation in the bio-chemical construction 
of the streptococcus hemolyticus and viridans is less than the variation 
in bio-chemical construction of either organism when growing in the 
human body and the ordinary culture media used for growing vaccines. 
In other words stock vaccines made from old cultures grown on simple 
culture media are different in their protein construction from organisms 
growing in the human body and cannot be expected to excite an identical 
immunizing response. 
Work done at the Pasteur Institute and elsewhere has shown that 
when a culture is grown on media enriched with the blood serum or 
tissue of an animal the culture becomes virulent for that animal. 
Following the careful selection of cultures for the preparation of 
Sherman's Stock Vaccines, the cultures are carried in media enriched 
with human blood serum. All our stock suspensions are grown on this 
enriched media so the organisms therein should be more nearly identical 
with the organisms in human infection and should produce a more 
specific and adequate immunizing response. The low toxicity and high 
antigenic properties of Sherman's Vaccines which distinguish them 
from others is undoubtedly due in part to our method of cultivating 
them. 
Heat is generally conceded to be deleterious to biological products. 
If heat is deleterious to vaccines, why are all other stock bacterial 
vaccines sterilized with heat? If ordinary room temperatures are 
deleterious what will 550, 65° or maybe even occasionally 70° centi- 
grade do to the potency of a vaccine? 
Numerous workers, among whom might be mentioned Dr. Kolmer, 
are of the opinion that heat is deleterious to bacterial vaccines. 
Sherman's Bacterial Vaccines have been sterilized without heat for 
many years. 
The question of standardization and methods of standardization is also 
of importance. The most common methods are Wright's comparison 
with blood cells, the counting chamber, opacity comparison with stand- 
ard suspensions and the centrifuge method with Hopkins' vaccine tube. 
Each method undoubtedly has certain advantages from the standpoint 
of time, accuracy, etc. of Vaccine Therapy 
7 
Wright's method and the counting chamber are both slow. Opacity 
comparison whether done against standard suspensions of bacteria or 
barium suspensions are extremely subject to the personal equation. Light 
conditions, eyesight, personal judgment, all influence the final result. 
It would be very difficult to get several different groups of workers with 
the opacity method to produce vaccines of uniform strength. Examina- 
tions of vaccines standardized in this manner have shown them to be 
both greatly undercount and overcount. 
The Hopkins method may serve a purpose but is open to the criticism 
that if the organisms are grown in fluid media the fine precipitates that 
form will be thrown down with the bacteria and counted as bacterial 
substance. The same might occur with small particles of agar. 
The number of organisms per cubic centimeter in a i percent suspen- 
sion as given by Hopkins in the Journal A. M. A., 1913, IX, 1615 which 
has been quoted extensively is as follows: 
Streptococcus hemolyticus-8 billions per cubic centimeter. 
Staphylococcus aureus and albus-10 billions per cubic centimeter. 
Gonococcus-8 billions per cubic centimeter. 
Pneumococcus-2.5 billions per cubic centimeter. 
B. Typhosus-8 billions per cubic centimeter. 
B. Coli-4 billions per cubic centimeter. 
Most text books give the size of the streptococcus as 0.4 to 1 micron 
and the typhoid bacillus as 1 to 3 microns long and 0.5 to 0.8 micron in 
diameter. How these two organisms which are so widely different in 
size can occupy the same space in the Hopkins tube is hard for us to 
understand. 
It is also hard for us to believe that the pneumococcus is on the aver* 
age four times as large as the staphylococcus. 
B. Coli according to the Hopkins tube is twice the size of the typhoid 
bacillus. 
As the Hopkins and opacity methods are extensively used in the 
standardizing of vaccine suspensions how are we going to decide or 
compare from a dosage standpoint the results obtained by different 
observers in the use of vaccines? Some workers have reported severe 
reactions from the subcutaneous injection of doses of 5 million organisms. 
In view of what we have observed of such standardizing of vaccines, 
particularly autogenous, we would hazard a guess that the strength of 
the vaccine was guessed at and probably contained several billions of 
bacteria instead of a few million. 
We have made it a uniform practice to count all our vaccine suspen- 
sions by Wright's method, three individual counts being made by dif- 
ferent laboratory workers. These counts must approximate and then 
the average of the three counts is taken as the count. 8 
A Physician's Manual 
The older text books on bacteriology did not make any particular 
differentiation between the Influenza Bacillus and Bacillus Pertussis. 
It was thought that the organisms were almost identical. (Park 6? 
Williams 1910 Ed. P. 484.) 
Laboratory workers when in need of Influenza B. cultures had recourse 
to whooping-cough cases. After the influenza epidemic of 1918 we 
collected quite a number of cultures which were used in the production 
of vaccine during the epidemic We were surprised to find that a 
number of these cultures grew well on media which did not contain 
hemoglobin. As near as we could classify them they were not B. 
Influenza at all but whooping-cough bacilli. As these cultures grow 
more readily than the influenza bacillus they undoubtedly were the 
predominant organism in many so-called influenza vaccines. Of course 
any investigation conducted with vaccines of this nature to determine 
the value of influenza vaccine would prove nothing but that that vaccine 
was valueless. 
From these observations we might say that the criticism against mixed 
vaccines has been due to faulty concepts as to selection of vaccine, 
improper dosage, and the use of products unscientifically prepared and 
lacking in antigenic properties. 
Our efforts have been directed particularly to the development of 
bacterial vaccines which would be efficacious against infections caused 
by the streptococcus, pneumococcus, staphylococcus, colon bacillus, 
micrococcus of catarrh, bacillus influenza and the Friedlander Bacillus or 
groups of these organisms in mixed infections, because these organisms 
cause such a large proportion of all disease and death. 
The streptococcus, for instance, can cause a primary infection in 
practically any part of the human body. Erysipelas, mastoiditis, appendi- 
citis, nephritis, pneumonia, lymphangitis and cellulitis are generally 
conceded to be due to the streptococcus. Rheumatism frequently is 
caused or aggravated by this organism. It is a most common secondary 
invader complicating the treatment of many diseases. The pneumo- 
coccus, while not as diversified in its activities is nevertheless a very 
serious and dangerous infecting organism. A large percentage of the 
pneumonias are probably directly caused by it. In conjunction with the 
streptococcus, this organism is responsible for approximately 100,000 
deaths annually from pneumonia alone. 
The staphylococcus, while not causing as many fatal diseases as these 
other organisms, is still responsible for many secondary infections, which 
undoubtedly aid the streptococcus and pneumococcus in maintaining 
themselves in the tissues of the body. The same is true of the 
micrococcus of catarrh, colon and the Influenza bacilli, as these organisms 
grow in symbiosis with the more virulent ones. of Vaccine Therapy 
9 
Fully two'thirds of the infections which the medical profession is 
called on to treat are due to or complicated by one or more of these 
organisms. 
Many hundreds of physicians have demonstrated to their entire 
satisfaction that it is possible to produce immune substances in appre' 
ciable amounts for therapeutic purposes against these organisms during 
an infection within 24 hours after an inoculation of an appropriate 
vaccine. It was formerly believed that immune bodies were not pro' 
duced until a considerable period of time had elapsed. Recent work by 
Wright has conclusively shown that immune bodies are produced in 
appreciable quantities within a few hours after the vaccine inoculation. 
This has been demonstrated clinically in pneumonia where it is possible 
by giving the vaccine on the first day of the disease to produce a normal 
temperature in a large proportion of the cases in 48 hours. 
This can be done with sufficient uniformity to entirely do away with 
any possibility of coincidence being responsible for the results. Even 
in cases of pneumonia in which the vaccine treatment is started late in 
the course of the disease when the patient is thoroughly overwhelmed 
with toxic substances and theoretically, the tissues have already respond' 
ed to their maximum immuno production, it is still possible to obtain a 
decided degree of therapeutic response. 
At several hospitals a series of pneumonia cases were treated under 
control conditions giving an average mortality rate of the controls as 
38.0% and the vaccine treated cases as 23.3%. These were practically 
all severe advanced cases before vaccine treatment was started. 
It is interesting to note in this connection that at these hospitals, 
our mixed vaccine formula 38 was administered in 1 to 2 c.c. doses at 6 to 
12 hour intervals, depending upon the severity of the case, the largest 
dose being used in those cases which showed the most profound toxemia 
and depression. 
The vaccine treatment of pneumonia is practically parallel to the 
treatment of diphtheria with antitoxin. The most marked results are 
obtained in the early stages of the disease. 
The epidemic of pneumonia which occurred in the Army camps prior 
to the influenza epidemic was very severe and showed a high mortality, 
particularly among the troops who had measles. 
Dr. Arthur Dare at Fort Oglethorpe encampment, by using the mixed 
vaccine early in the course of the disease was able to reduce the mortality 
of these pneumonias to 6.3%. 
Dr. D. H. Montgomery, of Denver, Acting Assistant Surgeon, U. S. 
Public Health Service, in the Alaska Influenza Epidemic Expedition, 
makes a Biologic Report on 958 cases, selected from over 3,000 cases of 10 
A Physician's Manual 
influenza and pneumonia attended in the epidemics of 1918, 1919 and 
1920 (The Bacterial Therapist, March 1923) which conclusively shows 
by comparison of results obtained, the superior qualities of Sherman's 
non'heat killed bacterial vaccines over other preparations that he 
employed. 
Under Resume he says: 
"A good chemically killed vaccine used at the onset of influenza and 
pneumonia with temperatures as high 103.50, will abort the disease and 
on the following day there will be a normal temperature in over 75% of 
the cases. 
"85% of these cases were normal on the day following the second 
dose in which the temperatures at the first visit were 103° to 104.50. 
In this group of cases I find that nearly all are unmistakably diagnosed 
influenza pneumonia. 
"More than 97% of the cases are normal after the third inoculation. 
"Bacterial vaccines sterilized with heat have a lower potency, will 
disintegrate and lose their physiological activity and become cloudy 
when carried in the bag for a short time. 
"Vaccines sterilized without heat are much more potent and physio' 
logically active, do not have to be kept on ice and are active therapeu' 
tically after being carried around for six months or more." 
We confidently believe that it will be possible to reduce the average 
mortality of pneumonia throughout the country to less than 5% by the 
timely and adequate use of bacterial vaccines. This, in itself, is a worthy 
contribution to contemporary medicine, but when it is realized that these 
pneumonias are due to the same group of organisms that are responsible 
for most of the other infections of the respiratory tract, sinus infections, 
eye infections, ear infections and that the same immunizing mechanism 
can be activated to overcome infections by these organisms, no matter 
where the location of the infection may be, it is at once apparent that 
vaccine therapy opens untold fields for the rapid cure of infective pro' 
cesses and the alleviation of untold human misery. 
In trying to appraise the value of these remedial agents, we have 
always tried to be conservative and not be carried away by undue 
enthusiasm. 
By coming in contact with thousands of physicians and discussing 
this subject from many angles the first flush of enthusiasm has long since 
worn off. The novelty of a new idea burns less brightly after seventeen 
years unless there is exceptional merit to the idea. 
We believe that we have arrived at an accurate appraisal of what can 
actually be accomplished with bacterial vaccines. 
It is interesting to note that the Sherman Laboratory has stood almost 
alone in this country in the advocacy of mixed vaccines in the treatment of Vaccine Therapy 
11 
of acute infections. That we have never deviated from the fundamental 
position taken in the early days of vaccine therapy and that our conten* 
tions have been substantiated. That we have not tried to produce any 
trademarked or proprietory variations of a standard product. That most 
of the favorable literature on the use of mixed stock vaccines has come 
from those physicians who have used our vaccines and followed our 
recommendations. That there is not a single report in the literature of 
anyone using our vaccines as we recommend that they should be used 
who has not favorably reported on the same and this in spite of the fact 
that many millions of doses of our vaccine have been administered. 
IMMUNIZATION 
IT IS now well known that most diseases are caused by infecting 
organisms which cripple or disturb the natural functions of the 
various organs of the body. Resistance to infection by pathogenic 
bacteria is what constitutes immunity. Immunity may be natural or 
acquired. Natural immunity constitutes a condition in which a certain 
specie will not become infected by pathogenic bacteria which will 
infect some other specie. Animals, for example, are naturally immune 
to typhoid bacillus infection while man is not. Acquired immunity 
constitutes a condition in which a susceptible person or animal becomes 
immune while overcoming an infection or by vaccination. With some 
pathogenic bacteria an acquired immunity usually lasts through life like 
in smallpox, measles, scarlet fever, chicken pox, whooping cough and 
mumps. With other infecting bacteria the immunity which develops 
while overcoming the infection will wear off in the course of a few months 
or a few years, after which the same susceptibility to the same bacteria 
will again prevail. In some instances enough immunity develops to 
overcome the infection but after this immunity wears off the person 
often becomes more susceptible to the same infecting organism. This is 
particularly noticeable in cases of erysipelas and pneumonia. To some 
pathogenic bacteria immunity is slowly and sparingly developed as is 
the case with the gonococcus. Frequently sort of a balance between 
the activities of the infecting organism and the tissues is established 
when the infection becomes chronic. If the infecting organism is very 
active, with destructive properties and multiplies rapidly, life may be 
destroyed within a few days by virtue of the extreme bacterial intoxica' 
tion which develops. On the other hand, life may be destroyed from 
the suspension of the function of some important organ as the result of 
the organ becoming infected, as, for example, in cases of acute nephritis. 
Much work has been done to determine the nature of a bacterial 
intoxication. From experimental data and from close observations of 12 
A Physician's Manual 
clinical infections it has been found that the ferment producing concept 
more closely fits into what actually takes place during the course of an 
infection than any of the other theories that have been advanced. This 
ferment intoxication concept is based on the fundamental fact that germs 
must produce or secrete ferments to prepare or digest the food on which 
they live and that this digestive capacity really furnishes the only means 
of defense which the germ possesses and constitutes the main element 
of the destructive process which develops during an infection. As a 
whole, in the main, virulence of an organism depends on rate of multiple 
cation, and rate of multiplication depends on the effectiveness of the 
ferment which the germ secretes to prepare or digest the food on which 
it lives. This ferment is secreted from the surface of the germs so the 
germs really surround themselves with this ferment and the digestion 
then becomes a contact process. The germs literally digest their way 
into the tissues they invade. 
All tissues of the body are endowed with the power of developing a 
resistance to germ invasion when such germ invasion is not sufficiently 
destructive to cripple the defensive capacity of the tissues which are 
involved. This is accomplished by the formation of protective ferments 
or antibodies which have a destructive influence on the infecting organ- 
isms as a result of the infection. When this has been accomplished an 
active immunity has become established. 
The tissues of the body are so constituted that a foreign protein 
(germs are composed of protein) substance is not tolerated and to dis- 
pose of it, ferments are produced which digest or destroy this foreign 
protein. Any substance which will cause the production of ferments 
which will destroy the substance itself when introduced into tissues 
or fluids of the body is an antigen. So it will be seen that the contest 
which develops during the progress of an infection is really a contest 
between the ferments which the germs produce to digest the food on 
which they live and the protective ferments which the living tissue 
cells produce to destroy the germs which are responsible for the infec- 
tion. 
A number of these protective ferments have been identified by the 
manner in which they influence germ destruction. When a protective 
ferment causes germs to form clumps, it is called an agglutinin; when it 
causes a precipitate, it is called a precipitin; when it dissolves germs, it is 
called a lysin; when it so influences germs that they become particularly 
susceptible to phagocytic destruction, it is called an opsonin. There are 
no doubt still other methods of action by these tissue-produced, protec- 
tive ferments which have not as yet been ascertained. There is every 
reason to believe that the main action of these protective ferments 
consists in neutralizing the ferment with which the germ surrounds of Vaccine Therapy 
13 
itself and employs to digest the food on which it lives and thereby 
robbing it of its only means of defense by putting its digestive apparatus 
out of commission. 
This antibody producing capacity or antigenic influence of an infecting 
organism is in direct proportion to its virulence to the particular person 
infected, the greater the virulence the less this antigenic influence, the 
degree or intensity of the immunity established being just as great from 
overcoming the less virulent germs as from a recovery from a very severe 
infection. This knowledge, that the less virulent organisms confer as 
great an immunity as the more virulent types, led to the practice of 
prophylactic inoculations which is so successfully employed in the 
prevention of smallpox. Pasteur accidentally discovered that chicken 
cholera germs that had been cultivated under unfavorable conditions, 
no longer produced ill effects when inoculated into healthy chickens, 
but at the same time immunised the chickens against the virulent chicken 
cholera organisms. This discovery laid the foundation for prophylactic 
immunization with attenuated organisms. It was somewhat later dis- 
covered that this attenuating process is not necessary but that it is better 
to kill the virulent organisms either by heat or preferably by means of 
dilute solutions of trikresol or carbolic acid and it was this discovery 
that really placed vaccine therapy on a practical basis for treating the 
ailments to which man is subjected. 
The first question that presents itself is, how can killed germs im- 
munize when injected under the skin? This whole problem of immunity 
is a problem of cell training to produce protective ferments of a particular 
kind which will destroy germs of the same kind that are instrumental in 
influencing these cells to produce these protective ferments. Germs 
that are very virulent to the infected individual are not suited as agents 
for favorably influencing the cells of that individual for protective fer- 
ment or antibody formation because the influence of virulent germs is too 
destructive to the cells with which they come in contact. The athlete 
does not develop strength by attempting the most difficult tasks first. 
That would cause fatigue with disastrous results. By doing the lesser 
tasks first strength is developed to make the more difficult tasks possible. 
The same rule applies to developing cell resistance to infecting bacteria. 
If tissue cells are invaded by very virulent germs, germs that are capable 
of secreting a very effective ferment which they employ to digest the 
food on which they live, the cells with which these germs come in con- 
tact stand a rare chance of surviving. The task is too severe for them. 
But if these tissue cells are brought in contact with less virulent or killed 
germs their defensive faculty is aroused, and since the task is not too 
great, the power of resistance is increased by developing the faculty of 
producing protective ferments or antibodies to destroy these germs and 14 
A Physician's Manual 
meantime they develop the faculty of being able to attack and destroy 
virulent germs of the same kind. In case killed germs, in the form of a 
bacterial vaccine, are injected under the skin, the tissues into which the 
bacterial vaccine is injected set up a protest against this intrusion and 
tissue cell activities become aroused to get rid of these injected killed 
germs. These injected killed germs possess the same biochemical con* 
struction as live germs of the same kind but being killed are deprived of 
the power of secreting destructive digestive ferments and multiplying 
in number. The tissue cells, however, act upon them just the same 
as if an active infection by these same germs had been started. This is 
accomplished by the production of a ferment by these tissue cells which 
will digest or aid the leukocytes in digesting these germs. When tissue 
cells are once aroused in their capacity for producing ferments or anti' 
bodies in the process of getting rid of intruding germs whether they 
have been injected with a hypodermic needle or have gained entrance 
otherwise, they continue to do so for some considerable time thereafter 
and thus establish an immunity. By repeating the injection of a suitable 
number of killed germs at proper intervals as taught by experience this 
immunity can be built up to a degree of efficient intensity. This is the 
method which is now being so successfully employed in the prevention 
of typhoid fever, whooping cough, colds, cholera, bubonic plague, and 
many other diseases. 
Therapeutic Immunization 
This question of prophylactic immunization by injecting killed germs 
is readily understood, but when we come to the problem of immunization 
after an active infection has already taken place to aid them in over 
coming the infection, further consideration becomes necessary. In the 
first place, it is necessary to realize that infections do not involve the 
entire body. As a rule the infection is confined to a definite part of the 
body or some special organ like the lung, kidney, liver, appendix, tonsil, 
skin, joints, mucus membranes, etc. Even in the so-called general 
infections where the circulating blood is infected, the great mass of body 
tissues remain uninvolved except where the infection happens to localize. 
So we see that in case of an infection, a major portion of the body is not 
actively attacked by the invading bacteria. During the immunizing 
process the infected portion of the body is mainly relied upon to produce 
the protective ferments or antibodies to get rid of the infection. That is, 
the infected tissues must come to their own rescue in overcoming the 
infecting bacteria. This is not always possible. If the infecting bacteria 
are sufficiently active with their ferment production to cripple the 
defensive faculty of the involved tissues, immunization will be retarded 
or suspended with a resulting prolonged illness or a fatal termination. of Vaccine Therapy 
15 
If then, bacterial vaccines are injected under the skin remote from the 
infected area composed of killed organisms like those responsible for the 
infection, protective ferments (antibodies) are produced by the tissue 
cells into which the killed bacteria are injected. These protective fer* 
ments are then conveyed by means of the circulating medium to the 
infected area and there aid the involved tissues in overcoming the infec' 
tion. In other words, healthy tissues are induced and made use of to 
produce protective ferments to aid the infected tissues in their battle 
with the destructive bacteria. 
That this actually takes place is readily demonstrated clinically, 
especially so when bacterial vaccines are given during the early stages 
of an acute infection. Let us take as an illustration a case of lobar pneu- 
monia during its early stages. Here we have a condition in which the 
pneumococcus is found in the blood and the infection localizing in the 
lung tissues about the time of the initial chill with pain in the chest, 
followed by high fever, rapid pulse, and coughing up blood'Streaked 
mucus. Every practitioner of clinical experience knows that such a 
combination of symptoms means the beginning of a lobar pneumonia. 
If a combined bacterial vaccine containing the various types of pneu* 
mococci and streptococci is given within three or four hours in suitably 
large dosage and repeated at 12 to 24'hour intervals for several days or 
more, the infection will in a large majority of cases be aborted and the 
case go on to recovery within 3 to 5 days. Similar results are obtained in 
cases of acute lymphangitis, tonsillitis, rhinitis, otitis media, mastoiditis, 
etc. Such clinical results are evidently due to rapid protective ferment 
(antibody) production as a result of the bacterial vaccine injection. 
That the lymphatic internal organs, as some contend, are responsible for 
this protective ferment formation is not established. From this conten* 
tion it must be assumed that it is the general bacterial intoxication which 
follows an infection which influences the internal lymphatic organs for 
this protective ferment production. It may be true that in severe cases 
of infection the internal lymphatic organs eventually come to the rescue, 
but at best this is a slow process which only too often results in a fatal 
termination. This concept would imply that the toxic material contained 
in a dose of bacterial vaccine would add sufficient bacterial intoxication 
to induce the internal lymphatic organs to produce protective ferments 
(antibodies). This cannot be possible because as a rule we have excessive 
bacterial intoxication and this bacterial intoxication often progressively 
increases until death ensues. Furthermore, bacterial vaccines are given 
in such infinitesimal dosage that when injected under the skin no appreci' 
able toxic reaction as shown by temperature or pulse rate is produced. 
About .0004 of a grain of killed germs is an average dose. This is evv 
dently a minute fraction as compared to the bacterial poisons already 16 
A Physician's Manual 
present and being produced every hour as the infection progresses and, 
consequently, could not be instrumental in influencing the internal 
lymphatic organs in any way. But at the site of bacterial vaccine 
injection the killed bacteria are deposited in the subcutaneous tissues in a 
rather concentrated form and there cause a local irritation as shown by 
the inflammatory reaction at that place. Evidently these subcutaneous 
tissues are being influenced in their defensive capacity. The injected 
killed germs bear a relation to these tissues similar to a localized infection 
by the same kind of germs as those contained in the vaccine, the only 
difference being that these killed germs are deprived of the power 
of multiplying and secreting toxic destructive ferments. By properly 
gauging the dose this local tissue reaction may be developed to a point 
where the greatest amount of defensive activity is aroused; a point 
where the tissue cells are not fatigued by excessive bacterial intoxication 
and yet enough to bring forth a maximum amount of protective ferment 
(antibody) formation by these tissues. In other words, by this means 
tissue cells may be stimulated to their utmost capacity for the formation 
of protective ferments. These protective ferments are then absorbed 
by the circulating medium and thus conveyed to the infected area, 
where the involved tissues are aided in destroying the infecting bacteria. 
It is found that the very best results from bacterial vaccine injections 
are obtained during the very early stages of an infection. Bacteria like 
all other living things are endowed with this universal law of developing 
resistance to survive and thereby become immune to substances that 
otherwise would be destructive to them. During the early stages of an 
infection every advantage presents itself for therapeutic immunization. 
First, the infecting bacteria have not had time to immunize themselves 
to the protective ferments (antibodies) of the infected individual. Second, 
they are less in number and consequently it requires less protective 
ferment (antibodies) to destroy them. Third, tissue cells are less capable 
of being induced to protective ferment (antibody) production after they 
have been fatigued by excessive bacterial intoxication and, fourth, the 
infection has not had time to cause as much destruction at the site of 
infection and consequently less repair is necessary to restore normal 
functions. When bacterial vaccines are given during the early stages of 
an infection distinct evidences of immuno development are seen within 
18 to 36 hours by a reduction in temperature, improved pulse rate and a 
noticeable improvement in the infected area. No such rapid improve' 
ments are observed in severe faradvanced infections although decided 
improvement is often observed soon after giving the vaccine and not 
infrequently, apparently hopeless cases eventually recover. For this 
reason no case should be abandoned but therapeutic immunization should of Vaccine Therapy 
17 
be instituted even in the worst kind of cases. The treatment is abso- 
lutely harmless even in severe advanced cases. 
A chronic infection is a condition where the resistance of the infecting 
bacteria to the protective substances of the body has developed to a point 
where the germ may maintain itself and continue to prolong the infection 
indefinitely. In these chronic infections a central focus of low resistance 
often develops which will develop sufficient resistance to eradicate the 
infecting bacteria very tardily and if accessable such foci should be 
treated surgically, therapeutic immunization being at the same time 
instituted to hasten recovery. Where the infection is such that surgery 
is not applicable, therapeutic immunization with bacterial vaccines may 
be relied upon as the best means to eradicate the infection. This is best 
illustrated in cases of chronic bronchitis, arthritis, neuritis, cystitis, 
gastritis, sinusitis, etc. Treatment must be started with small doses 
because these chronic cases are usually rather sensitive to bacterial 
vaccine injections, reactions with considerable inflammation at the site 
of injection being common. The dose should be so gauged that a red 
spot about the size of a silver dollar develops at the site of injection. The 
initial dose is usually about 0.2 c.c. of Sherman's standard suspensions. 
The dose is then increased by 0.1 or 0.2 c.c. each subsequent treatment 
until the dose is worked up to 1.0 c.c. As a rule the inflammatory 
reaction at the site of vaccine injection will become less as the dosage is 
increased. If this reaction should become worse under increasing dosage, 
it would indicate that the doses are too large and smaller doses should be 
employed. Injections should not be repeated in chronic infections until 
the inflammation from the previous injection has well subsided. This 
will take anywhere from 3 to 7 days. In most chronic conditions inocu- 
lations are best made at 5 to 7 day intervals. Most of these cases will 
not tolerate crowding. It is much better to gauge the doses so no marked 
reaction develops and persistently continue the treatment often for 6 
months, a year or more. 
A MULTIPLICITY OF DISEASES PRODUCED BY A FEW 
VARIETIES OF GERMS 
WHEN considering bacterial infections, we must keep in mind 
that we have a large variety of diseases caused by a compare' 
tively few varieties of disease'producing germs. Health is maintained 
by a proper co'ordination of the functions of the various parts and organs 
of the body. If the function of any one organ is interfered with, symp' 
toms will develop that do not conform to the normal standard. If the 
function of the liver is disturbed, we have symptoms that are entirely 
different from a disturbance of the function of the kidneys. So we 18 
A Physician's Manual 
may have a gastritis, cystitis, appendicitis, neuritis, arthritis, iritis, 
otitis, sinusitis, bronchitis, endocarditis, peritonitis, meningitis, rhinitis, 
pharyngitis, tonsillitis, conjunctivitis, dermatitis, lymphangitis, produce 
ing different symptoms in each diseased condition but all being produced 
by a streptococcus. In reality, the streptococcus is capable of infecting 
almost any part of the body and thereby cause a corresponding disease. 
What is true of the streptococcus in this respect, in a large measure also 
holds good with the pneumococcus and staphylococcus. Mixed infec' 
tions by these various organisms are exceedingly common in most of 
these infections. From this it is clear that the bulk of the disease condi' 
tions met with in everyday practice, and by adding the colon bacillus to 
the list which is a common infective agent either as a primary invader or a 
complicating factor in infections of the abdominal viscera and pelvic 
organs, we cover a large majority of the diseases met with in the general 
routine of practice and from an immunologic standpoint must be treated 
as infections by these various organisms regardless of the part of the 
body or organ that is involved. While the streptococcus, pneumococcus 
and staphylococcus are liable to infect any part of the body yet there are 
certain parts of the body in which the infections by these organisms are 
more prevalent. In infections of the tonsils, pharynx and middle ear, 
streptococci prevail. In the nasal mucus membrane and lung the pneu* 
mococci are most prevalent. Skin infections are most commonly due to 
staphylococci. In infections of the gall bladder, pelvis, the kidney and 
bladder, the colon bacillus usually predominates. In the respiratory 
tract we also find the micrococcus catarrhalis, Friedlander bacillus and 
the influenza bacillus as common invaders when either or all of these 
germs are present they are usually in association with pneumococci, 
streptococci and staphylococci. So in reality the latter three organisms 
are the real serious offenders. The same condition prevails in infections 
of the pelvic organs and abdominal viscera where colon bacillus infections 
prevail, staphylococci, streptococci and pneumococci are also liable to be 
present. So, when instituting therapeutic immunization, it is always 
well to bear in mind the prevailing infecting bacteria in the portion of 
the body involved. In infections of the respiratory tract we have the 
streptococcus, pneumococcus, and staphylococcus with the micrococcus 
catarrhalis, influenza bacillus or Friedlander bacillus added. In the 
abdominal cavity and pelvis, the three prior organisms with the colon 
bacillus added and in skin infections primarily the staphylococcus 
aureus and albus. 
In addition to the main general infections enumerated above, we 
have special infections which are very common. Of these, tubercle 
bacillus and gonococcus infections are the most common and serious. 
But when considering even these infections, we find that as a rule these of Vaccine Therapy 
19 
infections assume serious proportions after staphylococci, streptococci, or 
pneumococci become complicating factors of the infection. In gonorrhea, 
staphylococci make their appearance early in the discharge and in the 
chronic cases staphylococci, streptococci, pneumococci and colon bacilli 
become the dominant factors of the infection. In bone tuberculosis 
staphylococci make their appearance and are a prominent factor of the 
destructive process. Mixed infections are a predominating factor in 
pulmonary tuberculosis in which the prevailing infecting bacteria of 
respiratory infections are real pathogenic factors. It is an open question 
whether the tubercle bacilli or the mixed infections in pulmonary 
tuberculosis do the greater amount of harm. To institute therapeutic 
immunization in cases of tubercle infection without taking into account 
the mixed infections is certainly not logical and from clinical experience 
not justified. 
Whooping-cough is a special infection due to the Bordet bacillus. 
Whooping-cough is now being successfully prevented and cured by 
vaccine injections. The greatest source of danger in whooping-cough is 
broncho-pneumonia. In this connection it is necessary to know that this 
broncho-pneumonia is not due to the Bordet bacillus but to streptococci, 
pneumococci and staphylococci as secondary invaders superimposed on 
the whooping-cough infection. For this reason when treating whooping 
cough it is always preferable to employ a mixed vaccine containing the 
common respiratory infecting organisms in addition to the Bordet 
bacillus. By this method the patient becomes prophylactically immun- 
ized to the common respiratory infecting organisms while therapeutic 
immunization is instituted against the Bordet bacillus infection. 
The specific organism which is responsible for scarlet fever has not 
been determined but that the streptococcus is responsible for the serious 
complications which develop during the disease is well established. For 
this reason the use of streptococcus vaccine in this disease is logical and 
from the clinical results obtained, its efficiency has been demonstrated. In 
the natural course of the disease the temperature continues to rise until 
the rash begins to subside. If vaccine treatment is started early and 
injections made at daily intervals as a rule the temperature will come 
down as the rash comes out and extensive lymphangitis and other com- 
plications are avoided. 
Measles is another disease in which the causative infecting organism 
has not been found. The disease is not serious except when pneumonia 
and broncho-pneumonia develop. These pneumonias are essentially 
streptococcus-pneumococcus-staphylococcus infections and should be 
treated as such by giving a combined vaccine in full dosage containing 
these various organisms. By this means pneumonia complications are 
avoided and if pneumonia has developed before the patient is brought 20 
A Physician's Manual 
under treatment this vaccine treatment will materially aid in bringing 
about a rapid recovery. 
Diphtheria is being successfully treated with diphtheria antitoxin 
especially when given in full dosage during the early stages of the infec' 
tion, but not infrequently cases are found where the throat condition 
does not clear up promptly after the antitoxin is given. Such cases may 
safely be regarded as being due to streptococcus and pneumococcus 
infection in addition to the diphtheria bacillus infection. Such cases do 
much better when a combined pneumococcus'streptococcus'staphylococ' 
cus vaccine is given in conjunction with the diphtheria antitoxin. 
Really, all cases of diphtheria in which extensive involvement of the 
lymphatic glands of the neck is present should receive this combined 
vaccine in conjunction with the diphtheria antitoxin. 
Typhoid fever still prevails to a large extent in some communities. 
That preventive inoculations with typhoid vaccine is the best means of 
controlling this disease is now universally recognized. In the treatment 
of the disease typhoid vaccine has also established itself as an efficient 
therapeutic agent, especially so when treatment is started as soon as 
febrile symptoms present themselves. Where typhoid fever is prevalent, 
a clinical diagnosis can readily be made during the early stages. If the 
vaccine is given early a permanent normal temperature may be obtained 
by the 12th to 15th day of the disease. In advanced cases perforation 
from ulcerations of Peyer's patches is recognized as being of greatest 
danger. There is good reason to believe that the colon bacillus, staphylo' 
coccus and streptococcus are important factors in this destructive pro- 
cess and to give a combined vaccine containing these organisms in con' 
junction with typhoid vaccine has been found of advantage. 
From this brief outline of prevailing infections, it is clear that strep' 
tococci, pneumococci and staphylococci are the most persistent patho' 
genic agents to contend with and until this is fully realized our efforts 
at therapeutic immunization can only be partially successful. 
BACTERIAL INTOXICATION 
THE source of bacterial intoxication has long been a topic of interest 
when considering bacterial infections. Many theories have been 
advanced to explain the source of the toxins in infective processes. In 
infections by the so-called endotoxic organisms, like streptococci, 
staphylococci, pneumococci, etc., the theory that the endotoxin which is 
set free as a result of germ disintegration during the course of an infection 
received the most attention. Then, came the split protein theory which 
claims that during the immunizing process germs are destroyed which 
cause a setting free of a poisonous portion of the germ protein, and next of Vaccine Therapy 
21 
the proteose poisoning theory according to which bacterial intoxication 
is due to the absorption of the antitrypsin in the plasma by infecting 
organisms. All these theories fall down when investigated by animal 
experimentation and clinical data. 
The concept that bacterial intoxication, especially in infections caused 
by the more common pyogenic organisms, is due to germ secreted fer- 
ments more nearly conforms to all the conditions found in infective 
processes and is now being more generally accepted than any other. The 
ferment with which the germ surrounds itself and employs to digest the 
food on which it lives is really the only means of defense the germ possess- 
es and of necessity these ferments are also toxic to the tissues with which 
they come in contact. So when a toxic infection is encountered it is 
evident that the toxic irritation in the invaded tissues is due to germ 
secreted ferments. This is well illustrated in a case of streptococcus 
lymphangitis starting from a small abrasion of the skin like a needle prick 
such as have come under our observation and the observation of every 
general practitioner of large experience. Inflammatory symptoms will 
soon appear at the site of infection and within a day or two a chain of 
inflamed lymphatics will extend from the point of original infection. 
This shows that germ multiplication is going on rapidly and meantime 
bacterial intoxication is also progressing. If the streptococcus should be 
very virulent the case may die within 3 or 4 days. In each case it is very 
evident that the bacterial poisoning is most manifest along the chain of 
involved lymphatics. This bacterial poisoning could not be ascribed to 
endotoxins from dead streptococci nor from bacterial proteins derived 
from killed germs because there is every evidence of rapid germ multipli- 
cation and rapid germ multiplication cannot progress simultaneously in 
an infection with extensive germ destruction. The entire destructive 
process in a streptococcus lymphangitis points to the fact that the 
streptococci produce a toxic destructive substance during their growth 
and multiplication. That this destructive substance is a ferment is quite 
evident from our present knowledge of bacterial activities. So, when a 
toxic infection is encountered it should be considered in terms of germ 
secreted ferments which can only be relieved by eliminating the germs 
which are actively engaged in producing these toxic ferments. This 
cannot be accomplished by the application of antiseptics because any 
antiseptic that is powerful enough to destroy the germs will also destroy 
the tissues they come in contact with. Nature, however, has a better 
way. All living tissues possess an inherent power of self-preservation 
against germ invasions and this self-preservation is made manifest by 
ferments which these tissues produce to destroy the germs which attack 
them. These protective ferments are called antibodies. So, the real 
contest between bacterial intoxication and protection by tissue produced 22 
A Physician's Manual 
antibodies is really a contest between germ produced toxic ferments and 
tissue produced protective ferments. If the infecting germs happen to 
be able to produce a very effective ferment the tissues in the infected area 
are destructively influenced to a point beyond their defensive ability 
to produce protective ferments and consequently the destructive process 
will be carried on to a condition of tissue necrosis, pus formation, or a 
fatal termination. The less virulent germs do not secrete such efficient 
ferments and consequently are not so toxic nor so destructive to the 
infected tissues. Of necessity the infected tissues are, under these 
circumstances, more capable of defending themselves and in a better 
position to produce protective ferments which a destructive influ' 
ence on the infecting organisms. Experience teaches that this reduction 
in virulence may be carried to a point of actually killing the germs and by 
injecting them under the skin, tissues so treated will be as actively if not 
more actively aroused in antibody or protective ferment formation than 
they are when brought under the influence of living germs of the less 
virulent types. This is the foundation on which prophylactic and 
therapeutic immunization rests. For prophylactic purposes, killed germs 
are injected into healthy tissues to train and induce these tissue cells to 
produce protective ferments to prevent infections by germs of the same 
kind as those contained in the bacterial vaccine. For therapeutic pur 
poses killed germs of the same kind as those responsible for the existing 
infection are injected into healthy tissues to train and induce these tissue 
cells to produce protective ferments which will be conveyed from the 
site of vaccine injection to the infected area to there aid the involved 
tissues in destroying the infecting organisms. 
THE ADVISABILITY OF GIVING VACCINES ON A 
CLINICAL DIAGNOSIS 
IT IS obvious that in the application of bacterial vaccines a diagnosis is 
necessary. Many welbmeaning physicians contend that in the inter' 
est of scientific treatment, since vaccine therapy is specific in action, a 
bacterial diagnosis should always be made before giving a bacterial 
vaccine. From a superficial consideration, this position looks reasonable 
but it will not bear careful analysis. Science is classified knowledge so 
arranged that it is capable of application for the greatest good. In treat' 
ing disease, the aim is to restore health in the shortest possible time with 
the least suffering and the lowest mortality rate. Before any procedure 
in the treatment of infectious diseases can be regarded as scientific, all 
the factors that enter into the possibility of attaining this end must be 
taken into account. of Vaccine Therapy 
23 
When diphtheria antitoxin first came into use, being a specific treat' 
ment, it was thought necessary to verify the clinical diagnosis by a 
bacterial examination before its administration. Such practice is now 
known to be dangerous because a bacterial diagnosis will cause enough 
delay in treatment to prevent obtaining the best result and frequently is 
directly responsible for a fatal termination. 
Here the combined knowledge that diphtheria antitoxin is harmless, 
although the case may not be diphtheria, and that early treatment is of 
great advantage, makes its administration on a clinical diagnosis more 
scientific than when used after a bacterial examination because all the 
facts in the situation have been considered. 
The same principle applies in the administration of bacterial vaccines. 
In many cases of acute infection, delay in giving the vaccine may 
prolong the course of the disease or hazard the life of the patient. Prac- 
tically all users of bacterial vaccines in the treatment of pneumonia are 
agreed that their earliest possible administration gives the best results. 
Clinical pneumonia is not always caused by the pneumococcus. It may 
be primarily due to the streptococcus, Friedlander bacillus, influenza 
bacillus or other organisms, but here it should not be forgotten that 
dangerous cases of pneumonia are either due to the pneumococcus or 
streptococcus and frequently to a mixed infection of these two dangerous 
organisms. Where we have a serious pneumonia following epidemic 
influenza, pneumococci and streptococci coming in as secondary invaders 
are almost invariably the dangerous factors. This same condition applies 
to the Friedlander bacillus pneumonias and other pneumonias. By 
taking all these facts into consideration, it is certainly more scientific to 
give a combined pneumococcus streptococcus vaccine and preferably 
also one containing the other common respiratory infecting organisms 
(Formula 38) at once than to delay treatment for a bacterial examination, 
because at all events by this method the dangerous infecting organisms 
in clinical pneumonia are guarded against. If there were any clinical or 
experimental evidence to show that the immunizing mechanism is in 
the least interfered with by including the streptococcus in the vaccine 
when used in a pure pneumococcus infection, the objection would be 
valid. But on the contrary, we find that better results are obtained 
with a combined vaccine than where a single organism vaccine is em- 
ployed. This may be accounted for on the ground that in addition to the 
immunizing response, a greater leukocytosis is obtained with a mixed 
vaccine than from single organism preparations. 
In puerperal sepsis the streptococcus is pre-eminently the dangerous 
infecting organism, while staphylococcus, colon bacillus and other 
infecting organisms may also be factors. To overcome a streptococcus 
infection of this character, early treatment is absolutely essential to obtain 24 
A Physician's Manual 
the best results. A bacterial examination of the blood or uterine con' 
tents would not benefit the patient's opportunity to cope with a streptO' 
coccus infection, but the immediate administration of a streptococcus 
vaccine would. Should no streptococcus infection be present absolutely 
no harm could be done. Furthermore, by giving a mixed vaccine, having 
in addition to the streptococcus other organisms corresponding to a prob' 
able mixed infection present, the patient will receive the immunizing 
benefit against these infections without in the least interfering with the 
streptococcus immunization from the streptococcus contained in the 
vaccine. This is the scientific method for treating these cases because it 
most nearly meets the immediate necessary requirement in handling the 
case. 
In the application of vaccine therapy, a diagnosis which takes into 
account the existing infecting organisms as shown by clinical symptoms 
is very essential and in this connection it should be remembered that 
but a comparatively small variety of germs cause the bulk of diseased 
conditions met with, and that they usually gain entrance to the body 
by way of the mucous membranes. Of these the pneumococcus, strep' 
tococcus, colon bacillus and staphylococcus are the most important. 
In the respiratory tract, the pneumococcus, streptococcus, staphylo' 
coccus, micrococcus catarrhalis and Friedlander bacillus form the import' 
ant group, while in the digestive tract, abdominal viscera and pelvic 
organs, the colon bacillus, streptococcus, pneumococcus and staphylo' 
coccus are found the usual disturbing factors. From this it should be 
clear that by using a combined vaccine which conforms to the organisms 
present in the abdominal viscera and pelvic organs, most of the infectious 
diseases met with can be taken care of. In addition to this, we must 
consider that when specific infections like measles, whooping cough, 
influenza, or tuberculosis involve the respiratory tract and gonorrheal 
infection the pelvic organs, the group of infecting organisms mentioned 
above are usually found as complicating factors in the specific infection. 
Skin infections are most frequently due to staphylococcus with the 
streptococcus a frequent associate. 
Rheumatisms are due to the same organisms that involve the respira- 
tory tract or abdominal viscera. By associating these various facts, 
bacterial vaccines may be scientifically applied to better advantage in 
most instances than where they are used on a bacterial diagnosis only, 
but from this it should not be inferred that bacterial examinations should 
not be resorted to. Many times a bacterial examination is the only means 
at our command to determine the nature of an infection, and where the 
case does not progress favorably such examinations should always be 
made while the stock vaccines indicated by clinical symptoms are being 
used. of Vaccine Therapy 
25 
The statement may be made, although it follows as a matter of 
course, that surgical interference, local treatment, drainage and other 
general measures and supportive treatment should be carried out along 
with the administration of any bacterial vaccine. The vaccine stirm 
ulates the immunizing mechanism and naturally cannot take care of 
surgery, etc., where indicated. 
DOSAGE AND SITE OF INOCULATION IMPORTANT 
CONSIDERABLE opposition to the use of bacterial vaccines has 
been encountered, especially in the treatment of acute infections, 
due to improper concepts of dosage based on theoretical grounds. In no 
field of therapeutics is proper dosage of greater importance than in 
therapeutic immunization. The grave mistake has been made of placing 
the toxic element of a bacterial vaccine to the forefront. The thought 
that bacterial vaccines are really given in very small non'toxic doses has 
not received enough attention. The average hypodermic adult dose 
really amounts to less than 0.0004 a grain. of killed germs, containing 
an infinitesimal amount of germ toxin as compared to the toxic material 
already present in a case of extensive acute infection. The thought is 
advanced that in a case of an extensive acute infection the patient is 
literally saturated with bacterial toxins and consequently would require 
small doses of vaccines if at all given on the theoretical contention that 
in such cases giving bacterial vaccines would simply add more bacterial 
toxin to an overloaded system. This is absolutely wrong as shown by 
clinical experience. On the contrary, the initial dose in acute toxic 
infections, to obtain the best clinical results, should be three or four 
times larger (1.0 c.c. of Sherman's standard suspensions) than the initial 
dose in a subacute or chronic infection (0.2 c.c. of Sherman's standard 
suspensions) and the dose should be repeated at daily or twice daily 
intervals whereas in chronic cases injections should be made at four to 
seven'day intervals. Furthermore, in acute toxic infections no toxic 
reactions as shown by increased temperature, pulse rate or toxic nervous 
symptoms develop that can be attributed to the vaccine. Instead of this, 
if the vaccine is given reasonably early during the course of the infection, 
all these toxic symptoms will begin to subside in a large majority of cases 
within twelve to twenty'four hours with a distinct tendency to a rapid 
recovery and especially so if the vaccine injections are continued at proper 
intervals. These clinical results are so striking, when vaccines are used 
during the early stages of acute infections, that there can be no doubt as 
to their immunizing influence. The opposition to the use of bacterial 
vaccines in acute toxic infections is based primarily on the contention 
that immunization results from antibody or protective ferments which 
are produced by the lymphatic internal organs due to the presence of 26 
A Physician's Manual 
bacterial toxins. From the fact that extensive toxic infections usually 
run a prolonged course or have a fatal termination, it is evident that the 
lymphatic internal organs are not readily influenced for antibody forma' 
tion by bacterial toxins and it is also evident that the minute amount of 
bacterial toxin injected in the form of a vaccine could have no material 
influence on the lymphatic internal organs in the presence of extensive 
bacterial intoxication due to an infection. That the tissues at the site 
of the bacterial vaccine injection produce antibody as Wright contends, 
is much more probable. We do know that tissues at the site of vaccine 
injection change in respect to their tolerance to the vaccine. If vaccines 
are repeatedly injected into approximately the same area much less local 
reaction or inflammation will develop from a vaccine injection in this 
than in other portions of the body, showing that a distinct immunologic 
change has developed in these tissues as compared to other tissues of the 
body. It has also been found that better therapeutic results are obtained 
if a new area is selected for each vaccine injection. In compliance with 
this thought many doctors, when giving large doses of vaccine, divide the 
dose and make the injection in three or four different parts of the body 
so that a correspondingly larger area of tissues is brought under the 
vaccine influence. Some very excellent results are claimed for this 
method, especially when employed in advanced dangerous infections. 
It has also been found that it is better to make the injection remote from 
the infected area. If, for example, we have an abscess or lymphangitis 
in an arm, it is not advisable to inject the vaccine into that arm. When 
this thought, that antibodies or protective ferments are produced by 
the tissues into which the bacterial vaccines are injected, once becomes 
thoroughly fixed in a doctor's mind, he will find little difficulty in finding 
his way through the practical application of therapeutic immunization. 
All infections are acute before they become chronic and the severe 
acute toxic infections like pneumonia, erysipelas, lymphangitis, sepsis, 
mastoiditis, scarlet fever, etc., are the most dangerous and for that reason 
a thorough knowledge of the proper dosage in this class of cases is most 
important because if bacterial vaccines are properly applied here, the 
most brilliant results will be obtained. Early treatment is of paramount 
importance because tissues into which the vaccine is injected respond 
much more readily for antibody formation during the early stages of 
an infection than after the body cells have become fatigued from bacterial 
poisoning for several days or a week. The attending physician should be 
prepared to give the proper vaccine at the first visit. The adult dose 
should be i.o c.c. and in severe cases the dose should be repeated at ii' 
hour intervals until the toxic symptoms subside. In the less toxic cases 
the vaccine may be given at daily intervals. After the temperature 
becomes normal and stays there, inoculations should be made at i to 3 of Vaccine Therapy 
27 
day intervals until all signs of infection have subsided and to prevent a 
possible relapse, the vaccine should be given at weekly intervals for 
several weeks after a clinical recovery. 
In acute minor infections with no fever like a cold, inoculations should 
be made at one to two'day intervals starting with 0.2 to 0.5 c.c. and grad' 
ually increasing the dose to 1 c.c. In these cases it is also important to 
give a few doses at weekly intervals to guard against a possible relapse. 
In the treatment of acute infections we find every degree of severity 
from the cases without fever to the most severe cases of bacterial intoxi' 
cation so the doctor must discriminate in the dosage and intervals erm 
ployed to conform to the requirements of the case under treatment. 
The general practitioner, being accustomed to observe clinical symptoms, 
soon acquires the necessary information to gauge the dosage properly. 
In chronic infections, we are confronted with a condition in which 
the infecting organism has developed a sort of tolerance for the protective 
substances of the body and the body tissues have also developed a 
tolerance to the infecting organism. To get rid of an infection thus 
entrenched, a highly developed immunity is required which can only, 
as a rule, be acquired by persistently repeating inoculations. These 
chronic cases are less tolerant to vaccine injections than the acute ones 
and consequently it is advisable to start treatment with small doses to 
avoid unnecessary reactions. The dose should be so gauged that a red 
spot at the site of injection will develop within a day or two about the 
size of a silver dollar. Usually, 0.2 to 0.3 c.c. will suffice for the initial 
dose. The dose may then be increased by 0.1 to 0.2 c.c. with each subse' 
quent inoculation until the dose is worked up to 1 c.c. As a rule inocu* 
lations are repeated at 4 to 7 day intervals and it is found that the reaction 
at the site of injection decreases under increasing dosage. Where the 
patient is very tolerant to the vaccine, the dose may be worked up to 
2 c.c. In these chronic infections, it is of utmost importance that the 
treatment be continued until the case is cured if it takes 6 months, a year 
or more. This is especially true of chronic arthritis, neuritis, asthma, 
cystitis, acne, etc. If a focus of infection is found, it should be removed 
surgically if possible, the vaccine being used at the same time to hasten 
the recovery. In chronic infections unusual organisms are frequently 
present. This can readily be determined by making a bacterial examina* 
tion. In some cases an autogenous vaccine gives better results than a 
stock and on the other hand stock vaccines often effect a cure where 
autogenous vaccines have failed. In some cases very large doses, 2 to 3 
c.c., given in 3 or 4 different parts of the body, followed by slight chill 
and fever will cause a favorable reaction which is followed by marked 
clinical improvement. 28 
A Physician's Manual 
The vaccine should not be used intravenously because the reactions 
caused by this method of injection are too severe and dangerous. Just 
as good results, though not quite as spectacular, are obtained from the 
subcutaneous injection of vaccines and this method is absolutely harm- 
less. 
Infants and children tolerate vaccines very well and should receive 
one-quarter to one-half th/adult dose. 
THE NEGATIVE PHASE 
THE fear of the so<alled Negative Phase in applied therapeutic 
immunization has been largely responsible for otherwise well' 
informed physicians hesitating to employ bacterial vaccines in cases where 
they really would be of great service. Theoretically, the negative phase 
is a state of depressed or negative resistance to infecting organisms for 
several hours or more after a vaccine injection, during which time it is 
believed an existing infection, especially during the acute stage, may gain 
such headway that it will become difficult to bring the infection under 
control. 
That such a negative phase develops from overdosing with tuberculin 
in the treatment of tuberculosis is well known and was the cause of 
abandoning the tuberculin treatment in cases of tuberculosis soon after 
Koch's tuberculins came into use. A negative phase also manifests itself 
at times in the treatment of chronic infections due to streptococci, 
staphylococci, pneumococci, and other organisms. Here the symptoms 
produced by the infection become aggravated by overdosage or by giving 
the vaccine at too short intervals. For this reason it is always necessary 
when treating chronic infections, to start treatment with a small dose to 
gauge the individual's susceptibility to the vaccine, and then work up on 
the dosage in accord with the requirements of the case under treatment. 
To do this effectively requires clinical experience in vaccine therapy. 
Since the phenomenon of a negative phase does make its appearance in 
the vaccine treatment of chronic infections, it has been thought that such 
a state would of necessity be liable to assume dangerous proportions if 
vaccines were employed in extensive acute infections, and especially so 
if the infection had assumed such proportions that the life of the patient 
was in the balance as it were. We can readily see how reluctant anyone 
with this viewpoint in mind would be to give a bacterial vaccine in a 
critical case of acute infection. To have a severe acute infection assume 
an additional virulence, if only for a few hours, would certainly be a 
serious affair because the headway made during this time might be suffi' 
cient to seriously handicap the patient's ability to cope with the infection 
during the entire course of the illness. But theoretic considerations, in a of Vaccine Therapy 
29 
proposition as complicated as immuno-production proves itself to be in 
the course of an infection, bring us nowhere. The only reliable way this 
proposition can be efficiently worked out is by clinical application and 
by applying clinical tests, we find exactly the opposite of these theoretical 
contentions to be true. We find that no negative phase as indicated by a 
rise of temperature, increased pulse rate or unusual extension of the 
infected area develops after a vaccine injection when given in severe 
acute infections even under initial doses 4 to 5 times as large as those 
usually employed when starting treatment in chronic infections and 
repeating the injections at 12 to 2,4'hour intervals instead of 3 to 7-day 
intervals as found advantageous in treating chronic infections. Further- 
more, instead of a negative phase developing with a prolonged illness, 
toxic symptoms soon begin to subside. 
Why this tolerance to large doses of bacterial vaccines, (no negative 
phase in cases of extensive acute infections being produced) prevails 
may be difficult to explain, but since efficient immunizing responses, as 
shown by the favorable clinical results, can only be obtained by giving 
these large doses it is evident that the infective conditions in these acute 
infections are such that large doses at short intervals are required to 
bring out a proper immunizing response. That in acute infections exces- 
sive toxic materials are produced and that these toxic materials do not 
adequately stimulate immuno-production is evident since a large amount 
of toxic material is present; it is also evident that a large amount of anti- 
body is required to neutralize this toxic substance and clinical experience 
shows that only by giving large doses at short intervals can this be 
accomplished. So, to properly keep up adequate antibody formation, 
it is necessary to repeat large doses of vaccines at short intervals. 
FOCAL REACTIONS RELAPSES 
A FOCAL reaction in vaccine therapy is shown by a temporary 
clinical manifestation of increased irritability of the infected area 
and if such a reaction does develop after injecting a dose of vaccine, it is 
regarded as being of diagnostic value, it indicating that the infection is 
due to organisms identical to those contained in the vaccine. 
Many attempts to explain these focal reactions have been made on the 
theory of an anaphylaxis. Dr. W. Ford Robertson in his recent book on 
Therapeutic Immunization regards this anaphylaxis theory of focal 
reactions as absolutely unfounded. He shows that instead of being an 
anaphylaxis, it is simply a condition in which the patient is particularly 
intolerant to bacterial toxins. It is not an unusual experience to have a 
patient who is very intolerant to bacterial toxins-persons who get 
severe reactions from exceedingly small doses-develop focal reactions 30 
A Physician's Manual 
at the site of every previous vaccine injection as manifested by a distinct 
redness afld infiltration of the previously injected tissues. In protein 
anaphylaxis, this reaction becomes worse under repeated injections 
whereas under bacterial vaccine injections, this reaction becomes less 
under continuous treatment. This shows that instead of an anaphylaxis 
to the bacterial protein contained in the vaccine, a tolerance to the 
bacterial toxin contained in the vaccine is developed as the principal 
factor in focal reactions. It is this deficiency of resistance to bacterial 
toxins, especially the toxins produced by the more common infecting 
organisms like streptococci, pneumococci, and staphylococci, that is 
responsible for many ailments not ordinarily recognized as being due to 
infection. 
In the treatment of cases that are particularly sensitive to bacterial 
vaccines, we find that very small doses must be employed at first and then 
be gradually increased in accord with the resistance which develops. 
As a rule in such cases, very little therapeutic results will be observed 
until sufficient resistance has been developed so that an average dosage 
will be well tolerated. This shows that there is a close relationship 
between tolerance of bacterial toxins and immunity. This may be 
explained by considering bacterial toxins as substances that are destroyed 
by ferments or antibodies which are formed as a result of vaccine inocu- 
lations. So in the end, this question of tolerance would really consist of 
the ability to readily destroy these bacterial toxins. 
Theoretically, it would appear that after an infection has once been 
subdued by induced antibody formation as a result of vaccine injections, 
that the antigenic influence of the infecting organisms still present in the 
infected area, would be sufficient to complete the immunizing process 
and eliminate the infection; but from clinical experience, we find that 
this is not the case. It is a common experience to find, while treating 
cases of pneumonia, erysipelas, puerperal sepsis, typhoid fever, etc., that 
after giving several doses of vaccine and material improvement has 
developed, that if the vaccine treatment is then discontinued, in a large 
percentage of cases, the infection will again take on new activities which 
will again subside if vaccine treatment is reinstituted but unfortunately 
not infrequently, this renewed activity of the infection will not respond 
as adequately to the vaccine treatment as when the infection was first 
brought under control. This in all probability is due to the infecting 
organism, as time goes on adapting itself to its environment, immunizing 
itself to the antibody formed by the body cells, so that it becomes more 
and more difficult to destroy the infecting organism by the immunizing 
process. For this reason it is always advisable, when treating acute 
infections, to continue the vaccine treatment until the infection is en- 
tirely eliminated and also to give a few more doses during convalescence. of Vaccine Therapy 
31 
To summarize: The negative phase plays no part in the treatment of 
acute infections. The best therapeutic results are obtained by giving 
large doses at short intervals. • To obtain permanent results vaccine treat' 
ment must be continued until the patient is completely convalescent. 
RELIEF FROM PAIM LEADER THERAPEUTIC 
immunization: 
DURING his early work in therapeutic immunization, Wright 
demonstrated that with the development of an immunity during 
an infection, we also simultaneously obtained relief from pain. This is 
particularly noticeable in cases of acute infections under vaccine treat' 
ment. This is well illustrated in cases of lobar pneumonia. The pain 
of lobar pneumonia is characteristic. As a rule a person coming down 
with pneumonia suffers sufficiently to call a physician, soon after the 
initial chill. If vaccine treatment is started soon after the initial chill 
by giving a full dose of a combined pneumococcus'streptococcus'staphy' 
lococcus vaccine, it will be found that relief from pain will be observed 
within 18 to 24 hours and if the vaccine injections are continued at daily 
or twice daily intervals enough immunity will be developed to abort 
the infection in a large majority of cases with complete relief from pain. 
What is true of pneumonia, is also true of acute streptococcus infections 
of wounds or tonsils, otitis media, etc. 
This relief from pain under therapeutic immunization is readily ex- 
plained from what is known in immunologic science. That the severe 
pain at the site of an acute infection is caused by the irritating effect of 
the germ produced toxins or ferments, which the germ employs to digest 
the food on which it lives, is apparent. That other manifestations of 
pain, headache, aching pains throughout the body, etc., are due to germ' 
produced toxins that have been conveyed throughout the body from the 
infected area is also clear. Evidently, one of the first functions of an 
antibody, whether produced as a natural consequence in overcoming an 
infection, or as a result of vaccine inoculations, is to neutralize this germ- 
produced toxin or ferment. It is by means of this ferment, that the 
germ employs to digest the food on which it lives, that it defends itself 
against phagocytic action. If antibody is formed which neutralizes this 
germ-produced ferment, of necessity the toxic irritation will be eliminated 
and thereby relief from pain will be established. This would apply to 
the ferments that have permeated the entire body as well as those present 
in a more concentrated form at the site of infection. These germ-pro- 
duced ferments are not only irritating to the tissues but to the phagocytes 
as well and as long as a germ is capable of surrounding itself with an 
active digestive ferment, phagocytes find such a germ too toxic for attack A Physician's Manual 
32 
and consequently we have no phagocytosis, we have what is known as a 
negative chemotaxis. These antibodies, however, by neutralizing the 
ferment surrounding the germs, reduce the offensive character of the 
germ sufficiently to allow phagocytic action. Consequently this anti' 
body does not only function by eliminating the toxic, germ'produced 
substances but also indirectly causes germ destruction. 
There is really nothing more characteristic in immuno-therapy than 
this relief from pain after vaccine injections. In pneumonia cases, it is 
found that under daily injections of vaccine even in advanced cases, 
relief from pain is a characteristic symptom and will serve a better pur' 
pose in quieting a restless patient than morphine without producing 
harmful depressing effects which so often follow the administration of a 
narcotic. What is true of pneumonia also holds good with other acute 
infections under vaccine treatment. 
LIVE VIRULENT GERMS ARE NOT DEPENDABLE 
ANTIBODY PRODUCERS 
SPONTANEOUS recovery from an infectious disease is due to 
the development of an immunity. Prolonged infections are due 
to retarded immunization. Virulent, live bacteria in an active infection 
often inhibit immunization, resulting in a fatal termination. It is this 
tendency of live bacteria in an active infection to retard or inhibit 
immunization that makes the infectious diseases so dangerous. Killed 
or devitalized bacteria, when injected under the skin, rapidly stimulate 
antibody production. This is clearly demonstrated from our experience 
with prophylactic vaccine inoculations. 
It is the realization of this fundamental principle, that live virulent 
bacteria have a tendency to retard or inhibit immunization while killed 
bacteria inoculations readily stimulate antibody production, that justb 
fies the application of vaccine inoculations in the treatment of acute 
infectious diseases. 
Where the virulence of bacteria has such a devitalizing influence on 
the tissue cells with which they come in contact that antibody pro' 
duction is retarded or inhibited, enough healthy tissue can always be 
found into which vaccines may be injected for the purpose of "getting 
them busy" in antibody production and in this way aid the diseased 
tissues in overcoming the acute infection. 
EFFECT OF VACCINES 
TONIC properties are ascribed to many measures; but, generally 
speaking, any agent that aids in building up the vitality of the body 
may be considered a tonic. This implies increased healthy metabolism of Vaccine Therapy 
33 
with increased cell activity. Many measures in common use have this 
stimulating effect, among them wholesome outdoor exercise, sunlight, 
properly applied hot and cold baths, massage, electric radiation, mental 
composure, etc. 
Vaccines are primarily regarded efficient as immunizing agents in the 
treatment or prevention of infections; but, from clinical observation, we 
find that this does not limit their field of usefulness. One of the most 
constant and characteristic results, following the use of vaccines, 
especially when applied in the treatment of chronic infections, is the 
rapid development of a feeling of well-being associated with a keen desire 
to take food, good digestion and an increase of body weight. Here is 
evidence of increased cell activity, augmented healthy metabolism, which 
can only be ascribed to the vaccine injections and should be regarded as a 
tonic influence. 
This tonic influence of vaccines has not received the attention it 
deserves. Tonics in all probability exert their influence by stimulating 
cell activities through a certain kind of cell irritation. The tonic property 
of arsenic is probably due to cell irritation and the same may be said of 
other tonics. One of the most common experiences is the development 
of robust health after recovering from an infectious disease, even by 
those who are not so vigorous before the illness. Recoveries from 
typhoid fever are illustrative. This may be best accounted for on the 
ground that, as a result of the infection, tissue cells have been stimulated 
to renewed activities and that these activities, after being once acquired, 
will continue up and beyond the requirements of eliminating the infection, 
which culminates in increased constructive metabolism. Cell activities, 
which result from vaccine injections, are identical with those obtained 
from eliminating an infection; but since the injection of killed germs are 
incapable of doing any harm, the benefits of these tonic activities may be 
obtained without the danger incidental to an infection That these 
vaccine injections do arouse cell activities identical to those which devel- 
op by overcoming an infection is easily determined by compliment 
deviation tests, the opsonic index, agglutination tests, blood counts, etc. 
This general tonic effect of vaccines may be applied to advantage in 
any case where other remedies fail. It is usually advisable to use a colon 
bacillus combined vaccine for this purpose. A Physician's Manual 
34 
REFERENCE TO FORMULA BY NUMBER 
IN order to avoid the tedium of a useless repetition of formulae as the 
occasion of mention demands, the formulae have been referred to by 
number. The formula number and the formula following it is given in 
the following tabulation:- 
LIST OF SHERMAN'S BACTERINS 
Sterilized Without Heat 
Acne Combined Vaccines 
33 
Acne Bacillus 
40,000,000 
Staphylococcus Albus 
1,000,000,000 
50 
Acne Bacillus 
40,000,000 
Colon Bacillus 
300,000,000 
Staphylococcus Albus 
1,000,000,000 
Catarrhal Combined Vaccines 
40 
Streptococcus 
100,000,000 
Pneumococcus 
100,000,000 
Micrococcus Catarrhalis 
200,000,000 
Staphylococcus Aureus 
200,000,000 
Staphylococcus Albus 
200,000,000 
36 
Friedlander Bacillus 
300,000,000 
Micrococcus Catarrhalis 
200,000,000 
Pneumococcus 
100,000,000 
Streptococcus 
100,000,000 
Staphylococcus Aureus 
200,000,000 
Staphylococcus Albus 
200,000,000 
Colon Bacillus Combined Vaccine 
(Modified Van Cott) 
35 
Streptococcus 
100,000,000 
Pneumococcus 
100,000,000 
Staphylococcus Aureus 
300,000,000 
Staphylococcus Albus 
300,000,000 
Colon Bacillus 
200,000,000 
Erysipelas Vaccine 
1 
Streptococcus Erysipelatis 
100,000,000 
Staphylococcus Albus 
200,000,000 
Gonococcus and Combined Vaccine 
25 
Gonococcus 
1,000,000,000 
49 
Gonococcus 
1,000,000,000 
Streptococcus 
100,000,000 
Pneumococcus 
100,000,000 
Colon Bacillus 
200,000,000 
Pseudo'Diphtheria B. 
300,000,000 
Staphylococcus Albus 
1,000,000,000 
Influenza Bacillus Combined Vaccine 
38 
Influenza Bacillus 
200,000,000 
Streptococcus 
100,000,000 
Pneumococcus 
100,000,000 
Micrococcus Catarrhalis 
200,000,000 
Staphylococcus Aureus 
200,000,000 
Staphylococcus Albus 
200,000,000 
Meningococcus Vaccine 
34 
Meningococcus 
1,000,000,000 
Pneumococcus Combined Vaccine 
6 
Streptococcus 
100,000,000 
Pneumococcus 
100,000,000 
Staphylococcus Aureus 
200,000,000 
Staphylococcus Albus 
200,000,000 
Staphylococcus Combined Vaccine 
22 
Staphylococcus Aureus 
1,000,000,000 
Staphylococcus Albus 
1,000,000,000 
Streptococcus and Strepto. Combined 
42 
Streptococcus 
400,000,000 
10 
Streptococcus 
120,000,000 
Staphylococcus Aureus 
300,000,000 
Staphylococcus Albus 
300,000,000 
Tubercle Bacillus Vaccines (7{onn»irulent) 
45 
Non-virulent T. B. 
500,000,000 
47 
Non-virulent T. B. 
1,000,000,000 
Typhoid and Combined Vaccine 
30 
Typhoid Bacillus 
1,000,000,000 
46 
Typhoid Bacillus 
1,000,000,000 
Paratyphoid Bacillus "A" 
750,000,000 
Paratyphoid Bacillus "B" 
750,000,000 
Whooping Cough Vaccines 
37 
Bordet's Bacillus 
3,000,000,000 
43 
Bordet's Bacillus 
3,000,000,000 
Micrococcus Catarrhalis 
100,000,000 
Pneumococcus 
40,000,000 
Streptococcus 
30,000,000 of Vaccine Therapy 
35 
Of the more common Pathogenic Organisms. 
Streptococcus 
BACTERIOLOGY 
THE Streptococcus is a parasitic 
pathogenic organism. The 
cells are spherical and are usually 
united in chains, of varying lengths, 
due to the division of the organism 
in one plane only. Under certain 
conditions it may be aggregated in 
irregular heaps or masses. It is 
non'motile and does not form 
spores. 
The hemolytic streptococcus is 
one which causes destruction of 
hemoglobin in the blood. 
The streptococcus viridans 
causes a green discoloration of the 
blood when grown on artificial 
culture media. 
The nonhemolytic strains have little effect on blood culture mediums. 
Sherman's streptococcus vaccine contains a representative selection 
of these various strains. 
The streptococcus occurs not infrequently in the various orifices and 
in the alimentary canal of healthy individuals. Such organisms are to be 
regarded as potentially virulent and pathogenic in all cases. 
Streptococci may be primary pathogenic invaders, or they may be 
secondary invaders whose activities complicate, modify and sometimes 
outweigh in importance those of the primary invaders. They are found 
in tonsillitis, rheumatism, erysipelas, malignant endocarditis, periostitis, 
otitis, meningitis, pneumonia, empyema, lymphangitis, sepsis, puerperal 
endometritis and many other forms of inflammation and septic infection. 
In man, invasion by the streptococcus is usually associated with active 
suppuration and sepsis. 
The suppurative conditions for which the streptococcus is held to be 
responsible, differ from those caused by the staphylococcus in having a 
greater tendency to spread, and are more prone to generalized infection 
or septicemia. 36 
A Physician's Manual 
Pneumococcus 
THE typical pneumococcus is a 
small slightly elongated coccus, 
conical or lance shaped, which 
shows a marked tendency to occur 
in pairs (diplococci) with the 
broader ends in opposition. Occa' 
sionally it is arranged in short 
chains resembling the streptococ' 
cus. All pneumococci except a few 
strains are enveloped by a capsule. 
Since there is an unusually high 
mortality attending infection with 
the pneumococcus mucosus, or 
type III, which has a well de' 
veloped capsule, it has been sug' 
gested that the capsule may protect 
the organism against the injurious influence of the body fluids. 
Pneumococci are divided into four groups (Types I, II, III, and group 
IV). The most severe types of pneumonia are produced by Types I, II 
and III. Type I is often found in cases of lobar pneumonia. The types 
of organisms in group IV are variable in their pathogenic power. All 
four types of the organism are found in Sherman's pneumococcus vaccine. 
The pneumococcus is not only held responsible for most of the cases 
of lobar and broncho'pneumonia, but also for a large number of other 
pathological conditions. It is commonly found in the inflammations of 
the pleura, pericardium, endocardium and sometimes the meninges. 
Practically all body tissues are subject to attack by this organism. It 
may also be found in middle ear infections, abscesses, empyema, suppur* 
ation in the antrum, purulent arthritis and in acute and chronic catarrh. 
mm. of Vaccine Therapy 
37 
Staphylococcus Pyogenes Aureus 
THE staphylococcus is one of 
the most common pathogenic 
bacteria, usually present on the 
skin and mucus membrane, and is 
the organism commonly found in 
boils, furuncles, ulcers, eczema and 
abscesses, and similar suppurative 
inflammations. Infection by this 
organism is usually localized, and 
frequently produces copious quan- 
titles of pus. Primary infection 
by this organism is often followed 
by lowered resistance and repeated 
reinfection. 
The cells are small and spherical 
occurring solitary, in pairs as diplo- 
cocci or in groups of four but most commonly in irregular masses, similar 
to clusters of grapes. The staphylococcus aureus stains readily and is 
gram positive, non-motile, aerobic, facultative anaerobic micrococcus. 
Grows readily on all culture media. It liquifies gelatin. On agar the 
growth is whitish at first, later becomes a rich golden yellow on the 
surface. The yellow pigment is produced only in presence of oxygen. 
Milk is coagulated. Acid, but no gas, is produced in media containing 
carbohydrates. 
The staphylococcus has greater resistance to outside influences, heat, 
sunlight, dessication, etc., than other non-spore bearing pathogenic 
bacteria. The pathogenic effect of the staphylococcus aureus on test 
animals varies considerably as to application, virulence of culture em- 
ployed and species of animal used. 
Staphylococcus Pyogenes Albus 
THIS organism is found primarily on the skin, in certain types of 
acne as a primary factor and in others in symbiosis with the Bacillus 
Acne. It is also found as a complicating factor in various types of 
urethritis. 
It is morphologically identical with the aureus, and is considered by 
some to be the same organism which has lost the property of producing 
pigment. Surface cultures on all media are white. The Biological 
characteristics can not be distinguished from staphylococcus aureus. 38 
A Physician's Manual 
Staphylococcus Citreus 
THIS organism is seldom found in the pus of acute abscesses, but 
occasionally is found associated with other pyogenic cocci and is 
distinguished from the other staphylococci only by the formation of a 
lemon yellow pigment. 
If cases of staphylococcus infection do not respond promptly to 
inoculations of albus and aureus vaccine, it is advisable to have a bacterial 
examination made to ascertain if the staphylococcus citreus is responsible 
for the infection. 
Micrococcus Catarrhalis 
THE micrococcus catarrhalis is 
spheric or slightly ovoid. It 
may occur singly, though usually 
in pairs or clusters. It is readily 
taken up by the leukocytes and 
may resemble the gonococcus or 
meningococcus. 
It is found in the sputum, nose 
and throat, in cases of bronchitis, 
pneumonia, whooping cough, colds, 
bronchial catarrh and other affec- 
tions of the respiratory tract. 
Owing to the frequent occur- 
rence of this organism in the upper 
respiratory tract, it may be mis- 
taken for the meningococcus. It 
may be differentiated by the fact that it does not ferment dextrose and 
maltose as does the meningococcus. of Vaccine Therapy 
39 
Meningococcus 
THE meningococcus occurs as 
diplococci in groups within 
the leukocytes. In culture it oc- 
curs as cocci, diplococci and 
tetrads. There are four types or 
varieties of meningococci which 
are distinguished by their aggluti- 
nation reaction. 
This organism causes cerebro- 
spinal meningitis. It may also 
produce hemorrhagic septicaemia 
without meningitis. 
Gonococcus 
Gonorrhea, which is con' 
fined to the human race, is one 
of the most prevalent of bacterial 
diseases. It is met with through' 
out the civilized world. The causa' 
tive organism was first demon' 
strated by Neisser, in 1879, but 
was not cultivated on a culture 
media until 1885. 
Gonococci usually occur in pairs 
with the adjacent sides flattened 
and separated by a small interval so 
that they resemble a coffee'bean. 
They are non'motile, nomsporing 
and are not stained by Gram's 
method. In preparations made 
from gonorrheal pus, the organisms are found within the pus cells, very 
few ever lying free. For isolation they require nutrient agar containing 
blood, blood serum or ascitic fluid at a temperature of 300 to 38° C. 
They die readily at room temperature and are very sensitive to light and 
drying. 
The most frequent seat of infection by this organism is the genito' 
urinary tract but it also commonly causes conjunctivitis, arthritis, and 
endocarditis. Occasionally a septicaemic condition may occur. In rare 40 
A Physician's Manual 
cases meningitis is caused by the gonococcus in which case great care 
must be taken to distinguish that organism from the meningococcus 
which it resembles in appearance. The gonococcus does not grow on 
ordinary culture media unless a considerable quantity of pus is smeared 
on the surface, 
Influenza Bacillus 
THE influenza bacillus is one of 
the smallest pathogenic organ' 
isms. It is non-motile and non- 
sporing but the poles have a ten- 
dency to stain more deeply than 
the center. It occurs singly, in 
small groups, threads or in short 
chains. Hemoglobin is essential 
for the growth of this bacillus. 
The organism is found in abun' 
dance in the secretions of the 
mouth and nose of "influenza" 
patients. Mixed infections of the 
influenza bacillus with the pneu' 
mococcus or the streptococcus are 
frequently encountered. The in' 
vasion of the body is through the air passages. 
When lung tissue is affected, a lobular type of pneumonia is the result. 
It is sometimes found in inflammation of the middleear andof the meninges. 
THIS Bacillus, the cause of 
whooping-cough, is a short, 
oval rod, variable in size, non- 
motile, and gram negative. It is 
aerobic, facultative anaerobic; 
when first isolated in pure culture 
it grows best upon glycerin-potato- 
blood-agar. Later generations grow 
more or less copiously upon the 
ordinary culture media. The ba- 
cillus is isolated from sputum with 
difficulty. The first week of the 
disease offers the best opportunity 
for isolation. As the disease pro- 
gresses it becomes increasingly 
difficult to isolate the organism. 
Bordet Gengou Bacillus (Bacillus Pertussis) 
• M of Vaccine Therapy 
41 
This Bacillus can be differentiated from the influenza bacillus and other 
organisms closely resembling it, which are present in the sputum of 
whooping-cough cases by its growth without the presence of hemoglobin 
in the culture medium. 
Bacillus Friedlander 
B. FRIEDLANDER was at one 
time regarded as the cause of 
Lobar Pneumonia. The bacillus 
varies from coccoid forms to the 
longer bacilli which are often sur* 
rounded by a wide capsule. It 
grows freely on ordinary media, 
characteristically mucoid with a 
tendency to confluence. This 
organism at times is the cause of 
both broncho and lobar pneu' 
monia. 
This type of pneumonia has a 
high mortality, the bacillus is often 
present in the sputum, sometimes 
in almost pure culture. The ba' 
cillus is commonly present in the upper respiratory tract and the acces' 
sory sinuses, where it causes inflammation or infection of ear, eyes, and 
nose. 
It is found most frequently in cases of ozena or fetid catarrh. 
Bacillus Acne 
THE acne bacillus is a short, 
rather plump, irregularly club' 
shaped bacillus, occurring in acne 
pustules and comedones. It is 
non-motile, gram positive and takes 
ordinary stains readily. Pure aero- 
bic cultures are difficult to obtain. 
It grows best with only a small 
amount of oxygen. In the deep- 
indurated types of acne, other 
organisms, such as the staphylo- 
coccus, play an important role. 42 
A Physician's Manual 
(Pseudo Diphtheria Bacillus) 
Bacillus Hoffmann 
THIS Bacillus is found in the 
nose, throat, eye and other 
parts of the body. It bears some 
morphological resemblance to the 
diphtheria bacillus; its growth is 
also similar. 
It is rather short, plump and 
more uniform in size and shape than 
the true Loffler bacillus. In young 
cultures when stained by the 
Neisser method, it shows no polar 
granules, and stains evenly through' 
out with methylene blue. No acid 
is produced by the fermentation of 
glucose, as in the case of a virulent 
diphtheria bacillus. 
When these organisms are found in cultures from cases of suspected 
diphtheria they may lead to an incorrect diagnosis. 
Bacillus Typhosus 
THE typhoid bacillus is a short 
cell, rather plump and rod 
shaped, having rounded ends and 
often grows into long threads. It 
stains with the ordinary anilin 
colors, and is gram negative. The 
typhoid bacillus is motile when 
living under favorable conditions. 
It often has numerous flagellae, 
which spring from the sides as well 
as ends. Many short rods have 
but a single terminal flagellum. 
The bacillus grows well on all 
sugar free media and resembles the 
B. colon, but grows somewhat 
slower and not quite so luxuriantly. 
Acid and gas is produced in mannite, maltose and dulcite is acted upon 
after prolonged incubation. Acid, but no gas, is produced from dextrose, 
galactose and levulose. Milk is not coagulated. It is impossible to 
produce typhoid fever in animals except the anthrapoid apes. of Vaccine Therapy 
43 
Typhoid bacilli freshly obtained from typhoid cases will not produce 
the disease when introduced subcutaneously in animals. In typhoid 
fever, during the early stages, the bacilli pass to all parts of the body, 
and become localized in certain tissues. In typhoid fever, as in other 
infectious diseases, toxic poisoning may be manifested by disturbances 
in the circulation, and respiration as well as by manifest lesions. In a 
few cases the intestinal lesions are absent. The most practical test for 
early diagnosis of typhoid fever is the blood culture and later the Widal 
or Agglutination reaction. 
Para Typhoid A 
The Para Typhoid A. Bacillus produces a typhoid-like disease in man, 
most frequently encountered in the warmer areas. The bacillus may be 
present in the feces, urine, blood and bile. 
The Para Typhoid A. Bacillus is similar to the typhoid bacillus in 
many respects. It does not, however, produce acid from Xylose. It is 
communicable, the same as typhoid. Not all strains are alike in their 
agglutination reaction. 
Para Typhoid B 
This type is considered to be distinctly pathogenic to humans, there- 
fore different from similar paratyphoid types found in animals. If this 
is correct, the infection by B. paratyphosus "B" is transferred only from 
man to man. Clinically, the Para Typhoid B. infection resembles typhoid 
fever. Morphologically, the bacillus closely resembles the other mem- 
bers of this group but grows more freely and rapidly. Diagnosis is 
determined by agglutination tests. 
THE colon bacillus has a varia- 
ble morphology. The typical 
form is that of short rods with 
rounded ends but sometimes the 
rods are so short as to be almost 
spherical. They occur as single 
cells or sometimes as pairs joined 
end to end. The most typical of 
the colon group possess motility. 
There is a question as to 
whether the colon bacillus is ah 
ways virulent or whether it be- 
comes so under abnormal condi- 
tions. In some of the intestinal 
diseases such as typhoid, cholera 
and dysentery the bacillus seems to 
Colon Bacillus 44 
A Physician's Manual 
acquire an increased virulence at the same time, and easily finds its way 
into the general system causing suppurative lesions where it is thus 
absorbed from the intestines. It frequently enters the kidney causing 
inflammation and nephritis, or it may invade the bile duct leading to 
inflammation, obstruction, suppuration, or calculus formation. It may 
be the cause or complicating factor in cholera infantum, endocarditis, 
meningitis, liver-abscess, broncho-pneumonia, pleuritis, chronic tonsil- 
litis, urethritis, appendicitis, cystitis and peritonitis. 
THE tubercle bacillus is a slen- 
der non-motile rod-like organ- 
ism with an average length of about 
one-half the diameter of a human 
red blood cell. The bacilli occur 
singly or in pairs, and are usually 
slightly curved, branching and 
club-shaped forms may also be ob- 
served. 
Owing to a waxy substance, the 
bacillus does not readily take up 
the ordinary anilin colors but when 
once stained it is very difficult to 
decolorize, even by the use of 
strong acids, therefore it is called 
an acid fast organism. 
It grows best at a temperature of 370 C. It is very resistant to both 
heat and drying. Because of its purely parasitic qualities it does not 
multiply outside the living body. 
The tubercle bacillus is pathogenic not only for man but for a large 
number of animals; such as the cow, monkey, pig, cat, etc.; young guinea 
pigs are very susceptible and are used for detection of tubercle bacilli in 
suspected material. 
Tubercle Bacillus of Vaccine Therapy 
45 
A BSCESSES are formed as a result of tissue necrosis at the point of 
xA. a submerged infection. They are most commonly due to staphy- 
lococci, streptococci, colon bacilli or a combination of two or more of 
these organisms as a mixed infection. Drainage in these cases is essential. 
Bacterial vaccines to hasten immunization are very useful in that im- 
munization hastens repair and thus avoids the formation of a chronic 
fistula. Formula 35 or 10 are the proper combinations to be employed 
in these cases. Inoculations are made at one to three day intervals, 
depending upon the severity of the infection, one c.c. inoculations 
being employed at daily or two day intervals in severe cases and smaller 
doses at longer intervals in the less severe. 
ABSCESSES 
ACHE 
ACNE divides itself into two classes of cases. The pustular form, 
in which the pustules are superficial, and the nodular form, in 
which comedones predominate. 
In the pustular variety the staphylococcus albus is the infecting organ' 
ism and in this class of cases good results are being obtained with staphy' 
lococcus vaccine. Some doctors use a vaccine containing the staphy' 
lococcus albus only, but generally a combined staphylococcus aureus 
and albus vaccine (Formula 22) is preferably employed. This being 
a chronic condition, it is best to start treatment with a small dose 0.2 
c.c., gradually increasing the dose as indicated by the clinical results 
and reactions at the site of inoculation. If within a day or two, an 
infiltrated area, at the site of inoculation, develops greater than the size 
of a silver dollar, the dose has been larger than necessary, indicating 
that the subsequent dose should not be materially increased or possibly 
made slightly smaller. As treatment is continued there will be less 
infiltration under increasing dosage, and after four or five injections there 
may be no material reaction after giving 1 c.c., but from this it should 
not be inferred that the dosage must be continually increased to obtain 
therapeutic results. As a rule it is not necessary to go beyond 1 c.c., 
but occasionally a case is found where it is necessary to work up the 
dose to 2 c.c. It is also important not to make the injections at too short 
intervals. Generally, given 3 to 7 days apart is sufficient. Persistency 
in treatment, however, is of great importance. In most of the cases 
marked improvement takes place soon after starting treatment, while 
others progress slowly, but if the treatment is persistently carried out 
this class of cases will get better if necessary local treatment is also 
applied. Where deep'seated pustules exist they should be lanced, and 
the pus evacuated and local antiseptics employed to take care of surface 46 
A Physician's Manual 
infections. Hot applications and other measures to stimulate the circu- 
lation of the skin and hasten absorption of indurated tissues are em- 
ployed to advantage. 
In acne vulgaris of the nodular variety, where the skin is filled with 
comedones, the acne bacillus is regarded as the chief pathogenic factor. 
The organism is a difficult one to isolate and grow, and for this reason 
autogenous vaccines are seldom prepared from the acne bacillus, nor do 
they appear to be of any advantage where they have been employed. 
Autogenous vaccines are sometimes prepared from the staphylococcus 
found in acne infections and a stock acne bacillus vaccine added to the 
suspension. 
Most physicians preferably employ the acne bacillus combined with the 
staphylococcus albus in the vaccine, and there is no good reason why the 
two organisms may not be advantageously used together in a vaccine. 
There is some difference of opinion on dosage in the use of acne 
vaccine; some recommending large doses, but most observers cling to the 
small dose in starting treatment and working up. There have probably 
been more failures in the treatment of acne with acne vaccine from over- 
dosing than from not giving enough. The negative phase is an important 
factor in the treatment of acne with acne bacillus vaccine. Focal reac- 
tions in the skin lesions are common from overdosing. Treatment is 
usually started with 5,000,000 to 8,000,000 acne bacilli (0.1 to 0.2 c.c. 
of Formula 33). If three to six or more new pustules develop within 
24 to 48 hours after the injection, the dose has been too large. The next 
dose, then, should not be repeated until the reaction has entirely sub- 
sided and conditions appear to be at their best, which may be anywhere 
from the fourth to the tenth day after the inoculation, but usually about 
the fifth or sixth day. Where no material reaction follows an inoculation, 
as shown by new pustule developments, the dose may be increased by 
one to three millions for the next inoculation. The dose may be worked 
up to 40,000,000 or more. The staphylococcus albus vaccine is given in 
the usual small dosage at first and the dose is gradually increased to 
1,000,000,000 or more. 
The importance of proper dietetics and the necessity of taking care of 
digestive disturbances in the treatment of acne has long been recognized. 
In the presence of digestive disturbances the addition of the colon 
bacillus to the acne staphylo combined vaccine is a distinct advantage. 
Formula 50 is admirably adapted for this purpose. It contains Acne 
Bacillus 40,000,000, Colon Bacillus 300,000,000, and Staphylococcus 
Albus 1,000,000,000 per c.c. In persistently chronic cases a combined 
colon-strepto-pneumo-staphylo vaccine (Formula 35) used alternately at 
3 to 5 day intervals with an acne staphylo combined vaccine, will often 
bring results where the other vaccines have failed. of Vaccine Therapy 
47 
The local care of the lesions is of utmost importance in obtaining the 
desired results, and care should be taken that this treatment is applied 
at the proper time. Soon after giving the vaccine the patient passes into 
the negative phase. This lasts about two days, and during this time no 
local treatment should be employed, because any kind of irritation during 
this time has a tendency to aggravate matters. Two days after an inocu- 
lation the patient passes into the positive phase, and for about two days 
careful attention should be given to local measures. The patient is 
directed to then apply hot moist applications, press out comedones and 
manipulate the skin to increase the blood supply to the infected foci. 
Gasoline carefully applied with absorbent cotton naturally aids in soften- 
ing the crusted ends of the comedones, when they can be readily pressed 
out. Pustules that make their appearance should be opened and where 
possible the attending physician should do this. These pustules are 
often deep-seated and should be opened. The pustules should never be 
cauterized with carbolic acid or other chemicals that have a destructive 
influence on the tissues, because such treatment will cause unsightly 
scars and pits. 
Persistence in the use of the vaccines and local care of the skin 
are the essentials in procuring ultimate success. Apparently hopeless 
cases, relapsing after temporary improvement, by continuing the treat- 
ment for six months or a year as a rule ultimately get well. For this 
reason it is never wise to abandon a case, even if no material improve- 
ment is observed in the first few months treatment. 
ACCIDENTAL WOUNDS1 
ADENITIS 
ACUTE lymphatic gland inflammation is usually due to streptococcus 
infection from a focus of infection adjacent to the involved glands. 
Staphylococcus complications are very frequent. In throat conditions 
the pneumococcus also often plays a part. So a combined streptococcus, 
pneumococcus, staphylococcus vaccine (Formula 6) is preferably em' 
ployed. In cases with considerable fever treatment should be started 
with 0.5 to 1. c.c. and injections repeated at one to two day intervals 
until the infection has subsided and at 3 to 5 day intervals during 
convalescence. In very severe cases the vaccine should be given at 12 
hour intervals. 
APHTH/E2 
APPENDICITIS 
IN this serious inflammatory condition a mixed infection usually pre* 
vails in which the colon bacillus, streptococcus, pneumococcus or 
staphylococcus are the most important infecting organisms. Immediate 
iSee Wounds 
2See Mouth Infections 48 
A Physician's Manual 
measures for rapid immunization toward controlling the infection are of 
utmost importance to guard against postoperative extensions of the 
infection and to aid in procuring a rapid recovery. Formula 35 is ad' 
mirably adapted for this purpose. The attending physician should 
administer the vaccine at the first indication of an appendicular infection 
and meantime the advisability of an immediate operation should not be 
neglected. Where the infection has progressed to the production of 
fever 1.0 c.c. dosage of the vaccine should be employed, and injections 
made at 1 to 2 day intervals until the fever has subsided and at 3 to 5 
day intervals after that until convalescence is complete. 
ARTHRITIS1 
ASTHMA 
ASTHMA is caused by a sensitization to various forms of protein 
dust such as dust from feathers, fuzz, horse hair, the various pollens, 
flower, grain, etc., and from the irritation caused by the various bacteria 
which are responsible for respiratory infections. The streptococcus, 
pneumococcus, and staphylococcus are the most common and are 
frequently associated with the micrococcus catarrhalis, influenza and 
Friedlander bacilli. The tubercle bacillus is an important factor in some 
cases. Even in cases where the asthma is primarily due to dust or pollen 
sensitization germ invasions by these respiratory infecting organisms 
are material factors in aggravating the asthma. So therapeutic immuniza* 
tion with bacterial vaccines will even benefit these cases. The asthmas 
due to repeated attacks of bronchitis, which eventually become chronic, 
however, constitute by far the larger proportion of asthmatic cases that 
present themselves for treatment. As a rule these cases are very sus' 
ceptible to "taking cold" and every time they get an attack of acute 
coryza the infection in the bronchi becomes worse, resulting in an 
aggravation of the asthmatic condition. 
That bacterial vaccine inoculations have a marked therapeutic value 
in bronchial infections is now well established and in these asthmatic 
cases it is found that improvement usually takes place soon after giving 
the vaccine. Mixed infections being the rule, a combined bacterial 
vaccine should be employed. Formula 36 or 38 is the combination that 
is most extensively used. Treatment is started with about 0.2 c.c. or 
3 minims and the dose gradually increased to 1 c.c. or more. Inoculations 
should be made at from three to seven'day intervals. Where severe 
asthmatic symptoms exist, the usual drugs employed to give temporary 
relief should be used in conjunction with the vaccine. The vaccines, 
however, as a rule, will soon have enough influence so that medical seda' 
tives become unnecessary. 
iSee Rheumatism of Vaccine Therapy 
49 
Extremely chronic cases often require treatment over a long period of 
time, for 6 months or more and not infrequently cases that have recovered 
will relapse with the first "cold" they contract. In these cases the 
vaccine treatment must be renewed and vigorously carried out. In time 
these "colds" with the asthma will cease to relapse. 
BLEPHARITIS 
THIS chronic infection of the margin of the eyelids if not directly 
due to coccus infections is at lea§t complicated with staphylococci, 
and often with streptococci. The results obtained immunologically 
from the use of staphylococcus and staphylococcus, streptococcus com' 
bined (formula 22 or 10) vaccine would confirm the relationship of these 
organisms to the disease. Very obstinate cases have been cured by this 
method. Dosage and interval between inoculations should be the same 
as in other minor localized infections, i.e. start treatment with 0.3 c.c. 
of vaccine and repeat inoculations at 3 day intervals, increasing dosage 
as indicated by local reaction, which should not be greater in area than 
a silver dollar. 
BLOOD DEFECTIONS 
INFECTIONS of the blood are not uncommon. After germs have 
gained entrance to the blood stream and maintained themselves for 
several days immunity to get rid of them does not develop until the 
infection localizes in the tissues of some part of the body. The idea that 
if the blood is infected that the infection has invaded the entire body 
is erroneous. In these cases the great bulk of the body tissues are not 
infected; so the infection is not general. The streptococcus, pneu- 
mococcus and staphylococcus are the most common organisms capable 
of growing and multiplying in the blood. Wright calls such organisms 
serophytes. 
In the early stages of blood infections bacterial vaccines are very 
efficient. By injecting killed germs under the skin, a condition is pro- 
duced imitating localization of the infection, local tissues being involved. 
These tissues become actively engaged at the site of vaccine injection in 
antibody formation, which, when absorbed by the blood will sufficiently 
reduce the virulence of the infecting bacteria in the blood to make 
phagocytic activity effective for their elimination. This beneficial effect 
of bacterial vaccines is particularly noticeable when they are given 
early in cases of puerperal sepsis, and the septicemia following wound 
infections, relief from toxic symptoms with reduction of temperature 
often taking place within 24 to 36 hours. Early treatment being of 
paramount importance, treatment should not be delayed to make a bac- 
terial diagnosis but in the puerperal cases a mixed vaccine preferably also 50 
A Physician's Manual 
containing a colon bacillus (formula 35) should be given in 1 o c.c. dosage 
repeated at 12 to 24 hour intervals until the fever has subsided, when the 
injections may be extended to 3 or 4 day intervals until recovery is 
complete. In other forms of blood infections from infected wounds, etc., 
formula 6 or 10 may be employed to advantage. 
BOILS1 
BO\E I^FECTIOMS2 
BRONCHITIS 
Bronchitis prevails as an acute or chronic affliction. It is very 
common and in the acute condition is usually regarded as a "cold 
on the chest" and often appears in epidemic form. The various types 
of pneumococci and streptococci are the most constant and most danger' 
ous organisms present. Staphylococci, the micrococcus catarrhalis, in' 
fluenza and Friedlander bacilli are also common invaders in these acute 
bronchial infections. 
In the treatment of these cases a mixed vaccine is usually employed. 
Formula 40 meets the most common prevailing condition. If the in* 
fluenza bacillus is present formula 38 is preferable. The presence of the 
Friedlander bacillus calls for formula 36. In acute bronchitis treatment 
is started with the usual small dose, 0.3 c.c. and then increased by 0.2 
to 0.3 c.c. with subsequent injections in accordance with the amount of 
reaction which develops at the site of inoculation. Severe cases with 
fever should receive larger doses than those without fever and inocula' 
tions are made to advantage at one to two day intervals. By this prompt 
and persistent treatment the bronchial infection will usually subside 
within three or four days and infrequently will last more than a week or 
ten days. After the more acute symptoms subside inoculations should be 
made three or four days apart and should be continued until all symptoms 
of bronchial infection have disappeared. 
In chronic bronchitis we find the same organisms present that prevail 
in acute cases. Occasionally we find a case in which the colon bacillus 
is present with two or more of the other organisms. These cases usually 
have a foul breath. Cases with a chronic Friedlander bacillus infection 
also have a disagreeable odor and an expectoration which is inclined to be 
very copious. In chronic cases the same vaccines are employed as in the 
acute cases. Treatment is started with the usual small dose 0.2 or 0.3 
c.c. and the dose gradually increased to 1 c.c. or more, inoculations being 
made at 4 to 7 day intervals, in cases showing the greater amount of re' 
action the interval between injections being longer. Formula 40 or 38 is 
preferably employed. In cases of Friedlander bacillus infection, formula 
36 is necessary and in cases where the colon bacillus is present, formula 
35 is used. 
iSee Furuncles. 
2See Osteomyelitis. of Vaccine Therapy 
51 
The results from the use of bacterial vaccines in chronic bronchitis are 
uniformly good. It being a chronic infection, it takes longer to effect 
a symptomatic cure than in the acute cases and relapses when epidemics 
of "colds" prevail are common. By persistent treatment, however, an 
immunity is gradually developed which becomes lasting with a resulting 
recovery. 
bronchopneumonia1 
BURNS 
A BURN is essentially a wounded skin, subject to {infection by the 
staphylococcus and streptococcus. Much of the pain and burning 
sensation which develops after the initial pain subsides, which was 
caused by the burn itself, is due to infection of the burned area. By 
proper immunization with bacterial vaccines the pain due to this infec' 
tion is relieved. A staphylococcus'streptococcus combined vaccine, 
formula 10, when given at one or two day intervals in dosage proper- 
tionate to the severity of the infection will serve the best purpose. 
CARBUNCLES2 
CEREBRO SPIRAL MENINGITIS 
CEREBRO SPINAL MENINGITIS is most commonly caused by the 
meningococcus, but occasionally we have cases due to streptococci, 
pneumococci or influenza bacilli. This can be determined by bacterial 
examination of the cerebro'spinal fluid procured by lumbar puncture. 
In Meningococcus meningitis, antimeningococcus serum should be 
given intra'spinally. It has been found that meningococcus vaccine given 
hypodermically in conjunction with the serum treatment is of great ad' 
vantage. Formula 34 should accordingly be given in 1 c.c. doses at daily 
intervals until the meningeal symptoms have subsided and at 3 to 4 day 
intervals during convalescence. If the meningitis should prove to be due 
to other organisms, a corresponding vaccine should be employed in 1 c.c 
doses at daily or twice daily intervals. 
The prophylactic use of meningococcus vaccine is promising and 
should be employed in all cases exposed to meningococcus infection. 
Three or four injections of 1 c.c. of formula 34 should be made at 5 to 7 
day intervals. 
CHOLECYSTITIS 
GALL bladder infection is usually due to the common pyogenic infect' 
ing organisms, streptococci, staphylococci, pneumococci and the 
colon bacillus predominating. Formula 35 is here indicated. The dosage 
conforms with that used in subacute and chronic infections. Treatment 
is started with 0.2 or 0.3 c.c. and then gradually increased to 1 c.c., making 
iSee Pneumonia. 
2See Furuncles. A Physician's Manual 
52 
inoculations at 4 to 7 day intervals. Unless there is obstruction from gall' 
stones, liver symptoms will soon subside with a restoration of the normal 
functioning of the liver. 
REPEATED bacterial examinations of the minor respiratory inflam- 
* mations commonly called "colds," have conclusively demonstrated 
that these ailments are due to infection and that virulent strains and 
types of streptococci and pneumococci are the chief infective agents with 
staphylococci, micrococcus catarrhalis, Friedlander and influenza bacilli as 
common complicating agents. 
Most of us are bothered with these respiratory infections at various 
times, particularly during the winter months. To tolerate a cold until 
it "wears off" is the prevailing method of treatment. The average person 
does not consult a doctor for the treatment of colds because he is not yet 
aware that prompt relief can be obtained by the vaccine treatment. 
These respiratory infections often run a prolonged course because the 
infecting organisms irritate the mucus membranes too severely to actively 
stimulate them for rapid antibody formation. In fact, the infection en* 
tirely too often lapses into a chronic condition. By injecting killed germs, 
like the ones responsible for the infection, in vaccine form in a remote part 
of the body, antibodies are produced by the tissues into which the vac* 
cine was injected. By means of the circulating medium these antibodies 
are conveyed to the infected mucus membrane and there aid in overcome 
ing the infection. A polyvalent mixed vaccine (formula 40, 38 or 36) 
should be employed. 
In these minor acute infections with little or no fever, treatment should 
always be started with a small dose about 0.3 c.c. of the standard sus* 
pension; not because large doses are dangerous, but because unnecessary 
uncomfortable reactions are liable to develop if treatment is started with 
a large dose. The dose should be gradually increased to 1.0 c.c. and inoc' 
ulations made at 1 to 3 day intervals. 
Usually within one or two days after the first inoculation, the acute 
symptoms subside, and if the inoculations are then repeated at 3 to 5 day 
intervals for several more injections to prevent a relapse, recovery will 
soon be complete. 
Much has been said of late about the advantages of prophylactic vac' 
cination against pneumonia. The results so far obtained show this to be 
entirely practical, but most people are not inclined to take prophylactic 
injections for a disease that appears to be a remote possibility. This is 
entirely different, however, when one has a cold. By curing the cold with 
vaccine, we at the same time prophylactically immunize ourselves against 
pneumonia. We have never known a case of pneumonia to develop where 
COLDS1 
iSee also Rhinitis. of Vaccine Therapy 
53 
the preliminary cold was treated with vaccine. Colds are the forerunners 
of other serious infections, such as mastoiditis, sinusitis, nephritis, arth' 
ritis, endocarditis, etc. If the primary respiratory infections are treated 
with vaccine, enough immunity will be established to prevent the later 
complicating infections. 
COLITIS 
INFLAMMATORY conditions of the colon are due to the same pyo- 
genic organisms which prevail in gall-bladder infections, and the 
same vaccine is used in these cases. 
CONJUNCTIVITIS1 
CORNEAL ULCER1 
CYSTITIS 
THE bacteriology of cystitis has been extensively studied, and it ap- 
pears that in about 60 percent of the cases the colon bacillus is the 
primary cause. In many cases, however, other organisms come in as sec- 
ondary invaders, especially the staphylococcus, streptococcus and pneu- 
mococcus. The pseudo-diphtheria bacillus, bacillus pyocyaneus and 
Friedlander bacillus are found in some cases. The gonococcus in cases 
of gonorrhea is also frequently present. A specimen of urine procured 
under aseptic precautions with a catheter makes a ready means of pro- 
curing a culture for bacterial examination. 
A colon bacillus vaccine does not give as satisfactory results in these 
cases as a mixed vaccine, even if no other organisms but the colon bacilli 
are found. Observers on the use of vaccines in cases of cystitis are quite 
unanimous that this is the best method of treatment, but many contend 
that while the clinical symptoms indicate a cessation of the inflammatory 
condition and urine examinations show a great reduction in the number 
of germs, in a majority of cases the germs do not entirely disappear. For 
this reason, the vaccine treatment should not be discontinued after in- 
flammatory symptoms subside. Treatment should be continued to build 
up a high degree of immunity. Being a subacute or chronic condition 
treatment should be started with the usual small dose 0.2 or 0.3 c.c. of 
Formula 35 and the dose gradually increased to 1 c.c. or more, making 
inoculations at 4 to 7 day intervals. In cases of gonorrhea, the gonococ- 
cus should be included in the vaccine. If other organisms are present as 
shown by bacterial examination, a corresponding stock vaccine should 
be used or an autogenous vaccine should be prepared. 
iSeeTye'Infections. 54 
A Physician's Manual 
DACRYOCYSTITIS1 
DERMATITIS is due to infection of the skin by the ordinary skin 
organisms, the staphylococci predominating. Staphylococcus vac- 
cine Formula 22 is employed to good advantage in these cases. "Prickly 
heat" or chafing during hot weather where the skin becomes irritated 
from excessive perspiration is really due to a lowered resistance to staphy- 
lococcus activities. Staphylococcus vaccine given at 5 to 7 day intervals 
is very effective in these cases. Impetigo is also due to infection by the 
ordinary skin organisms assuming an extensive, acute form and should 
be treated with staphylococcus or staphylo-strepto combined vaccine 
Formula 22 or 10. Injections are made at 2 or 3 day intervals. 
DERMATITIS 
DIABETES 
THAT diabetes is due to a suspension of the secretion of a sugar 
metabolizing substance by the pancreas or more particularly that 
portion of the pancreas containing the islands of Langerhans has recently 
been conclusively demonstrated by the discoveries of Dr. Banting and 
his co-workers in the University of Toronto of Canada. They extracted 
a substance from the pancreas which they called Insulin that serves the 
purpose of metabolizing the sugar contained in the blood of diabetics 
when administered hypodermically. This shows that the pancreas is an 
internal secreting organ as well as performing the function of secreting 
the pancreatic fluid which is employed in intestinal digestion. 
The suspension of the internal secretion of the pancreas can be 
accounted for as being the result of an infection which interfered with 
the function of the organ. This is verified by the fact that pancreatitis 
is commonly associated with diabetes. Whether the use of Insulin in 
cases of diabetics will restore the health of the patient sufficiently to 
overcome this infection of the pancreas must be determined by extensive 
clinical investigation. At all events, if the infection has gone on to a point 
of actual destruction of this pancreatic internal secreting function, no resto- 
ration of the function can be expected, even if the infection subsides. In 
that event, it would be necessary to continually supply the insulin much 
the same as thyroid extracts are being supplied to cases of cretinism. 
Since diabetes is evidently due to an infection of the internal secreting 
portion of the pancreas, our first aim should be to get rid of the infection. 
(See "Pancreatitis as Related to Gastro-Intestinal and Gall Bladder In- 
flections"-Seale Harris, M. D., Birmingham, Ala., J. A. M. A., Nov. 3, 
1923.,?. 1496.) Unless the infection is extremely acute, an organ may be 
infected for a considerable length of time before the function of the organ 
is destroyed. Pancreatic infections apparently are not of the extreme 
iSeejByeJInfection*. of Vaccine Therapy 
55 
acute type. There is always a period during which the function of the 
pancreas can be restored if the infection is relieved. Furthermore, there 
are many cases of diabetes in which the infection of the pancreas has only 
extended to a point of partially suspending the internal secreting function 
so by relieving the infection the pancreatic function is readily restored. 
That the immunizing method by means of bacterial vaccine injections 
is the best method for eradicating infections and restoring normal func- 
tioning of infected organs is now generally admitted. That this applies 
to diabetes is a matter of clinical experience where vaccines are applied 
reasonably early, before the function of the pancreas has been irreparably 
destroyed by the infection. As a rule, a decrease in the amount of sugar 
in the urine with an increase of the general health condition is observed 
w;thin a few weeks after starting treatment. To avoid overtaxing sugar 
metabolism, a diabetic diet should be adhered to until it is found that 
more sugar and starches can be assimilated and where indicated Insulin 
should of course also be administered. Eventually, the urine will 
become sugar free and allow of a return to normal diet. In early cases, 
such results will be obtained within two or three months. If the infec' 
tion has progressed to an actual destruction of the internal secreting func* 
tion, no restoration of this function can be expected. Since it is impossb 
ble to know just to what extent the infection has progressed, it is always 
advisable to give the patient the benefit of the doubt by giving the vac' 
cines. Many advanced cases will materially improve, even if they are not 
entirely relieved, showing that some portions of the insulin secreting 
function of the pancreas are restored so a moderate diet of sugar and 
starch can be taken care of. 
In selecting a vaccine for administration, we must realize that the pan* 
creas is subject to infection by the same pathogenic bacteria that are 
responsible for other acute and chronic abdominal infections. Of these, 
in the abdominal viscera, streptococci, colon bacilli, staphylococci and 
pneumococci are the most common and mixed infections by two or more 
of these organisms are the rule. It would appear logical to give a mixed 
vaccine such as Formula 35 which contains these organisms. Being a 
subacute or chronic infection, treatment is started with 0.2 or 0.3 c.c. 
and the dose gradually increased to 1 c.c., making inoculations at 5 to 7 
day intervals. If not much reaction develops at the site of injection, the 
dose may be rapidly increased to 1 c.c. or more. 
Many cases of diabetes are subject to furunculosis and boils. In such 
cases, it is well to give a staphylococcus vaccine, Formula 22 alternately 
with 35, at 3 or 4 day intervals until the furunculosis has disappeared. 
This vaccine treatment is entirely harmless and will not interfere nor 
conflict with the insulin or any other treatment, and may be employed in 
any stage of the disease in children as well as in adults, children receiving 
proportionately smaller doses. 56 
A Physician's Manual 
duodenitis1 
EAR INFECTIOUS 
UNDER ear infections it is well to include infections of the external 
auditory meatus, because they are usually classed as ear diseases. 
Of these, furunculosis is the most important. Furuncles of the auditory 
canal are particularly painful and often run a prolonged course when 
immuno-therapy is not employed. The offending organism in the less 
severe types is usually the staphylococcus albus, while in the more severe 
types, the staphylococcus aureus is found. These cases yield readily to 
combined staphylococcus aureus and albus stock vaccines. If treatment 
is started early, before a necrotic center with pus formation has devel- 
oped, the infective process can be aborted, with a resulting rapid recov- 
ery. Where the infection is farther advanced, the immunizing influence 
of the vaccine will relieve the pain, and the swelling will subside, with a 
resulting small abscess which can be readily drained and healed. Full 
sized doses of staphylococcus vaccine (Formula 22) should be given by 
starting treatment with 0.5 c.c. and working the dose up to 1 c.c. or more 
within three or four inoculations. Injections should be made twe or 
three days apart for the first two or three doses, and five to seven days 
apart thereafter for three or four weeks, so as to build up an immunity 
and prevent a recurrence. 
Acute otitis media is practically always due to an extension of the in- 
fective process from the naso-pharynx through the Eustachian tube and 
naturally is due to the same organisms found in infections of the pharynx. 
The streptococcus and the pneumococcus have a more distinct tendency 
to infective extension than other organisms found in the nose and throat, 
and for this reason are most frequently found in acute middle ear infec- 
tions. The Friedlander bacillus, the micrococcus catarrhalis and the 
influenza bacillus, are also found. After there is an opening through the 
ear-drum, staphylococci, by migration from the auditory canal, gain en- 
trance to the middle ear and in time the staphylococcus often overgrows 
and displaces the original infecting organisms so that the staphylococcus 
may be the only organism found. In cases of chronic suppurating otitis, 
various organisms like the bacillus pyocyaneus, the colon bacillus, the 
pseudo-diphtheria bacillus, and the bacillus proteus are frequently found 
and occasionally we find typhoid or tubercle bacilli. 
In the treatment of suppurating otitis with vaccines, it is necessary to 
take this difference in the bacterial flora of the early acute stages and the 
chronic conditions into account. In the acute conditions, early treat- 
ment is of great importance, both as a means of relieving pain and to avoid 
destructive and dangerous extensions of the infection. One of the first 
iSee Gastrointestinal Infections. of Vaccine Therapy 
57 
symptoms of otitis is pain in the ear. When an earache is associated with 
an acute infection of the nasopharynx, this is sufficient evidence that the 
infection has extended to the middle ear and if a vaccine has not been 
given for the existing "cold," it should be employed at once for the ear 
complication. If there is a bulging of the drum.it should be lanced, but if 
the infection has not advanced sufficiently to cause much fluid accumu* 
lation in the middle ear, the early use of vaccine will in most instances 
abort the affection in time to avoid the necessity of opening the eardrum. 
Because of the fact that streptococci and pneumococci are the principal 
offenders, a stock vaccine containing at least these two organisms should 
be employed, but the combined vaccine usually employed in the treat* 
ment of colds (Formula 40) serves every purpose. The initial dose should 
be about 0.3 c.c. If no material reaction develops at the point of inocu* 
lation, a somewhat larger dose should be given the next day. By this 
time the pain in the ear should be practically gone and inoculations at 2 
or 3 day intervals with gradually increasing doses, until 1 c.c. is given, 
should entirely clear up the trouble within one to two weeks. Where it 
is necessary to lance the drum or where the drum is ruptured, it will be 
found that the ear dries up rapidly with a correspondingly rapid closing 
of the eardrum. Where drainage through the tympanic membrane is 
established, cultures for bacterial examinations should be made, and if 
the patient should not be progressing favorably under the stock vaccines, 
an autogenous vaccine should be prepared. 
The advantages of treating acute otitis in infants and children with 
vaccines deserves special mention. Local treatment in these cases is al* 
ways surrounded with much difficulty and as a rule the mother or nurse 
finds it difficult to follow instructions, whereas a few vaccine inocu- 
lations will accomplish infinitely more, while the little patient 
allowed to go without treatment between inoculations. 
In cases of chronic suppurative otitis media, the staphylococcus 
aureus and albus are the most frequent pathogenic factors. For this 
reason a combined staphylococcus aureus and albus vaccine (Formula 22) 
in doses of 0.5 to 1 c.c. may be given on a clinical diagnosis for several 
inoculations, and if prompt improvement does not take place, cultures 
for a bacterial examination should be made to determine the infecting 
organisms and a corresponding stock vaccine given, and, where unusual 
organisms are present, an autogenous vaccine should be prepared. 
From a review of the literature on this subject, it is apparent that some 
cases are not benefited by vaccines even when the utmost care is em- 
ployed in the selection of a vaccine and its administration. In many of 
these cases, there is, in all probability, some necrotic bone present in some 
obscure place, while in others the conditions of the tissue cells in the in- 
fected area have become such that a tolerance to the infecting organisms 58 
A Physician's Manual 
has been created to a point where immunizing responses can no longer be 
aroused. This should emphasize the importance of always employing 
vaccines in the acute cases, where uniform good results are obtained, and 
by this means prevent the development of an unfortunate chronic con- 
dition. 
Mastoiditis 
THE great danger from an acute otitis is extension of the infection to 
the mastoid cells. When immuno-therapy is applied sufficiently 
early, this complication can be avoided. If the infection has already ex' 
tended to the mastoid, a dose of combined streptococcus'pneumococcus' 
staphylococcus vaccine (Formula 6) should be given at once as an adjunct 
to such surgical procedures as may be necessary. 
In such cases the infection is usually so extensive that 0.5 to 1 c.c. 
should be given, and the same dose repeated at 1 to 3 day intervals. 
Cultures should also be made for bacterial examination, and to provide 
for the possible necessity of preparing an autogenous vaccine. 
The importance of therapeutic immunization in acute in* 
fections is not sufficiently appreciated. These ear infections are too seri' 
ous to allow them to progress without employing all the means at our 
command to stop the progress of the infection. The time to avert danger 
and to institute the best treatment is before the danger point has arrived. 
The early use of a mixed stock vaccine containing the organisms that 
cause dangerous mastoid infections is the safest and surest method of 
avoiding the development of a mastoiditis. 
ECZEMA AND PSORIASIS 
THE bacterial cause of eczema and psoriasis has not been established. 
We have made many bacterial examinations from scrapings of the 
skin in eczema cases but the staphylococcus aureus which is normally on 
the skin is the only organism found. In our early experiences with 
vaccines, staphylococcus aureus and albus vaccine was used in acute 
cases of the moist variety of eczema with excellent results. The same 
vaccine was used both stock and autogenous in chronic dry eczema with 
indifferent results. 
In the acute moist cases, a staphylococcus combined vaccine (Formula 
22) is given by starting treatment with 0.5 c.c. and gradually increasing 
the dose to 1 c.c. or more, making inoculations at 3 to 5 day intervals. 
As a rule, the skin dries up within a week or so. The injections, how* 
ever, should be continued for several weeks at weekly intervals to pre* 
vent a relapse. 
In the chronic cases-and this includes eczema of infants and children 
who should receive proportionately smaller doses-Formula 35 is being of Vacc'ne Therapy 
59 
successfully employed. Treatment is started with 0.3 c.c. and the dose 
increased by .1 or .2 c.c. to 1. or 1.5 c.c. inoculations being made at 5 to 
7 day intervals. Some cases improve very rapidly while others progress 
slowly but steadily. In some of these obstinate cases, it has been found 
that giving Formula 35 alternately with Formula 22 by giving each 
vaccine at weekly intervals will do better than 35 alone. This will bring 
the inoculations 3 or 4 days apart. In some cases, it is necessary to 
continue the treatment for six months or more with an eventual re* 
covery. 
Psoriasis is a skin affliction in which the causative organism has not been 
isolated but from experience we find that the same vaccine employed in 
chronic eczema will also take care of psoriasis. As a whole, psoriasis 
cases are more stubborn, but by persistent treatment it is possible to ob' 
tain satisfactory clinical results in a large proportion of the cases treated. 
EMPYEMA1 
endocarditis2 
EPIDIDYMITIS3 
ERYSIPELAS 
IMMUNITY assumes two forms, local and systemic. A local im- 
munity is manifested by the development of a local resistance to cer- 
tain infecting organisms while other parts of the body, composed of the 
same variety of tissue are still susceptible to the infection. This is well 
illustrated in a case of erysipelas. Here the inflammation subsides first 
where the infection started, but continues to extend into new territory 
until it finally dies out. This shows that during the infection a localized 
immunity does not influence the surrounding tissues sufficiently to pre- 
vent its extension until sufficient antibody has been absorbed from the 
tissues in the affected area to develop a systemic immunity, when the 
infection can no longer extend. In addition to this localized tissue resist- 
ance, antibodies formed in any part of the body may, by means of the 
circulating medium, be conveyed to all parts of the body and render the 
entire body immune. 
Of the various skin infections met with by the general practitioner, 
erysipelas is the most serious. That the streptococcus is the cause of the 
infection, is now well established. Clinical symptoms are sufficiently 
characteristic to enable an early diagnosis; in fact, a clinical diagnosis can, 
as a rule, be made in less time than a culture could be incubated and exam- 
ined. From an extensive experience in taking cultures from cases of 
erysipelas, it will be observed that the streptococcus is not as easily found 
iSee Pneumonia. 
2See Heart Infections. 
«5ee Gonorrhea. 60 
A Physician's Manual 
as might be expected. We have never isolated streptococci from cultures 
procured from blebs; staphylococci always being found in abundance. 
Cultures from pus, where an abscess developed in the deeper tissues, 
always showed streptococci in great numbers. Where no pus has de* 
veloped, the best way to procure cultures is to make small incisions 
through the skin with advancing margin of the infection and then press 
out blood and serum from the deeper structures. 
As in other acute infections, early treatment is important to procure 
the best results. The theoretical contention that vaccines are not applica* 
ble in severe acute infections largely accounts for the reluctance displayed 
by many physicians to apply vaccines in erysipelas. Some of our early 
experiences in the use of vaccines were in cases of erysipelas and from the 
results obtained there was no question concerning their therapeutic 
value, regardless of theoretical considerations. 
A stock vaccine prepared from a number of strains, isolated from ery' 
sipelas cases, should be employed. Because of the fact that staphylococci 
are found in such great abundance in the inflamed area it occurred to us 
that this organism is a complicating factor of some importance in this dis* 
ease, and accordingly we combined staphylococci with the streptococcus 
erysipelatis in the preparation of vaccine Formula i. Inoculations 
should be repeated at daily intervals in i. c.c. doses until the acute symp' 
toms subside, and thereafter at 2 or 3 day intervals. If the vaccine is 
given before the infection has had time for spreading extensively-during 
the first and not later than the second day-the course of the disease will 
be aborted, a speedy recovery occurring. Such striking results are not 
secured when the vaccines are employed later in the course of the dis' 
ease, but even in advanced cases marked beneficial results are obtained, 
unless the case is already moribund. In extremely bad cases it is advis' 
able to give two doses of vaccine the first day, and then inject it at daily 
intervals for two or more days. A reduction of temperature with sub' 
sidence of toxic symptoms such as nervousness and delirium should ensue 
within one or two days. The inflamed area will not be so pronounced 
and the swollen margin not so elevated. Where pus formation has taken 
place, proper drainage is necessary. After the more acute symptoms have 
subsided, vaccine treatment should be continued at 4 to 6 day intervals 
for several more inoculations. 
Spontaneous recovery from an attack of erysipelas often leaves the 
person more susceptible to subsequent attacks, showing that the live 
virulent organisms do not influence tissue cells for permanent immuniza- 
tion, but on the contrary have a tendency to break down the immuniz' 
ing mechanism. If vaccine treatment is continued, however, for a month 
or two, making inoculations at weekly or two week intervals, an immun* 
ity can be built up which will be fairly permanent. of Vaccine Therapy 
61 
ETHMOIDITIS1 
EYE 
IN considering the treatment of eye infections with vaccines, the 
question naturally arises whether immunizing substances which are 
developed in other parts of the body can be conveyed by means of the 
blood to the non*vascular structures of the eye, like the cornea, lens, 
vitreous, etc. It is well known that wher infecting organisms gain lodge* 
ment in the tissues where immunizing substances are not readily avail* 
able, the infections are liable to become destructive in character. This 
applies with unusual significance to the eye, in view of the importance 
of the organ and the amount of serious permanent damage that may 
follow even a small amount of tissue destruction. It does not require 
much of a central corneal ulcer to permanently impair vision. Let us 
take, for example, a corneal ulcer due to a streptococcus or pneumococcus, 
in a case where the immunizing resistance to these organisms is compara* 
tively low. A corneal ulcer is necessarily too small a lesion to arouse 
systemic reaction enough for so much production of antibodies that an 
adequate amount of them will find their way to the eye and destroy the 
infecting organism before irreparable damage is done. But by injecting 
a bacterial vaccine under the skin a very large amount of tissue, as com* 
pared with that involved in the corneal infection, is actively called into 
service for antibody production. This antibody is then conveyed, by 
means of the circulatory system, to the infected cornea and aids in 
destroying the germs long before it would have been possible for the 
infection in the cornea to stimulate an equal amount of antibody pro* 
duction. 
What is true of corneal infections applies equally to infections of other 
non*vascular structures of the eye. Eye infections are quite common and 
are met by the general practitioner almost as frequently as by the eye 
specialist. Early immunization being of so much importance, it is neces* 
sary that the general practitioner should familiarize himself with the 
bacteriology and the vaccine treatment of eye infections, because he is 
often called to treat these cases before an eye specialist is called into 
service. 
Eye infections are most prevalent during the season of the year when 
"colds" prevail. This conforms to the popular conception that "the 
cold has gone to the eye" and the etiologic findings show that this con* 
ception is well grounded because the same infecting organisms which are 
found responsible for complications following colds are also responsible 
for eye infections. Of these the pneumococcus and streptococcus are 
the most important with the staphylococcus as a secondary invader. 
iSee Nose Infections. 62 
A Physician's Manual 
This knowledge furnishes a basis for giving a combined pneumococcus, 
streptococcus, staphylococcus vaccine (Formula 6) as a routine in eye 
infections like conjunctivitis, keratitis, iritis and dacryocystitis, on a 
clinical diagnosis especially so because early treatment is so important. 
On arriving at a clinical diagnosis, however, it is very important to care' 
fully consider a possible gonorrheal conjunctivitis or a specific iritis. In 
case a gonorrheal conjunctivitis or iritis should be found, gonococcus 
vaccine should be employed at once in conjunction with appropriate local 
treatment. Treatment may be started with a 200,000,000 dose of gono' 
coccus vaccine and injections repeated at two or three day intervals, 
increasing the dose as indicated by reactions and clinical results. Syphi' 
litic iritis should be treated with appropriate syphilitic measures. 
The nonspecific eye infections constitute by far the larger proportion 
of acute eye infections met with in the daily routine of practice. In 
these cases the combined pneumococcus, streptococcus, staphylococcus 
vaccine serves a very useful purpose. In conjunctivitis, keratitis, 
dacryocystitis and iritis marked improvement may be confidently ex' 
pected within a few days and by repeating the inoculations at two to 
four day intervals, a speedy recovery may be confidently expected. In 
ulcerative keratitis, especially in children, one of the most characteristic 
clinical symptoms of improvement is almost complete relief from bleph' 
arospasm within one or two days after the first inoculation. The 
ulcer will also be found to heal much more rapidly. In dacryocystitis, 
the destructive character of the infection is avoided to the extent that 
the lachrymal sack and canal will resume their normal function and thus 
avoid the disagreeable condition following a constricted tear duct. 
Treatment in these acute eye infections is started by giving the small 
dose employed in other minor acute infections and gradually increasing 
it as indicated by the reaction and clinical improvement. 
In chronic eye infections it is always advisable to make a bacterial 
examination, especially if marked improvement does not follow a few 
injections of vaccines on a clinical diagnosis, because in chronic eye 
infections, infecting organisms may be present that have a distinct 
tendency toward chronic infections, when a corresponding stock vaccine 
or an autogenous vaccine should be employed. 
One of the annoying infections of the eye is the hordeolum. Styes are 
nothing more than small furuncles in the margin of the eyelids. The 
staphylococcus, albus and aureus are responsible for these furuncles. A 
combined staphylococcus aureus and albus vaccine (Formula 22) gives 
excellent results in these cases. The vaccine is given at three to seven 
day intervals and since these styes are so liable to recur, the treatment 
should be continued for several weeks after the furuncles have dis* 
appeared to effect a permanent cure. of Vaccine Therapy 
63 
FELON 
A FELON is one of the more common types of painful, and from a 
utilitarian standpoint, important periosteal and bone infection. 
Many a person has a crippled thumb or finger due to this infection. 
Early drainage by cutting through the periosteum gives fairly good results 
but due to the infection, healing is frequently slow, resulting in bone 
necrosis. When seen early the cases can be aborted with staphylococcus, 
streptococcus (Formula io) vaccine given in 0.5 to 1 c.c. doses at one to 
three day intervals. This vaccine is also of great advantage to promote 
healing after drainage has been established. 
FISTULA1 
FURUNCLES, CARBUNCLES AND BOILS 
THAT drainage and local applications in the treatment of furuncles, 
carbuncles and boils serve a useful purpose, is beyond dispute, but 
to solely rely on these measures, as many physicians do, clearly shows 
how reluctantly new and better methods of treatment are adopted as 
long as the ones employed are in a measure efficient. These localized 
skin infections, if not as a rule serious, are certainly painful and suffi' 
ciently disagreeable to deserve the best available treatment. 
That a low resistance to the staphylococcus prevails is evident from 
the tissue destruction and intense inflammation which develops before 
the infection runs its course. There is a distinct tendency for several 
boils to develop in succession. This shows that a systemic immunity 
does not develop spontaneously during recovery from a boil. 
There is little difficulty in making an early diagnosis. The intensely 
painful throbbing localized inflammatory condition is very characteristic. 
As a rule, the infection is sufficiently virulent to cause tissue destruction, 
forming a necrotic center rather early, but characteristic of staphyky 
coccus infections, this destructive process usually does not become ex' 
tensive, but remains confined near the site of primary invasion. In this 
respect, staphylococcus infections differ markedly from streptococcus 
infections. Streptococcus infections, sufficiently virulent to cause tissue 
necrosis, spread rapidly and cause extensive destruction. So, when a 
very circumscribed intense inflammatory area of the skin is observed, it 
may safely be regarded as staphylococci. The therapeutic value of 
staphylococcus vaccine in these cases is very pronounced and for this 
reason, early treatment is of great advantage. If the vaccine is given 
before a distinct necrotic center has developed the infection can be 
aborted. Unfortunately the doctor does not often see these cases 
sufficiently early to apply the vaccine in time to abort the infection. On 
iSee Abscesses 64 
A Physician's Manual 
the other hand, during this early stage, a boil appears such a small affair 
that many times it is not regarded as of sufficient importance to merit a 
vaccine injection. This is an erroneous viewpoint. All infections start 
with a small beginning, and if the fact that therapeutic immunization 
can be most effectively carried out when applied early were generally 
recognized, infections would be brought under control before destructive 
processes would have time to develop. 
When treatment is started later, after pus formation and tissue necrosis 
has developed, the inflammation around the necrotic center will become 
less angry and recede, leaving a small inflamed area in close proximity to 
the center of infection. Drainage will then be freer, because the sur- 
rounding tissue is not so intensely swollen, and will not encroach on the 
opening. In far advanced cases with several openings, with extensive 
inflammatory infiltration and irregular slough, vaccines are employed to 
advantage in that the inflammation will subside sooner and the healing 
process be augmented. 
Wright's contention that pain and a low immunity are closely related 
in infective processes is well illustrated in the treatment of boils with 
vaccines. The infecting organisms during their life process secrete 
digestive ferments which are utilized to prepare the food on which they 
live. These ferments have a distinct irritating destructive influence on 
the tissues with which they come in contact and necessarily cause a 
great amount of pain. Germs when exposed to antibodies, lose their 
virulence, evidently due to the neutralizing influence that the antibody 
has on the digestive ferments which they secrete; consequently the 
destructive, irritating, pain producing property of the infection is elim- 
inated. Relief from pain is often felt twelve to eighteen hours after 
the first inoculation, and, as a rule, the patient is quite comfortable in 
twenty-four to thirty-six hours. 
Stock vaccines serve every purpose, but in the selection of a vaccine, 
many doctors make the mistake of employing what is known as a "mixed 
infection vaccine" instead of a staphylococcus vaccine, simply because 
the mixed vaccine, in addition to other organisms contains staphylo- 
coccus. To employ these other organisms in addition to the staphylo- 
coccus in the vaccine, can do no harm, but as a rule, the staphylococcus 
portion of a "mixed infection vaccine" is not sufficient to properly take 
care of a distinct staphylococcus infection to the best advantage. A 
frank staphylococcus infection, like a carbuncle, calls for a staphylo- 
coccus vaccine, and since the staphylococcus albus is sometimes present, 
a combined staphylococcus aureus and albus preparation (Formula 22) is 
preferably employed. Treatment should be started by injecting 0.5 c.c. 
and gradually increasing the dose to 1.0 c.c., making inoculations at one 
to two day intervals until the extreme acute symptoms have subsided, of Vaccine Therapy 
65 
and at three to four day intervals after that. The treatment should be 
continued for several weeks after the carbuncle has entirely healed, at 
weekly intervals, to build up an immunity which will prevent additional 
boils from developing. 
In furunculosis the infection assumes a less acute form with a distinct 
tendency to successive crops developing. The staphylococcus aureus is 
the one most frequently found as the pathogenic agent, but the albus 
variety is also often found and calls for a combined staphylococcus aureus 
and albus vaccine (Formula 22). 
The results from the use of staphylococcus vaccine in the treatment 
of furunculosis are so striking that this serves as a classical illustration to 
show that killed organisms are better agents to stimulate tissue cells for 
anti-body formation in the presence of an active infection, than the live 
organisms responsible for the infection. Furuncles have a distinct ten* 
dency to relapse and become chronic, new furuncles continually appear- 
ing while the old ones are healing, and this may continue over periods of 
months or years. Every one of these furuncles will cause more local and 
constitutional disturbance than a staphylococcus vaccine inoculation, still 
one dose of vaccine will stimulate more antibody production, as shown 
by the clinical results, than that developed from the combined influ- 
ence of all the furuncles, extending over a period of months or years. 
Every physician is familiar with the obstinate character of these cases 
under medical and local treatment; especially their tendency to relapse. 
Furunculosis cases usually present a condition in which all stages of 
furuncles may be seen, some healing, others fully developed, some partly 
developed, or just starting. This gives a good opportunity to study the 
aborting effect of staphylococcus vaccine. The fully matured furuncles, 
after being drained, will heal rapidly, the partially matured will become 
less active and heal rapidly after being lanced, while those that are just 
starting will generally subside. Treatment should be started with the 
usual small dose, 0.3 c.c., and increased as indicated by clinical improve- 
ment. Inoculations are preferably made at three or four day intervals, 
until the infection is brought under control and at five to seven day 
intervals after that-for at least one or two months-to prevent relapses. 
For this purpose, large doses are sometimes necessary, it being generally 
advisable to work the dose up to 2.0 c.c. of Formula 22 before discon* 
tinuing treatment. 
gangrene1 
GASTROWTESTDIAL IHFECTIOHS 
THE colon bacillus frequently becomes a pathogenic organism in the 
alimentary tract, instead of restricting its activity to feeding upon 
the fecal masses. It is then a pus producer, infecting the intestinal walls 
iSee Wounds. 66 
A Physician's Manual 
with a resulting colitis, duodenitis, appendicitis, proctitis, etc. The 
consequences of these alimentary infections may manifest themselves in 
practically any portion of the body; it is well known that acne, eczema 
and other skin disturbances may have an enteric basis. An ascending 
infection into the gall bladder may take place, with a resulting cholecys- 
titis or cholangitis. Nor does it fail to make its way into the genito- 
urinary organs, causing cystitis, pyelitis, nephritis and the like. The 
frequency of intestinal disturbances in cases of chronic rheumatism indi- 
cates a causal relationship. 
Generally the colon bacillus is accompanied by other pus producers 
found in the mouth and swallowed, streptococci, pneumococci and 
staphylococci. In gastric ulcers for example, the streptococcus is practi' 
cally always present. Duodenal ulcers have a similar bacterial flora. In 
colitis streptococci and staphylococci also play an important role. So 
when selecting a vaccine in the treatment of these cases a combined 
vaccine containing all these organisms should be selected (Formula 35 
serves this purpose). Treatment should be started with the usual dose 
0.3 c.c. and gradually increased to 1 c.c. or more, making inoculations at 
5 to 7 day intervals. The tonic influence in addition to its immunizing 
action is a decided advantage, in these cases. This tonic influence in- 
creases the appetite, which is always a good symptom to those suffering 
from gastro-intestinal infection. Proper diet and regulation of the 
bowels of course is necessary, 
GONORRHEA 
WHEN treating gonorrheal infections it is important to realize that 
the gonococcus is an organism which has a distinct tendency to 
produce subacute and chronic infections and is very slow in building 
up an immunizing resistance. This has been clearly brought out by 
applying the complement fixation test as a means of determining the 
presence of a gonorrheal infection; complement fixation being obtained 
only in cases where gonococcus antibodies have developed to measurable 
proportions. These complement fixation tests show no positive reactions 
from cases of anterior urethritis or vulvowaginitis. A posterior urethritis 
may show a positive reaction during the sixth week. Positive<eactions 
may be obtained in about fifty per cent of prostatic cases. From this we 
must infer that extensive deep'seated gonorrheal infections are necessary 
to produce a measurable amount of antibody. It is also found that 
immunities produced by the gonococcus are of short duration. Recovery 
from an attack of gonorrhea offers no protection to a subsequent attack. 
In fact a second gonorrhea is often more intractable than the first infec' 
tion. 
As a result of the early conceptions of vaccine therapy, that vaccines of Vaccine Therapy 
67 
were not applicable in the early stages of acute infections, a divergence 
of opinion has existed as to the advantages of employing gonococcus 
vaccine in acute gonorrhea. Much of this opposition to the use of 
gonococcus vaccine in acute gonorrhea was due to the "fear of the nega- 
tive phase," with a consequent insufficient dosage to procure any results. 
That the antigenic or immuno-producing properties of the gonococcus 
in a surface infection are nil, is evident from the prolonged course such 
infections run and this is also demonstrated by the fact that complement 
fixation tests do not show any antibodies or positive reactions from these 
surface infections. On the contrary, it has been abundantly demon' 
strated that killed organism injections rapidly train or develop tissue cells 
for antibody production in the presence of acute infection, and clinical 
results in the treatment of acute gonorrhea with gonococcus vaccines 
when given in sufficiently large dosage at proper intervals shows that 
the gonococcus is no exception to this rule. 
In the treatment of gonorrhea it is the end results that count. There 
is nothing more discouraging than a case of gonorrheal infection which 
refuses to clear up and such a condition is always due to deep-seated 
infections which have gone beyond the reach of local treatment and have 
become too chronic to respond to therapeutic immunization. By giving 
the vaccine during the acute stages of a gonorrheal infection a systemic 
immunity is developed which will guard against deep-seated invasions 
of the gonococcus and by this means will go a long way toward avoiding a 
chronic infection. That acute gonorrhea is favorably influenced from 
the hypodermic use of gonococcus vaccine when properly given, is 
shown by relief from pain at the site of infection and the changed 
character of the discharge, which usually becomes much thinner and con- 
sists mostly of serum, while in many cases the discharge also becomes 
much less in quantity within a few days after the first inoculation. 
The advantages of employing vaccines in conjunction with local 
treatment were well brought out by N. P. L. Lamb, British Medical 
Journal, Oct. 6,1917, in a report of five hundred cases of acute gonorrhea 
among British soldiers. An analysis of the uncomplicated cases shows 
that 60 per cent were under treatment 30 days or less, with an average 
of 19 days. The average duration of all complicated cases was 52 days. 
That many of these cases were far advanced before treatment was started 
is shown by the fact that 70 out of the 500 cases had epididymitis and 
two cases of arthritis developed after the vaccine treatment was started. 
This indicates that large doses of vaccine in the acute stages of gonorrhea 
do not produce a negative phase. The most remarkable feature of this 
entire series of cases is shown in the permanence of the cure, the relapses 
being less than 1 per cent. The author emphasizes the importance of 68 
A Physician's Manual 
this showing and considers it a satisfactory proof of the value of vaccines 
as a test of cure. 
The collective experience among vaccine users in the treatment of 
acute gonorrhea shows that gonococcus vaccine must be employed in 
much larger doses than was formerly supposed, to obtain the best results. 
Instead of giving doses from 5 to 25 million, treatment may be started 
with 300 or 400 million and the dose rapidly increased to 1,000 million 
and as much as 2000 million or more gonococci in addition to the other 
organisms contained in the formula 49. During the acute stages inocula- 
tions are made at two to three day intervals. The dose should be in' 
creased from the initial dose as rapidly as the tolerance of the patient 
will permit. 
Careful bacteriological investigations show that the staphylococcus 
soon becomes a complicating factor in gonococcus infections and that as 
the infection becomes subacute or chronic, the streptococcus, colon 
bacillus, pneumococcus, pseudo'diphtheria or a combination of these 
organisms are liable to become associated in the infection. For this 
reason it has been found practical to employ a mixed vaccine (Formula 
49) containing these various organisms, at once, instead of using a straight 
gonococcus vaccine and waiting until the later stages to use the mixed 
vaccines, after infections by these organisms have been established. By this 
means the patient is protected prophy tactically toward probable infections. 
Since gonorrheal urethritis is essentially a surface infection, the 
importance of appropriate local treatment to eliminate the germs on the 
surface of the mucus membrane, really beyond the reach of the immune 
bodies, should not be neglected. Too often the patient, after finding the 
discharge almost gone, thinks he is cured and all treatment is neglected, 
only to find that the trouble will flare up again, whereas if treatment had 
been continued the entire infection could have been extinguished. 
While it is important to employ vaccines early it is equally important to 
continue the treatment for a month or more at weekly intervals, in full 
size doses, to maintain the immunity that has been attained and by this 
means completely eliminate possible foci of infection. 
The great prevalence of chronic gonorrhea is a reproach on the pre* 
vailing methods of treating the acute stages; but since this condition 
prevails, these chronic cases must be taken care of. That bacterial 
vaccines are a valuable adjunct in the treatment of chronic gonorrheal 
infections is now almost universally admitted. Mixed infections in these 
chronic cases are the rule. The most important of these in addition to 
the gonococcus are the staphylococcus, colon bacillus, streptococcus, 
pneumococcus and pseudodiphtheria bacillus. So, to meet this condi' 
tion, it is necessary to employ a vaccine containing these several organ- 
isms (Formula 49). It is important in treating these chronic cases to be of Vaccine Therapy 
69 
careful and not give too large doses when starting treatment, because 
unpleasant reactions are more liable to occur from overdosing than in the 
acute cases and inoculations should be made at somewhat longer intervals. 
Treatment should be started by giving 0.3 c.c. and the dose gradually 
increased to 1 c.c. making inoculations at three to seven*day intervals. 
In some cases it is necessary to work the dose up to 2.0 or 3.0 c.c. but, 
when giving these large doses, it is best to make the injection in three or 
four different parts of the body so the tissues at the site of inoculation 
will not become overtaxed. Local treatment must be carefully followed 
out. Enlarged prostates must have the pus pockets evacuated by gentle 
massage and where possible, local treatment should be applied to the 
focus of infection. Where bacterial examinations show unusual organ* 
isms present, a corresponding stock vaccine or an autogenous vaccine 
should be employed. 
A most important factor in successfully treating chronic gonorrhea, 
is persistence. In chronic infections the immunizing mechanism is often 
slow to respond and in gonorrheal infections an immunity once estab* 
lished is liable to soon wear off unless the vaccine inoculations are con* 
tinued. In many cases the immunity builds up slowly where crowding 
the treatment will not be tolerated. Many cases will require treatment 
for a year or more before the infection is entirely overcome and it is 
always wise to continue the injections at one or two week intervals for 
several months after all symptoms of the disease have subsided to insure 
permanency of results. 
Epididymitis and Orchitis 
THE opinion as expressed in current medical literature by vaccine 
users is practically unanimous in favor of employing gonococcus 
vaccine in the treatment of epididymitis and orchitis. Early treatment 
is very important to obtain the best results. Intense prolonged inflam' 
mation with pus formation has a tendency to destroy the function of the 
epididymis. Vaccines can not restore destroyed tissues. With the early 
administration of gonococcus vaccine the inflammation will be held 
sufficiently in check to avoid destructive inflammatory developments 
and instead of leaving the patient with an indurated epididymis the organ 
is again restored to its former condition. 
These acute cases, especially in the presence of fever, tolerate large 
doses of vaccine at short intervals and it is by giving sufficient dosage 
repeated at daily intervals that the most striking results are obtained. 
The initial dose may be 500,000,000 killed gonococci or 0.5 c.c. of For' 
mula 25. The dose may be rapidly worked up to 1.0 c.c. or more, de' 
pending entirely on the amount of reaction which develops at the site 
of inoculation. Injections should be made at daily intervals until the 70 
A Physician's Manual 
acute symptoms subside, then three or four days apart until recovery is 
complete. Many doctors prefer a gonococcus combined vaccine (For 
mula 49) on the ground that by this means mixed infections, if not ab 
ready present, will be avoided. There is no good reason why this 
mixed gonococcus vaccine should not serve every purpose. Clinical 
observations would certainly justify a trial with Formula 49 in place 
of 25. 
Gonorrhea in Women 
IN women, gonorrheal infections are usually extensively mixed even 
during the early stages of the disease. For this reason a mixed vaccine 
(Formula 49) should be employed. The principle of therapeutic im- 
munization applies here the same as in men, consequently the same 
dosage and intervals between inoculations are resorted to. Since the 
anatomical conditions are different, local treatment and operative inter* 
ference where necessary, must conform to the natural requirements. 
In this connection special mention should be made of the advantages 
of employing bacterial vaccines in cases where the infection involves the 
Fallopian tubes. Here the inflammatory process generally seals up the 
opening with pus accumulation in the tube. Operative interference in 
the early acute stages is now generally regarded as not advisable on 
account of the dangers involved and because many of these cases recover 
spontaneously and thereby save important organs that would otherwise 
be sacrificed. It is found that in four or six months the pus in these 
tubes usually becomes sterile when operative methods may be employed 
without much danger. Here is where vaccine treatment right from the 
early stages of the infection is very important. By raising the immuno 
resistance the infection can be kept within bounds and destructive 
activities prevented. By keeping the infection down drainage through 
the Fallopian tubes may be maintained and the function of the organ 
saved. The infection does not subside rapidly but by continuing the 
treatment persistently month after month good results will follow. 
The mistake is often made that because this is primarily due to gonococ- 
cus infection, a straight gonococcus vaccine will suffice. Mixed infec- 
tions are the rule, and consequently a mixed vaccine must be employed 
to obtain the best results. (Formula 49 is the preparation usually em- 
ployed.) 
GONORRHEAL rheumatism often presents symptoms so closely 
allied to other forms of acute and chronic rheumatic arthritis that 
it is often difficult to make a diagnosis. It is not an uncommon experience 
to have some one contract gonorrhea who has been subject to rheumatic 
affections. In such cases the question naturally arises whether the 
Gonorrheal Rheumatism of Vaccine Therapy 
71 
rheumatism is a recurrence of the old trouble, whether it is due to 
gonorrheal infection, or possibly to a gonorrheal infection added to a 
rheumatic infection caused by other organisms. Where a history of 
gonorrhea exists it is always well to consider the case gonorrheal until 
it has been demonstrated that the joint infection is not due to the 
gonococcus. 
Gonorrheal rheumatism is in most cases associated with a focal infec- 
tion in the prostate, Fallopian tubes or other parts where mixed infections 
with staphylococci, streptococci, colon bacilli, pneumococci, in addition 
to the gonorrheal infection are common. As common experience shows, 
focal infections, containing pyogenic organisms, are liable to produce 
rheumatic joint involvement. In view of the fact that gonococci and 
other pyogenic organisms preferably grow side by side, in these focal 
infections, there is every reason to believe that gonorrheal joint involve- 
ments are gonococcus. So, in treating gonorrheal rheumatism, the ques- 
tion of mixed infections must always be taken into account and for this 
reason a mixed vaccine containing gonococci, streptococci, pneumococci, 
staphylococci, and colon bacilli, or a gonococcus vaccine alternated with 
a mixed vaccine containing the other organisms, gives the best and most 
permanent result. 
In cases of chronic arthritis the question whether it is of gonorrheal 
origin may often be settled by giving a large initial dose, 500,000,000 or 
1,000,000,000 of gonococcus vaccine. If the infected joints get markedly 
worse within twelve to eighteen hours with a slight rise of temperature 
it is safe to conclude that the gonococcus is at least a factor in the 
arthritis. The fever and joint reaction will subside within a day or two, 
often with improvement of the joints. 
When gonorrheal arthritis develops during the acute or subacute 
stages of a gonorrheal infection, the question of mixed infections is not 
of such great importance as far as the joints are concerned, but the focal 
infection is so complicated with staphylococci involvement that to aid in 
overcoming this infection staphylococcus at least should be added to the 
gonococcus vaccine to be employed for acute gonorrheal arthritis. 
It is now generally admitted that vaccines are the best therapeutic 
agents at our command in the treatment of this intractable disease, but 
while employing the vaccine local treatment at the focus of infection 
should not be neglected. Strictures should be taken care of, a pus-loaded 
prostate should be gently massaged and when possible the focus of infec- 
tion should receive proper local or surgical treatment. To procure per- 
manent relief, it is important that vaccine treatment should be continued 
in conjunction with other methods until the focus from which the germs 
were liberated to reach the joints is eliminated. 
Later experience shows that where gonococcus vaccine was first used 72 
A Physician's Manual 
entirely too small doses were employed. A mixed vaccine containing 
the organisms usually found in the focal infection associated with gonor 
rheal rheumatism, Formula 49, is preferably employed. Treatment should 
be started by giving 0.2 or 0.3 c.c. subcutaneously and gradually increas* 
ing the dose to 1 c.c. or more, making inoculations at 4 to 7 day intervals. 
Where not much reaction follows an injection, the dose may be increased 
to 1 c.c. within four or five treatments. Usually the dose need not be 
increased beyond 1.0 c.c. but some cases will require larger doses, possP 
bly 2.0 c.c. or more and the treatment should be continued for several 
months after all signs of rheumatism have disappeared to obtain a per* 
manent result. 
As a rule, improvement will be observed soon after vaccine treatment 
is instituted and this is particularly so where the case is not of too long 
standing. In some cases the results are most striking, the entire inflam' 
mation subsiding after one or two inoculations, but in such instances 
vaccine treatment should not be discontinued for at least two months 
because otherwise they are liable to relapse. 
In the old chronic cases where the results are not so good there is good 
reason to assume that a mixed infection exists, including the same condP 
tions that prevail in deforming arthritis, and consequently must be 
treated over a long period of time with a vaccine that contains the gono' 
coccus in addition to the combined vaccine employed in rheumatoid 
arthritis. 
GUMBOILS1 
GYNECOLOGICAL INFECTIONS 
A SIDE from gonorrheal infections, there are many cases of suppressed 
pelvic infections-metritis, endo-metritis, vaginitis, salpingitis, 
ovaritis-due to colon bacillus, streptococcus, pneumococcus and staph* 
ylococcus infections. Here a course of vaccine treatment with Formula 
35 in conjunction with local treatment will give results that cannot be 
attained with local treatment alone. Many obscure symptoms of ner- 
vousness, nausea, neuritis, etc., disappear after using the vaccine. Leu- 
korrhea, which is such a disagreeable ailment with many women, will dis- 
appear under this treatment. In these chronic conditions, treatment is 
started with the usual dose 0.2 or 0.3 c.c. and the dose gradually increased 
to 1 c.c. inoculations being made at 5 to 7 day intervals. In obstinate 
cases, treatment must be continued for six months or more. 
In acute pelvic cellulitis, the same vaccine is employed, but being an 
acute toxic infection, 1 c.c. doses should be given and repeated at daily 
intervals until the acute symptoms subside and at 3 to 5 day intervals 
during convalescence. Most excellent results are obtained by this 
1 See Mouth Infections. of Vaccine Therapy 
73 
method. If given early, the infection can be aborted and thus prevent 
abscess formation. 
Thrombophlebitis is a condition that usually develops from an infec' 
tion of thrombi in the veins beneath the placental site, or from the pelvic 
veins which extend from thence to the larger veins. This may readily 
produce an extensive thrombosis. The same bacteria which are respon* 
sible for other gynecological infections are also responsible for infections 
of these veins. Often small blood clots in the infected veins soften and 
the broken'down substances enter the blood stream, setting up a pyemia 
or septicemia. This condition usually sets in during the second week of 
the puerperium, the infection which is of a mild character, gradually 
extending along the veins. This shows the importance of therapeutic 
immunization, even in mild infections during the puerperal state. If such 
infections were aborted during the early stages, thrombophlebitis would 
be avoided. Where extensive thrombi develop, the condition is always 
serious. Here we have a blood infection combined with the plugging of 
large veins which interferes with the circulation of the leg, favoring the 
formation of metastasis. 
Being an extremely acute infection, vaccine treatment should be started 
at once by giving i c.c. doses of Formula 35 at daily intervals and in ex- 
tremely bad cases twice daily. After the fever subsides, the intervals 
are extended to 2 or 3 days and continued during convalescence. The 
results are uniformly good. If the vaccine is used early, the infection 
can be aborted with a resulting rapid recovery. Even far advanced cases 
should not be abandoned. Apparently hopeless cases have been saved 
by induced immunization with this vaccine. 
Puerperal Sepsis 
FEVER a few days after a confinement is always regarded with appre* 
hension, because it may be the first indication of the development 
of a dangerous infection. While it is true that we often have in these 
cases a rise of temperature which subsides spontaneously in a few days, 
it is just this hope that nothing serious will happen that is responsible 
for costly delay in instituting therapeutic immunization. The best au* 
thorities consider a temperature of 100.4° F. inside of ten days after a con* 
finement with few exceptions, as being due to infection and that in slight 
infections the fever rarely goes beyond ioi°. When the temperature 
reaches 103° or 104° inside of 3 or 4 days, the infection must be regarded 
as belonging to the severe types. When associated with rigors, it is prob' 
able that a blood infection has taken place. 
Local treatment, with the object of destroying the infection, is at best 
difficult to carry out because the entire surface of the uterine cavity can* 
not be reached. Curetting, unless very carefully done, will do more 74 
A Physician's Manual 
harm than good by exposing new surfaces for infection and by manipu- 
lating an inflamed organ. If the infection has extended into the uterine 
tissue, it can not be reached by any local treatment. 
In puerperal sepsis, the streptococcus is by all odds the most dangerous 
micro-organism to deal with. The colon bacillus, pneumococcus and 
staphylococcus are also frequently present, either as primary invaders or 
as complicating factors in a mixed infection. Where there is a gonorrheal 
infection, the gonococcus is also found. Other organisms of less patho- 
genic significance may also be present. 
Vaccine treatment should not be delayed for the purpose of making a 
bacterial examination. Early immunization is of more importance in 
these cases than an exact diagnosis. A streptococcus-colon bacillus com- 
bined vaccine (Formula 35) serves the best purpose. Treatment should 
be started with 1 c.c. and injections made at daily intervals until the 
fever and other toxic symptoms subside. When treatment is started 
early, we may confidently expect a normal temperature within one or 
two days. In these cases, it is a mistake to discontinue vaccine injections 
after the temperature comes down because they are so liable to relapse. 
It is better to continue the vaccine for two days after a normal tempera- 
ture at daily intervals and then extend the interval to 2 to 4 days. It 
is also of advantage to give the vaccine at weekly intervals for several 
weeks after convalescence. 
Blood cultures to determine whether a blood infection has developed 
should be made as soon as possible. The blood is drawn from a vein with 
a sterile hypodermic syringe and mixed with liquid culture media in a 
sterile flask and incubated. Making bacterial examinations of the uterine 
contents is unsatisfactory. If an unusual organism should be found in the 
blood, a corresponding stock or autogenous vaccine may be prepared and 
given. 
In case there is gonorrhea present, a gonococcus vaccine should be 
given in conjunction with the other vaccine. 
HAY FEVER 
HAY FEVER is primarily a pollen irritation in persons sensitized to 
certain pollens. By means of skin tests, we are enabled to deter 
mine the particular pollen a hay fever sufferer is sensitized to. From ex- 
tensive application of these tests in hay fever cases, it has been shown 
that hay fever patients are usually sensitized to several pollens-and skin 
tests also show pollen sensitization in persons who do not show symp- 
toms of hay fever when exposed to the same pollen. 
Invasion by pathogenic bacteria-streptococci, pneumococci, staph- 
ylococci, etc.-of the pollen irritated respiratory tract is a constant fea- 
ture of hay fever and in fact soon becomes the most important factor of of Vaccine Therapy 
75 
the ailment. The febrile symptoms are in all probability entirely due to 
this bacterial invasion. It is for this reason that by far the best results 
in the treatment of hay fever have been obtained from the use of bacterial 
vaccines. In some cases it appears that better results are obtained by 
giving pollen vaccine in conjunction with bacterial vaccines. So when 
treating hay fever it is best to always immunize the patient to the com* 
mon pathogenic organisms responsible for respiratory infections. A 
polyvalent combined vaccine (Formula 40, 36 or 38) is the formula 
usually required. In ordinary cases Formula 40 serves the best purpose. 
If the case is complicated by the Friedlander bacillus, Formula 36 should 
be employed and, if the influenza bacillus is present, Formula 38 would 
be the proper combination. 
Dosage should be gauged by the amount of reaction at the point of 
injection. The dose should not be so large that constitutional reactions 
are produced. A red infiltration two or three inches across at site of in- 
jection is all that is required. The initial dose should not exceed 0.5 c.c. 
or 8 minims. If not much reaction follows, the dose may be rapidly in- 
creased to 1 c.c. Inoculations should be made at about 3 day intervals. 
In many cases the hay fever symptoms subside entirely after three or four 
inoculations but the treatment should be continued for several weeks 
at 4 to 6 day intervals to guard against a relapse. In other cases the dis- 
ease runs a decidedly modified course. If the case does not clear up en- 
tirely, treatment should be continued and in some cases it is advisable to 
give the vaccine at 2 day intervals. The vaccine should be injected into 
the connective tissues under the skin and a new area should be selected 
each time. 
The severe symptoms of hay fever may also be prevented by immu- 
nizing the patient to respiratory infections by giving 4 or 5 doses at 5 
day intervals prior to the usual onset of symptoms. In many cases only 
slight symptoms develop which will subside entirely after a few more 
injections. If severe symptoms should develop, treatment must be con- 
tinued the same as if no vaccine had been employed prior to the attack. 
Occasionally hay fever becomes complicated by an unusual organism. 
If a case should not improve promptly under the vaccine treatment, a 
bacterial examination might determine the presence of an unusual organ- 
ism when an autogenous or corresponding vaccine should be employed. 
HORDEOLUM1 
HEART IXFECTIOXS 
HEART infections-endocarditis, pericarditis and myocarditis-are 
sufficiently common and because of their seriousness, assume a 
prominent position in everyday practice. Heart infections are probably 
1SeeJIye Infections. 76 
A Physician's Manual 
always preceded by a blood infection. Streptococci are most frequently 
responsible for endocarditis, but pneumococci, staphylococci, gonococci 
and other organisms are also occasionally found. What is true of endo' 
carditis also bolds good with myocarditis and pericarditis. 
When considering vaccine treatment in heart infections, it must be 
remembered that by curing an infection, tissues that have been destroyed 
during the course of an infection can not be restored. A heart valve 
that has been crippled by germ activities can not be made to function 
properly after the infection has been eliminated. For this reason early 
treatment is most important, not when heart lesions are detected but be' 
fore this, during the presence of the blood infection, before heart infec' 
tion develops. By this means the infection can be eliminated before the 
heart becomes involved. Good results are also obtained when vaccine 
treatment is started during the early stages of heart involvement, before 
active destructive processes have taken place. By inducing early immu' 
nization, the inflammation in the heart valves will subside and leave them 
in a condition so they are able to function properly. 
Heart infection is a common complication of acute rheumatic arthritis 
and is the primary cause of death from this disease. This alone should be 
sufficient reason for giving bacterial vaccines in the treatment of rheu' 
matic fever because it is found that by treating these cases with vaccines 
heart infections are avoided, providing the treatment is started before 
heart complications have developed. The same may be said of tonsillitis 
and sinus infections which are so often followed by heart infections. 
A mixed vaccine containing streptococci, pneumococci, and staph' 
ylococci (Formula 6) is preferably employed. In the acute febrile condi' 
tions, i c.c. doses are given at i to 2 day intervals. After the acute symp' 
toms subside, injections are made at 4 to 6 day intervals. In chronic 
cases, the injections are made in accord with the rules which apply to 
other chronic infections, i. e., start treatment with 0.2 c.c. of the combined 
vaccine and repeat inoculations at 4 to 6 days, increasing the dose at each 
injection 0.1 to o.i c.c. depending upon the amount of local reaction. 
IMPETIGO is a skin infection due to the staphylococcus and sometimes 
complicated with the streptococcus. In the former a staphylococcus 
vaccine (Formula 22) and in the latter condition, a strepto'Staphylocom* 
bined vaccine (Formula 10) is employed. The condition is rather acute 
and requires inoculations at 2 to 3 day intervals, starting with 0.3 c.c. 
and gradually working the dose up to 1 c.c. 
IMPETIGO1 
1 See Dermatitis also. of Vaccine Therapy 
77 
INDIGESTION1 
INFLUENZA2 
IT HAS been quite evident that epidemic influenza is caused by an 
infecting organism that lowers the resistance of the infected person 
to pneumococci, streptococci, staphylococci, influenza bacilli and other 
organisms commonly responsible for infections of the respiratory organs. 
This conforms to the common experience that the real danger in epidemic 
influenza is due to pneumonia or broncho-pneumonia caused by pneu- 
mococcus, streptococcus, influenza bacillus, and staphylococcus infec- 
tions. This knowledge makes the use of a combined vaccine containing 
these various organisms (Formula 38) a logical procedure both as a pre- 
ventive and curative measure in influenza. 
Our experience with Formula 38 during the influenza epidemic of 1918 
and since then has been very extensive which makes logical deductions 
possible. In the presence of an epidemic our experience shows that pre- 
ventive inoculations are entirely practical. While these inoculations do 
not entirely prevent attacks of influenza, it is entirely within ascertained 
demonstrations that those who received three or more doses of Formula 
38 were much less liable to contract the disease and those who did con- 
tract it had much milder attacks, making deaths among those receiving 
the inoculations so few that the mortality rate dropped to less than one 
in three thousand of those receiving the inoculations, and, as far as we 
have been able to ascertain, no one died who received the vaccine 
prophylactically and therapeutically if he contracted the disease. In the 
presence of an epidemic, preventive inoculations are best made at 2 or 
3 day intervals, the first injection being 0.5 c.c., the second 0.8 c.c. and 
the third 1 c.c. To be on the safe side, it is well to give two or three 
more injections of 1 c.c. at weekly intervals. In case there is no imme- 
diate danger of an epidemic, inoculations may be made at 5 to 7 day 
intervals. 
In the treatment of influenza, the dosage and intervals between inocu- 
lations depend largely on the severity of the case-the more severe the 
case the larger the dose and the shorter the intervals between the inocu- 
lations. In the ordinary cases without lung complications, treatment is 
started with 0.5 c.c. and inoculations are made at 3 day intervals, 
gradually increasing the dose to 1 c.c. After the acute symptoms sub- 
side, inoculations are made at 3 to 5 day intervals. In the more severe 
cases with high temperature, 1 c.c. doses are given at daily intervals 
until the acute symptoms subside and at 3 to 5 day intervals after that 
until convalescence is complete. If indications of pneumonia develop- 
ment are present, 1 c.c. doses are given at twelve hour intervals until the 
iSee Gastro-Intestinal Infections. 
2See Rhinitis and Pneumonia. 78 
A Physician's Manual 
temperature comes to normal when the intervals may be extended to 
one or two days, depending on the progress of the case. During con' 
valescence vaccines are given at about 5 day intervals. In bad pneu* 
monia cases, the dose may be worked up to 1.5 or 2 c.c. given at 8 to 12 
hour intervals, changing the site of inoculation at each injection. When 
giving large doses, the vaccine should be injected in two or three different 
parts of the body. Many bad cases of influenza start with a subnormal 
temperature and great prostration. These cases are particularly danger 
ous, and it is found that by giving the vaccine promptly there will be a 
rise in temperature associated with a general recuperation. Influenza 
pneumonia cases are treated essentially the same as other pneumonias. 
See pneumonia, 
IRITIS1 
ISCHIO RECTAL ABSCESS2 
JAUNDICE3 
KERATITIS1 
laryngitis4 
LARYNGITIS is due to the same infecting organisms which cause 
bronchitis and from an immunologic standpoint should be treated 
the same. 
LOBAR PNEUMONIA6 
LEUKORRHEA5 
MASTITIS 
MASTITIS is due to an infection of the milk ducts of the mammary 
gland. The common pyogenic organisms, of which the staph' 
ylococci are the most important, are usually the responsible invaders. 
An inflammatory condition of the gland is sufficient evidence that an in' 
fection has developed and calls for immediate vaccine treatment. A 
mixed vaccine containing the usual infecting organisms (Formula 6 or 35) 
is employed to advantage. The size of the initial dose is gauged by the 
amount of infection present when treatment is started. In the minor 
cases from 0.2 to 0.3 c.c. should be given as the initial dose. In cases with 
extensive involvement with fever the initial dose should be from 0.5 to 
1 c.c. Inoculations should be made at 1 to 2 day intervals until the acute 
symptoms have subsided and then at 3 to 5 day intervals. If treatment 
is started early, the infection can be aborted without abscess formation. 
In cases where an abscess is present, drainage must be established, but 
meantime the vaccine should be employed to hasten recovery. 
1See Eye Infections. 
2See Abscesses 
3See Cholecystitis. 
♦See Tuberculosis also. 
5See Gynecological Infections. 
8 see Pneumonia. of Vaccine Therapy 
79 
MASTOIDITIS1 
METRITIS2 
MOUTH INFECTIONS 
INFECTIONS of the mouth are common and cause much pain and often 
permanent trouble. Slight superficial ulcers of the mouth or aphthae 
are the result of superficial infections by the usual infecting organisms 
found in nose and throat infections-streptococci, pneumococci and 
staphylococci. When acute infections of the throat exist, very slight 
injury to the mucous membrane of the mouth will suffice to start one of 
these ulcers and from the frequency that this condition is met with dur- 
ing acute colds it appears that these localized infections can take place 
without a previous abrasion of the mucous membrane. 
In adults these mouth ulcers usually heal spontaneously especially 
when local treatment of an antiseptic nature is applied, but in infants 
we have seen cases where practically the entire mouth was involved. The 
use of bacterial vaccines is of distinct advantage in all these cases. It will 
be found that the ulcers will heal much more rapidly and the tendency for 
new ulcers to develop will be avoided. Some people are subject to thrush 
and while the ulcers usually heal rapidly, new ones appear at short inter- 
vals. In these cases, vaccines are also of great value in that approxi- 
mately permanent results may be obtained. 
Among the acute infections of the mouth, abscess formation at the 
root of teeth, known as septic apical and mandibular abscesses, are the 
most troublesome to handle and often lead to the loss of teeth that can 
be saved by the timely use of bacterial vaccines and at the same time re- 
lieve much pain. An acute abscess at the root of a tooth is a small affair 
which, by early immunization can be aborted, with subsequent absorp- 
tion of the small amount of pus present. In many instances, immuniza- 
tion in this manner will be instrumental in saving the tooth. Necessarily, 
the earlier in the course of abscess formation immunization is established 
the better are the chances to avoid permanent injury to the tooth and 
make its removal unnecessary. The early symptoms of apical abscess 
formation are deep-seated pain in the tooth with a feeling that the tooth 
is too long and very painful when biting. As the infection develops, 
much swelling of the gum and surrounding tissue, with contiguous 
lymphatic gland involvement, takes place. 
Streptococci, pneumococci and staphylococci are, with few possible 
exceptions, the responsible infecting agents and would require a vaccine 
containing these organisms (Formula 6). It being an acute affair, vaccine 
injections should be made at i to 2 day intervals. The initial dose should 
iSee Ear Infections. 
*See Gynecological Infections and Gonorrhea 80 
A Physician's Manual 
conform to the amount of inflammation present, ranging from 0.5 c.c. to 
1 c.c. After the acute symptoms subside, inoculations should be ex* 
tended to 4 to 6 day intervals. This treatment is of inestimable value in 
these cases. As a rule, relief from pain will follow within twenty-four 
hours and meantime the swelling will also begin to subside. 
Gumboils should be lanced and where fistulous openings exist, necrotic 
bone should be looked for and removed. Bacterial vaccines should be 
given to hasten repair. 
MYELITIS1 
NASAL INFECTIONS2 
NEPHRITIS 
THE bacteriology of the urine in health and disease has been exten- 
sively studied. To arrive at a positive conclusion whether or not 
the urine is sterile in health is surrounded with some difficulty because 
staphylococci are frequently present in the urethra. So, even when a 
specimen is collected by catheterization, there is always a chance of 
urethral contamination, but the number of organisms from such a source 
are always small, and when a considerable number of germs are found in 
the urine it is safe to assume that the organisms are present in the urine. 
Some extensive work on the bacteriology of urine was done by Drs. 
George F. and Gladys R. Dick (Journal A. M. A., July 3, 1915, p. 6), 
who, to avoid contamination, collected the urine by catheterizing the ure- 
ters. Cultures of 2 c.c. of catheterized urine were made in deep tubes of 
dextrose agar; aerobic and anaerobic cultures on blood ascites agar were 
made from the sediment of 15 c.c. of centrifuged urine. 
A study of their work shows that the urine in health is for all practical 
purposes sterile, that the streptococcus is the most common known patho- 
genic organism found in both the acute and chronic cases of nephritis. 
They also found that in cases of coccus infections, organisms identical 
to those present in the infected focus may also be found in the urine 
without the presence of albumin, casts or other indications of kidney 
disease. This is in accord with the findings of other investigators and 
would indicate that the kidney is capable of eliminating live pathogenic 
organisms from the blood as it passes through the kidney. 
The frequency with which streptococci are found in the urine in scar- 
let fever, pneumococci in pneumonia, and micro organisms in typhoid, 
and other acute infections without albuminuria or other indications of 
kidney involvement is good evidence that germs may pass through the 
kidney without injuring it. The frequency with which nephritis follows 
scarlet fever shows, however, that streptococci may become active patho- 
genic agents in kidney inflammations. 
iSee Osteomyelitis 
2See Rhinitis. of Vaccine Therapy 
81 
Two concepts prevail concerning the cause of kidney inflammation; 
A, that toxic materials passing through the kidney while being eliminated 
irritate the kidney structure and lead to inflammation; B, that kidney in- 
flammation is due to a direct infection of the kidney substance. That irri- 
tating substances eliminated by the kidneys do cause kidney inflammation 
is well illustrated in cases of bi-chloride of mercury poisoning, etc., but 
we find that these cases recover rapidly if the specific poison is disposed 
of. In case a nephritis develops during the course of an acute infection, 
it is believed by some that the kidney inflammation is similarly due to the 
elimination of toxic materials, but this contention does not appear well 
grounded because in the vast majority of acute toxic infections no evi- 
dence of kidney inflammation develops. From our present knowledge of 
inflammatory processes we must conclude that an active nephritis, except 
when due to some specific poison, must be regarded as due to infection. 
[See Editorial J. A. M. A., Dec. 15 1923, p. 2035} 
The fact that so many cases of nephritis date back to the various acute 
infections is strong evidence that the kidney infection is a sequence to 
such an infection. It is not uncommon to have cases of nephritis follow 
tonsillitis or a "cold," and in such cases we must conclude that the infect- 
ing organisms responsible for the primary infection developed a metas- 
tasis in the kidney. This would emphasize the importance of therapeutic 
immunization with vaccines in the treatment of colds and other minor 
infections. By this method sufficient immunity is developed during the 
primary infection to avoid the concurrent or subsequent kidney involve- 
ment. At least this is our experience, to our knowledge no case of neph- 
ritis has developed in cases where vaccines were employed for the 
treatment of the primary infection. Since the streptococcus is always a 
primary infecting agent or a complicating factor in infective processes 
that lead to the kidney infection, and since careful bacterial examinations 
of the urine in cases of nephritis uniformly show the presence of strepto- 
cocci, it is necessary to regard all cases of nephritis as being fundamen- 
tally due to streptococcus infection. Other organisms are also frequently 
found in the urine of nephritic cases, but these may be regarded as sec- 
ondary invaders. So, in the selection of a vaccine for the treatment of 
nephritis, it is essential that the streptococcus should be an important 
constituent, and that the other organisms usually found as secondary 
invaders should also be contained in the vaccine. The combination most 
generally employed contains streptococci, pneumococci, staphylococci 
and colon bacilli (Formula 35). 
In the treatment of nephritis a clear distinction must be made between 
extensive acute and chronic varieties. In acute nephritis the inflamma- 
tion of the kidney is often so intense that the entire function of the organ 
is suspended. This makes the infection a very serious one, not so much 82 
A Physician's Manual 
from the amount of tissue involved and the amount of toxic materials 
produced from the infected tissue, as from the fact that a most important 
organ of the body has been deprived of its ability to function. In case of 
erysipelas, for example, the streptococcus will involve much more tissue 
than in a case of nephritis, but in this instance, the tissues involved are not 
essential toward sustaining life while the infection is running its course 
as is the case in nephritis. This makes it doubly important in the case of 
kidney infection to get rid of the inflammation as soon as possible, before 
enough of the waste products which the kidneys otherwise eliminate, 
have time to accumulate in the body to cause death by uremic poisoning. 
The earlier in the course of the disease, immunity can be established, the 
better are the chances for recovery. This necessitates the administration 
of a proper combined stock vaccine at once, preferably Formula 35. To 
delay vaccine treatment in such a case until a careful bacterial examina- 
tion of the urine can be made to determine the infecting organism might 
be responsible for a fatal termination. The infection being acute, prob' 
ably associated with considerable fever, a large dose 1.0 c.c. repeated at 
daily intervals for two to four injections is indicated, then at 2 to 4 
day intervals if the patient progresses favorably. It is very important 
that the vaccine should be employed early, before extensive uremic poi- 
soning has set in, because tissues are much more responsive to the stim- 
ulating influence of the vaccines for antibody formation before the vitality 
of the patient has become exhausted. Meantime, elimination by cathar- 
sis, hot packs, drug-induced perspiration should be persistently carried 
out to sustain the life of the patient until immunity with a resulting elim- 
ination of the kidney inflammation, becomes established. 
In the less acute cases where the kidneys continue to function fairly 
well, these adjunct measures to vaccine treatment are not so important. 
As a rule, they progress favorably under the vaccine treatment. In this 
class of cases, treatment should be started by giving 0.2 c.c. and grad- 
ually increasing the dose to 1.0 c.c., making inoculations at 3 to 5 day 
intervals, depending on the reactions and progress of the patient. Cases 
of nephritis of pregnancy that are not too far advanced would come under 
this class. 
Chronic cases of nephritis progress under the vaccine treatment in 
direct proportion to the permanent damage that the kidneys have sus- 
tained before therapeutic immunization is instituted. Kidneys that have 
become contracted as a result of long-continued inflammation cannot be 
expected to be restored to function normally. If, however, sufficient 
kidney structure remains which can function normally after the infection 
has been abated, to eliminate the waste products of body metabolism, 
health can be restored. It is impossible to know in advance just how 
much of the kidney function can be restored to health. For this reason, of Vaccine Therapy 
83 
no case of nephritis should be abandoned until the vaccine method has 
been given a thorough trial. 
In the treatment of chronic nephritis, the same streptococcus, pneu' 
mococcus, staphylococcus, colon bacillus, combined vaccine (Formula 35) 
is employed that is used in the acute cases. The dosage and management 
of the case, however, is different. Following the rule of treating chronic 
conditions, treatment is started with the usual dose, 0.2 c.c. and admin' 
istered at long intervals 4 to 7 days apart. The dose is gradually in' 
creased to 1.0 c.c. or more, but should not be increased so rapidly that 
marked reactions follow the injection. Treatment should be continued 
until the urine clears up or until it is evident that the damage cannot be 
repaired. Treatment should be continued for at least six months before 
considering the case beyond improvement. 
The statements made naturally presuppose proper and timely surgical 
interference where indicated. This applies to vaccine therapy in 
general. 
IT is striking that so many doctors disregard the use of vaccines in the 
treatment of the various forms of neuritis. Conventional remedies 
certainly are inefficient, and for this reason alone it would appear that 
every doctor would at once avail himself of this remedy, because it does 
not only give relief, but actually effects cures. 
That neuritis is due to infection is now well established. Neuritis 
frequently follows such acute infections as scarlet fever or septicemia, 
or, like rheumatism, it may develop after an attack of tonsillitis, or some 
infective process of the mouth, teeth, nose, throat, sinuses, middle ear 
or bronchi. 
We now know that the streptococcus, pneumococcus and even the 
staphylococcus often gain entrance to the blood current from these lo- 
calized ailments, and through the blood these germs are carried to distant 
parts of the body, where localized infective processes develop. This is 
what evidently takes place in rheumatism, endocarditis and osteomyelitis. 
In rheumatism the synovial membrane and connective tissues around 
the joints are attacked, and the infection, while often very acute, does 
not go on to suppuration. In the subacute and chronic types the infec- 
tion continues for a long time in the connective tissue around the joints 
without material change in the character of the inflammation. This class 
of subacute and chronic infections of connective tissues is particularly 
liable to take place from streptococcus infections. 
Rosenow, Journal A. M. A., Nov., 1915, experimentally produced 
neuritis in lower animals by intravenous injections of streptococci iso- 
lated from focal infections of cases suffering with neuritis. The fact that 
NEURITIS 84 
A Physician's Manual 
streptococci and certain types of pneumococci readily invade connective 
tissues with a tendency to produce subacute or chronic inflammatory 
processes, would lead us to believe that in neuritis the connective tissue 
connecting the nerve fibres instead of the nerve structure itself, is in* 
volved. This would account for the pain and irritated condition of the 
nerve, whereas if the nerve structure itself were involved in the infection, 
the function of the nerve would probably be destroyed. Long continued 
infection of connective tissues produces a characteristic proliferation and 
hardening; just the condition found in chronic sciatica or sciatic neuritis 
where the nerve is found indurated and enlarged. 
The infectious character of neuritis being recognized, vaccine treat' 
ment suggests itself as a logical procedure. From the character of the in* 
fection, it would appear that a streptococcus or pneumococcus vaccine 
should be employed, but from extensive experience we find that a com' 
bined streptococcus, pneumococcus, staphylococcus, colon bacillus vac' 
cine (Formula 35) gives the most consistent results. In many cases, how' 
ever, where the neuritis is associated with bronchitis, sinus or throat 
infections, Formulas 40, 38, or 36 may be employed to advantage. 
As far as the application of vaccines is concerned, it makes little dif' 
ference whether the neuritis assumes the form of sciatica, tic'douloureux 
or multiple neuritis. The results obtained from vaccine injections are in 
direct proportion to the length of time the neuritis has existed before 
vaccine treatment is started. In cases of but few weeks' standing, dis- 
tinct benefit will be observed after the first or second injection, where' 
as, chronic cases will respond more slowly, probably requiring 
one or two months' treatment before much improvement is observed. 
This closely follows our experience with other infections; the more 
chronic the infection the longer treatment must be continued to effect a 
cure. In cases of several years' standing, it is often necessary to continue 
treatment for six months or a year before desired results are obtained. 
In the application of the vaccine, the same rules should be observed 
that are employed in other forms of chronic infections. Treatment 
should be started with 0.2 c.c. of the usual stock suspension, and the dose 
gradually increased to 1.0 c.c. or more, making inoculations at 5 to 7 day 
intervals. Marked reactions should be avoided. This is best done by 
gauging the dose to the amount of reaction produced by the previous in' 
jection. If the previous injection caused considerable reaction, the subse' 
quent dose should not be materially enlarged. It is also important that 
the vaccine should not be injected in the same part of the body a large 
number of times. The tissues where a number of injections have been 
made develop a tolerance to the vaccine and become less responsive to 
antibody production than new tissue. So, when giving the vaccine a 
new area for the injection is preferably employed with each treatment. of Vaccine Therapy 
85 
Too large dosage and giving the vaccine at short intervals as a rule will 
not hasten recovery. Chronic infections will not tolerate crowding in 
vaccine therapy, but by persistent treatment, over a long period of time, 
with careful observation of reactions and dosage adjusted thereto, good 
results may be confidently expected. The results from the use of vac- 
cines in the treatment of neuritis have been so striking that no case should 
be considered hopeless. 
OPTHALMIA, SYMPATHETIC 
IT is quite probable that the involvement of the healthy eye is due to 
spreading of the infection from the diseased one along the sheath of 
the optic nerve. The vital necessity of saving the sight calls imperatively 
for the injection of vaccines for the purpose of arousing general immuni* 
zation and thereby limiting the process. There can be no harm, and 
there may be priceless gain, to the patient, from injections of Formula 6. 
ORCHITIS1 
OSTEOMYELITIS, OSTEITIS PERIOSTITIS 
ONE striking characteristic of bone and joint infections is that the 
same microorganisms that cause infections of the soft tissues of 
the body are also responsible, with few exceptions, for infections of the 
bony structures, and in the treatment of bone infections with vaccines 
it is well to keep this in mind. In the early acute stages, before surgical 
intervention is advisable, much can be accomplished by giving vaccines 
empirically on a clinical diagnosis. In making a diagnosis for the purpose 
of selecting a vaccine, a possible tubercle, gonorrheal or syphilitic infec' 
tion should always be carefully considered, and when present, corre* 
spending specific treatment should be instituted. When a localized 
inflammatory focus on some bone has persisted after an attack of typhoid 
fever, a possible typhoid infection should be suspected. 
The most common infecting organisms of joints and bones are strep* 
tococci, staphylococci, pneumococci and colon bacilli. More rarely we 
have Friedlander bacilli, pyocyaneus, and diphtheroid bacilli. One 
characteristic symptom of acute joint and bone infections is severe pain; 
and as a rule, when severe acute pain comes on suddenly, it may safely 
be considered to be due to pyogenic organisms, and the immediate 
administration of a combined vaccine containing at least streptococci, 
staphylococci, and pneumococci is indicated. Early immunization is 
the most essential factor in the successful treatment of these cases. 
If given sufficiently early, before pus formation has taken place, the 
vaccine will as a rule stimulate enough antbbody production to prevent 
iSee Gonorrhea. 86 
A Physician's Manual 
suppuration and often will avoid the necessity of an operation. If an 
operation for the evacuation of pus should become necessary, it will be 
found that the immunizing influence of the vaccine will promote healing 
with a much more rapid recovery than where no vaccine has been 
administered. Where operative interference becomes necessary for the 
purpose of establishing drainage, cultures should always be taken for the 
purpose of making a bacterial examination and if necessary an autog' 
enous vaccine can then be prepared. 
The organisms responsible for osteomyelitis are the staphylococcus, 
the streptococcus, the colon bacillus, the typhoid bacillus, the gonococcus 
and the tubercle bacillus. Of these the staphylococcus aureus is the 
most common. In the early stages an extensive blood infection often 
accompanies the bone involvement. On theoretical grounds some 
writers consider the use of vaccines contraindicated where such an 
extensive acute infection exists, and contend that if vaccines are em- 
ployed, exceedingly small doses should be given, but experience shows 
that such theoretical conceptions are based on a false premise. Many 
of these cases are very toxic as shown by the temperature, pulse-rate 
and nervous symptoms. This shows that immunization with adequate 
antibody formation is retarded or inhibited by the virulence of the 
invading organism. To depend on the antigenic properties of such de- 
vitalizing agents is unscientific and disastrous. Antibody production 
to stop the ravages of the infecting organism is of utmost importance. 
As has been pointed out before, live virulent organisms when circulating 
in the blood do not arouse tissue cell activities as adequately for anti- 
body production as when tissues themselves are involved; and when 
tissues are attacked by live virulent organisms the devitalizing influence 
of the germs hinder antibody production, and this applies most emphati- 
cally to staphylococci, and streptococci. The result is that usually 
extensive pus formation and tissue and bone destruction takes place 
before sufficient antibody production is aroused to overcome the infec- 
tion. Staphylococcus infections have a distinct tendency, as shown in 
cases of boils and furunculosis to develop new foci of infection, demon- 
strating that immunization develops slowly under the influence of the 
live organisms. This same tendency to develop new foci of infection, 
with retarded immunization is also observed in cases of osteomyelitis. 
It has been our experience, and has been abundantly verified by other 
observers, that the very best results are obtained when vaccines are 
given as early as possible in acute infections, and this holds good whether 
the infection involves the blood or is localized. Furthermore, to secure 
the best results larger doses should be given than when treating less 
severe or subacute or chronic infections, and the vaccine should be given 
at daily intervals for two or three days. of Vaccine Therapy 
87 
Before a positive bacterial diagnosis can be made from pus examination 
or blood culture the patient should be immunized by giving a polyvalent 
stock vaccine containing staphylococci, streptococci, pneumococci and 
colon bacilli, in the full average dose, about twice or three times the 
usual initial dose, and this repeated at daily intervals for two or thre 
days. Later, when the infection is under control, the interval is leng' 
thened to three to five days. 
If bacterial examination should show other organisms present, cor- 
responding vaccines should be employed, and when the infection is 
due to staphylococcus it may be necessary to work the dose of staphy- 
lococcus vaccine up to several thousand million organisms before a cure 
is effected. 
In subacute and chronic cases with fistulous openings a careful search 
for necrotic bone should not be neglected and when this is found, re- 
moved. Staphylococcus infections of the soft tissues near necrotic 
bone infections have a tendency to heal slowly even after the dead 
bone has been removed, but it is found that when staphylococcus 
bacterins are employed this tendency is avoided resulting in a rapid 
healing of the wound. When no dead bone is present many fistulous 
openings will heal under the influence of the vaccine and when healing 
does not take place a tubercle infection is probably a factor. Careful 
bacterial examinations should be made in all these cases, because old 
fistulous openings are liable to harbor a large variety of organisms. 
OTITIS MEDIA1 
OZENA as a result of extensive bacteriological work was for a time 
regarded as being due to a special organism but at the present time 
it is generally believed to be due to some varieties of the Friedlander 
bacillus. Streptococci, pneumococci and staphylococci are common asso' 
ciates in the infection. The infection is associated with a very disagree' 
able odor and is very obstinate. In view of the unsatisfactory results 
from local treatment alone and from the many good results that have 
been obtained from vaccines, this treatment should be resorted to. 
Formula 36 contains some strains of the Friedlander bacillus isolated from 
cases of ozena. Some very good results are being obtained. Treatment 
is started with the usual dose 0.2 c.c. and gradulaly worked up to 1 c.c. 
inoculations being made at 4 to 6 day intervals. 
ozena2 
iSee Ear Infections. 
''See Rhinitis and Colds. 88 
A Physician's Manual 
PERITONITIS1 
PERTUSSIS2 
pharyngitis3 
PHLEBITIS, THROMBOPHLEBITIS 
PHLEBITIS is not uncommonly seen before and during confinements, 
especially in cases of varicose veins, and for this reason this ailment 
deserves mention here. The staphylococcus or streptococcus are usually 
the infecting organisms, although other germs may also be present. 
Streptococcus'staphylococcus mixed vaccine, when used in these cases, 
gives the best results. We have seen conditions after confinement, 
which from the extent of the veins involved promised serious trouble, 
that disappeared after a few injections of streptococcus'staphylococcus 
vaccine. One case occurred in a woman during the seventh month of 
gestation. The veins of one leg had for some time been varicosed and 
at this time became extensively inflamed. She was very much alarmed 
on account of a very tedious recovery from the same trouble on a previous 
occasion. She was assured that the vaccine method of treatment would 
avoid any serious complications and this relieved her mental state. 
After two inoculations at five'day intervals the entire inflammatory 
process subsided and she went on to full term without further trouble. 
The same treatment should be equally applicable in other cases of 
phlebitis. 
In thrombo'phlebitis we have a condition that usually develops from 
an infection of thrombi in the veins which extend from thence to the 
larger veins. This may readily produce an extensive thrombosis, 
Frequently small bloodclots in the pelvic veins soften and the broken* 
down substances enter the blood stream, setting up a pyemia or septice' 
mia. Staphylococci, streptococci, or, at times, both organisms are 
found. This condition usually sets in during the second week of the 
puerperium, the infection, which is often of a mild character, gradually 
extending along the veins. If such an infection were aborted in this 
early stage by the use of vaccines, thrombophlebitis and its attendant 
pain and danger would be avoided. Where extensive thrombi develop 
the condition is always very serious. Here we have a condition of a 
general infection combined with the plugging of large veins which inter- 
feres with the proper circulation of the blood in the leg, favoring the 
formation of metastasis. From the serious character of the infection a 
iSee Gynecological Infections, Appendicitis, Puerperal Sepsis, and Blood Infections. 
2See Whooping Cough. 
3See Rhinitis and Colds of Vaccine Therapy 
89 
high mortality rate under conventional treatment should be expected. 
Lea ("Puerperal Infection," p. 178) places the average mortality at 60 
per cent. 
AND ITS COMPLICATIONS 
THE most important proposition confronting the medical profession 
at the present time is the successful treatment of pneumonia. Pneu* 
monia is still responsible for more deaths than any other disease in nor* 
mal times and in case of influenza epidemics is the real cause, as a compli* 
eating factor, of the enormous mortality rate. Under the prevailing or 
expectant method of treatment the mortality rate runs anywhere from 
io to 40 per cent, depending on the virulence of the prevailing infecting 
organisms responsible for the pneumonias. Such a high mortality rate 
conclusively shows that the usual methods of treatment employed are 
radically inefficient. 
Much has been done in classifying the various types of pneumococci 
that are responsible for pneumonia and a few years ago it was believed 
that types I, II and III were responsible for practically all fatal cases of 
pneumonia, but during the influenza epidemics of 1918 and 1920 it was 
found that pneumococci belonging to the conglomerate group classed 
as type IV were about as frequently found as the prevailing organisms in 
fatal cases as types I, II and III. 
Most of the leading pathologists failed to recognize the streptococcus 
as a serious complicating infecting organism until it was shown that a 
hemolytic streptococcus was usually found as a pathogenic factor in fatal 
cases of pneumonia in the army camps during January, February and 
March of 1918, when the mortality rate among the recruits who con* 
tracted pneumonia was so high. The importance of the streptococcus as 
an active infecting agent was again demonstrated in the pneumonias that 
developed during the influenza epidemic in the fall of 1918 and winter of 
1920. In fact the streptococcus factor of the infection was so pronounced 
during these epidemics that the rapidly fatal cases with lung oedema, fol* 
lowed by cyanosis, were primarily attributed to the ravages of this or* 
ganism. The bacillus of Pfeiffer or so*called influenza bacillus no doubt 
also plays an important role as a complicating agent in many cases. In 
some cases the staphylococcus aureus has been found to be the predom* 
inating organism. In cases of broncho*pneumonia all these various organ* 
isms may be expected to be present. All these findings are a verification 
of our contention, held for many years that mixed infections are the im* 
portant elements that enter into the etiology of pneumonia amd must be 
reckoned with in the application of immunologic therapy. 
On the theory of absolute specificity in applied immunology, much im* 
portance has been placed on the necessity of determining the type of 90 
A Physician's Manual 
pneumococcus which is responsible for the infection before instituting 
immunologic treatment. That immunities which develop from vaccine 
injections are specific is established, but this applies most particularly to 
immunizing responses from the various types in certain groups. 
The theoretical contention that vaccines are contraindicated in exten* 
sive acute infections has been mainly responsible for the vaccine treat' 
ment of pneumonia not coming into general use long before this and curb 
ous as it may seem, those who are opposed to the use of vaccines in pneu' 
monia, have had no experience with them in the early treatment of the 
disease. In order to clear up the fallaciousness of this theoretic opposi' 
tion to the use of vaccines in the treatment of pneumonia, it will be nee- 
essary to elucidate some of the fundamental activities of the immunizing 
mechanism. 
When infecting organisms gain entrance to the tissues or fluids of the 
living body, they maintain themselves by the ferments which they se* 
Crete by means of which they prepare the food on which they live, grow 
and multiply. In pneumonia, for example, the pneumococcus gains en* 
trance to the blood stream from a primary localized infection of some pot' 
tion of the respiratory tract. From these primary localized surface infec' 
tions, pneumococci, by a process of growth, work their way through the 
walls of the small blood vessels and are then carried away by the blood 
current. If normal immunizing substances are present in sufficient pro' 
portion in the blood to retard the virulence of the pneumococcus suffi* 
cientlyso that the white blood corpuscles can attack and destroy the pneu' 
mococci after they enter the blood, no infection of the circulatory system 
will develop. If, on the other hand, the pneumococcus possesses suffi* 
cient virulence, if it has surrounded itself with the ferment which it em- 
ploys to digest the food on which it lives, in sufficient quantity and effec' 
tiveness to protect itself from attack by the leukocytes, the pneumococci 
will continue to grow and multiply in the blood until protective ferments 
or antibodies have been produced in sufficient quantity to cause their 
destruction. Wright calls pneumococci, streptococci and staphylococci 
serophites because they are capable of growing in the blood serums of the 
circulating blood. After the pneumococci have continued to grow in the 
blood for probably several days, at about the time the infection begins to 
localize in the lung, the patient usually has a chill followed by fever and 
other symptoms which mark the beginning of an active lobar pneumonia. 
If the patient progresses favorably in the natural course of the disease, 
the pneumococci will disappear from the blood within a few days after 
lung consolidation has taken place. This would show that germ destroy* 
ing protective substances have evolved sufficiently to destroy the germs 
in the blood and that in time the pneumococci involving the lung will also 
be eliminated. Protective germ destroying ferments or antibodies are o f VfA cTc i n e Therapy 
91 
produced by the involved tissues during the infective process. During 
an infection, however, the central portion of the infected area is often so 
devitalized by the virulence of the infecting organisms that destructive 
processes with pus formation develop and if these tissues survive, it is 
because the tissues surrounding the central portion of the infected area- 
tissues that have come under the influence of the infection with less in* 
tensity-produce immunizing substances in sufficient quantity to eliminate 
the virulence of the infection and prevent destructive processes. So in 
cases of pneumonia where the pneumococcus is eliminated from the blood 
within a few days after lung consolidation develops, and since pneu- 
mococci meantime are found in great numbers in the deeper portions of 
the involved portions of the solidified lung tissue which is sparingly sup- 
plied with blood, the antibodies which are responsible for eliminating 
the pneumococci from the blood are produced by the involved lung 
tissues surrounding the consolidated portions of the lung. If, on the 
other hand, the pneumococci do not disappear from the blood after con' 
solidation takes place, it indicates an unfavorable prognosis. In other 
words, adequate antibody formation is not taking place. 
Now let us visualize the situation from an immunologic standpoint. 
From the time the pneumococcus establishes itself in the blood, it makes 
unhindered progress until lung involvement takes place. Then, if later 
on certain portions of the lung are favorably influenced by the infecting 
organisms, enough antibodies will eventually be evolved to overcome the 
infection; if not, the patient will die. The theoretic objectors to the use 
of vaccines in such acute infections contend that the patient already has 
an overdose of antigen in the form of a live infecting organism, then why 
inject killed organisms in the form of a vaccine? Dorland in his medical 
dictionary defines an antigen as "A substance that causes the formation 
of antibodies; a substance which has the power of inducing in the animal 
organism, under suitable conditions, the formation of antibodies." Evi- 
dently a pneumococcus which continues to grow and multiply until it 
destroys the life of the patient does not perform the function of an anti- 
gen. And even if the organism develops properties during the course of 
the infection which will cause the formation of antibodies, these proper- 
ties certainly do not make their appearance until the infection has caused 
considerable damage. Evidently then, the all-important requirement is 
to supply the patient with a real antigen at the earliest possible moment 
so rapid antibody formation will take place and the infecting organisms 
become eliminated before destructive processes have time to develop. 
There is absolutely nothing pertaining to our immunologic knowledge 
that can in the least conflict with this fundamental principle. That killed 
organisms when injected into healthy tissues possess marked antigenic 
influences is so well established that further comment is unnecessary and 92 
A Physician's Manual 
that such immunizing responses develop from killed organisms or vac' 
cine injections during the course of an acute infection is a matter of clini' 
cal experience. This is readily explained. Live virulent organisms, as 
long as they exert destructive influences on the tissues with which they 
come in contact, can certainly not induce these tissues to produce anti' 
bodies, because the excessive toxic influence of the germ secreted fer- 
ments cripple these tissue cells in their defensive capacity. But when 
killed organisms are injected into healthy tissues, these tissues get busy to 
dispose of them and since the killed germs cannot produce toxic ferments 
to cripple the cells with which they come in contact, the entire cell energy 
can be devoted to the production of immunizing substances making the 
killed organisms or vaccines dependable antigens. 
An objection to the use of vaccines in the treatment of such acute in' 
fections is based on the assumption that, since by this method the injected 
tissues must produce the antibodies before the therapeutic results can be 
expected, the process is too prolonged to be of practical value. From 
clinical results regularly obtained we know that this assumption does not 
hold good. Naturally the best results are obtained when the vaccine is 
applied early in the course of the disease. No one could expect prompt 
immunizing action from any antigen after the entire body has been satur 
ated with germ produced toxins of comparatively long standing. We 
find that if a vaccine containing the various organisms usually found in 
respiratory infections or at least the various types of the pneumococcus, 
streptococcus and staphylococcus, is given within four or five hours after 
the initial chill, immunizing responses sufficient to cause a reduction of 
temperature to normal or near normal with corresponding other improved 
conditions will be found within eighteen to twentyffour hours, and, if 
the vaccine inoculation is repeated at daily or twice daily intervals in 
severe cases, recovery may confidently be expected with very few excep' 
tions, within three to five days. In fact, if the vaccine is given early as 
suggested, typical lung consolidation seldom takes place. Such results 
certainly offer a conclusive demonstration that these vaccines possess 
antigenic properties which produce antibodies promptly. 
The theoretic contention has been that if vaccines are employed at all 
in acute infections on account of the toxic conditions, treatment should 
be started with a small dose, but we find the reverse to be true. Acute 
conditions like pneumonia require large doses and short intervals and the 
more toxic the case the shorter the interval between inoculations. The 
usual initial adult dose of vaccines in extensive acute infections is i .o c.c. 
or 15 minims, repeated at daily intervals and in extremely toxic cases 
twice daily during the extreme toxic conditions, after that at 2 or 3 day 
intervals until recovery is complete. 
This repeating of the inoculations at sufficiently short intervals is just of Vaccine Therapy 
93 
as important as the early application of the vaccine. This antibody pro* 
duction by means of vaccine injections is essentially a quantitative proc- 
ess. During the life process of the infecting organism, it produces fer* 
ments with which it defends itself by digesting the food it extracts from 
the available tissues. Some of these germ produced ferments become 
absorbed throughout the body. These tissue produced protective fer* 
ments or antibodies which develop from the vaccine injections combine 
with the ferments surrounding the infecting organisms and by this means 
rob them of their virulent properties so phagocytes dare to attack and 
destroy them. Some of these antibodies no doubt also combine with germ 
produced toxic ferments, which are present throughout the body and 
thus relieve the general toxic factor of the infection. But all this requires 
a quantitative proportion of tissue produced antibodies. If these tissue 
produced antibodies are all consumed before all the infecting organisms 
are eliminated, they may again begin to multiply and experience shows 
that this is just what happens; relapses take place, again followed by 
improvement after vaccines are again administered, but unfortunately 
this faculty to respond is sometimes lost if the relapse should take on 
serious proportions. For this reason, to be on the safe side, it is necessary 
to continue the inoculations at short intervals until the infection is 
brought thoroughly under control. 
If the vaccine treatment is started after lung consolidation has taken 
place, the results are not so spectacular. While occasionally we precipb 
tate a crisis by giving the vaccine, usually recovery takes place by lysis. 
While the results from the use of vaccine are not uniformly good when 
used late in cases of pneumonia, yet some apparently hopeless cases have 
shown distinct improvement within twentyTour hours after giving the 
vaccine with ultimate recovery. In this class of cases, there is great ad' 
vantage in giving the vaccines in divided doses, i.o c.c. being given in 
three or four different parts of the body. In this class of cases, the free 
use of oxygen to prolong the patient's life until antibodies have time to 
develop, is of decided advantage. 
What holds good with the use of vaccines in the treatment of lobar 
pneumonia also applies in broncho pneumonia and the pneumonias fob 
owing epidemic influenza. In all these cases, vaccine treatment should 
?e instituted at the earliest possible opportunity. Where the diagnosis 
is obscure, the patient should be given the benefit of the doubt just the 
same as diphtheria antitoxin is given in suspected cases of diphtheria. 
IN severe cases of pneumonia, pleurisy often develops with pus forma* 
tion in the pleural cavity which requires drainage. Bacterial examina* 
tion of the contents of the pleural cavity in these cases shows the pneu* 
Empyema 94 
A Physician's Manual 
mococcus as the predominating organism. Streptococci, staphylococci 
and other organisms are also found. As a rule, after using vaccine in 
these cases during the early acute stages, the pus becomes very thin 
within a few days and then develops the appearance of serum. If, during 
this stage, the infecting organisms have disappeared, the drainage tubes 
may be removed and the opening allowed to close. In favorable cases, 
this may take place within five or six days after drainage has been estab' 
lished. 
The same vaccine is employed as in the treatment of pneumonia. Dur 
ing the toxic stages it is given in i c.c. doses at daily intervals and after 
the toxic symptoms subside at 3 or 4 day intervals until recovery is com' 
plete. 
In chronic cases that have been drained for a long time, any one of a 
large variety of organisms may be present. In addition to the streptO' 
coccus and pneumococcus, staphylococci, bacillus pyocyaneus, proteus, 
colon and tubercule bacilli are the most common. A bacterial examina' 
tion of the discharge is necessary to make a diagnosis. The results in 
these cases of long standing are not so uniformly good. In some cases, 
autogenous vaccines will give results where stock vaccines have failed, 
and in others stock vaccines do better than autogenous. Not infre' 
quently, however, indifferent results are obtained. 
Pulmonary Abscess 
ADETAILED description of pulmonary abscess formation is not 
necessary here. As a means of proper vaccine treatment, it is well 
to take into account the three principal conditions under which pulmo- 
nary abscesses develop: intense localized infection, pulmonary embolism 
and extension of an abscess through the diaphragm from the abdominal 
viscera. 
Where pus accumulations exist, drainage is, of course, the first requb 
site, but to build up an immunizing resistance to limit the ravages of the 
localized infection is of equal importance. If the abscess is confined to 
the lung, the same infecting organisms usually found in respiratory infec- 
tions are responsible and demand the same vaccine that is employed in 
empyema and broncho-pneumonia. 
In cases where the abscess has its origin in the appendix or some other 
abdominal organ and has broken through the diaphragm, the colon 
bacillus is almost invariably the principal offender and should be con- 
tained in the vaccine. If the abscess has broken into a bronchial tube and 
the pus is being coughed up, a bacterial examination will readily indicate 
what vaccine should be employed or an autogenous vaccine prepared. of Vaccine Therapy 
95 
Pneumonia Prophylaxis 
MUCH has been accomplished toward preventing pneumonia by 
prophylactic immunization. This is best done by injecting three 
or four doses of a mixed polyvalent vaccine. This procedure is particu' 
larly applicable in large industrial plants especially to prevent pneumonia 
during the prevalence of influenza. Formula 38 is admirably adapted for 
this purpose. This vaccine was employed for this purpose in many thou- 
sands of cases during the epidemics of 1918 and 1920, resulting in a mor' 
tality rate of but one in two thousand. To employ prophylactic immu' 
nization against pneumonia as a routine proposition during normal times 
does not appeal to the general public. Most people disregard the possP 
bility of contracting a disease like pneumonia and consequently don't see 
the importance of procuring protection through prophylactic immuniza' 
tion. There is another condition, however, where prophylaxis against 
pneumonia can be universally applied without the least objection and that 
constitutes the treatment of the minor respiratory infections called colds 
with vaccines. These colds are very amenable to vaccine treatment. 
Usually the acute symptoms subside within twentyTour hours after the 
first inoculation and by repeating inoculations at 2 to 3 day intervals for 
three or four injections, the cold is entirely eliminated and the many se- 
quelae, such as pneumonia, broncho'pneumonia, mastoiditis, endocarditis, 
cholecystitis, nephritis, etc., will be avoided. In the treatment of colds, 
vaccines should be employed. Treatment is usually started with 0.2 c.c. 
and the dose gradually increased to 1.0 c.c. and the rate of increase will 
depend on the amount of reaction that develops after each inoculation. 
The dose should be so gauged that marked reactions are avoided. Inocu' 
lations are usually made at 2 to 4 day intervals. 
PROCTITIS 
INFECTIONS of the rectum are most commonly due to the colon bacib 
lus and staphylococcus. Mixed infections with the streptococcus and 
other organisms are frequently found. Local treatment and operative 
procedures are usually indicated but the infection can more readily be 
brought under control by therapeutic immunization in conjunction with 
the other treatment. A combined colon'bacillus vaccine (Formula 35) is 
usually indicated. The infection being subacute or chronic, treatment 
is started with the usual dose 0.2 c.c. and then worked up to 1 c.c. InoC' 
ulations in the more acute varieties are made at 2 to 3 day intervals and 
in the chronic cases, 5 to 7 days apart. 96 
A Physician's Manual 
PROSTATITIS1 
PSORIASIS2 
PUERPERAL FEVER3 
PYORRHEA is due to an infection of the peridental membrane with 
a resulting absorption of the alveolar process, retraction of gum, and 
final loss of tooth unless the infective process is arrested. 
Much bacteriological work has been done to determine the exact 
etiologic factor in this disease. The usual pyogenic organisms, strep- 
tococci, pneumococci, staphylococci and other germs usually found in 
infective processes of the mouth, are found in the pus procured from 
scrapings in the space around the teeth. 
The entamoeba buccalis has been considered a possible etiologic factor 
in this disease for some years. Smith and Berrelle, at a meeting of the 
Pennsylvania State Dental Society, July, 1914, announced that as a result 
of their investigations they considered this organism the real cause of the 
disease. About the same time and a little later, Bass ("Alveolar Pyor* 
rhea," p. 22) found the entamoeba buccalis in 300 cases of unquestioned 
pyorrhea, while the organism was not found in control cases. He con* 
siders the entamoeba buccalis the real cause of the disease, because of its 
constant presence and from the clinical symptoms of improvement after 
killing of the organism with the use of emetin, one of the alkaloids ob* 
tained from ipecac, which has a specific poisonous effect on the entamoeba 
buccalis. 
From this viewpoint, the pus organisms always found in the diseased 
tissues would be secondary invaders, entering after the entamoeba has 
destroyed the peridental membrane. Bass is of the opinion that these or* 
ganisms cling to the entamoeba buccalis and are carried down into the 
tooth socket with them. He contends that entamoebae, by their con* 
tinuous motile activities, disturb the granulating surface in the alveolar 
process and by this means dig up new soil, as it were, for the deeper pene- 
tration of the pus organisms, with a resulting gradual destruction and 
absorption of the alveolar process. 
At all events, from a careful study of this disease, it must be quite 
clear that the diseased condition is due to the combined activities of the 
entamoeba buccalis and pyogenic organisms and that neither of these 
factors would cause the same amount of destruction when operating 
alone. This fact, to my mind, has been clearly brought out bv the immu- 
nizing and the emetin methods of treatment. 
PYORRHEA 
iSee Gonorrhea 
2See Eczema 
3See Gynecological Infections, Blood Infections and Gonorrhea. of Vaccine Therapy 
97 
It can readily be seen that, where a comparatively low resistance to 
streptococci or other pyogenic organisms exists, more rapid progress of 
the disease will take place under the combined influence of the entamoeba 
buccalis and the pyogenic organisms than where the pus organisms could 
not maintain themselves on account of a high immunizing resistance to 
them. In fact, there is good reason to believe that the entamoeba could 
not maintain itself, especially in the early stages of the disease, if the pus- 
producing organisms were not present as accomplices. The good results 
obtained from the use of vaccines in the treatment of pyorrhea, especially 
when used in the early stages, demonstrates this. In our own experience, 
we have seen well-advanced cases cured with the use of vaccines. The 
good results from the use of vaccine in pyorrhea were recently seen in 
one of our employees. In this case the pyorrhea had been fairly well 
advanced. A dentist was consulted who took care of the teeth by the 
usual methods of cleansing and scraping and without his knowledge 
vaccine inoculations were given at the same time. The case improved 
rapidly and the dentist was surprised at the progress that was being 
made. In three months' time the pyorrhea was relieved without any 
apparent return of the disease. 
From the results obtained in the treatment of pyorrhea with vaccines, 
the pathogenicity of the pyogenic organisms associated in the infection 
becomes evident, and, furthermore, the apparently permanent results 
that are secured also indicate that the entamoeba buccalis cannot success- 
fully maintain itself in the peridental membrane when the soil is unfavor- 
able for the growth of pyogenic organisms, especially so in the early 
stages of the disease. 
The unquestionable good results that have been obtained from the use 
of emetin hydrochloride, hypodermically or in the pus pockets, as shown 
by Bass and others, is conclusive evidence of the pathogenic character of 
this organism in pyorrhea. Bass has found that in practically all cases the 
entamoeba disappears from the tooth sockets after a week's treatment 
with emetin. Concerning the results procured, Bass ("Alveolar 
Pyorrhea," p. 137) says: 
"Though the specific emetin treatment causes the disappearance of 
demonstrable entamoebae, the lesions or pockets remain and will require 
days, weeks, or months to heal, depending largely upon the size, extent 
and nature of the individual lesions as well as upon the natural healing 
powers of the individual patient. In many lesions there is considerable 
alveolar bone denuded of its periosteum, which, therefore, must be re- 
moved by the long, slow process of nature, if not aided by artificial, me- 
chanical means. It requires nature several months also to remove the 
alveolar bone above the level of living peridental membrane in the case 
of pyorrhea. After the entamoeba have been destroyed and the blood 98 
A Physician's Manual 
no longer contains emetin, these lesions or pockets offer the most favor' 
able soil for reinfection." 
It should be remembered that emetin, in the doses given to destroy 
the entamoeba has practically no germicidal effect on the pyogenic cocci, 
and here the natural healing power of the patient depends largely on his 
ability to cope with the pus organisms present in the alveolar process 
and tooth sockets. That vaccines will aid the "healing powers" in the 
presence of an infection has been sufficiently demonstrated. 
From these various considerations, it would appear that the most ra' 
tional procedure would be to employ emetin to get rid of the entamoeba 
buccalis and vaccines to hasten the healing process by immunizing against 
the pyogenic organisms. 
Emetin hydrochloride is marketed by drug houses in sealed ampules 
containing oneffialf grain each, ready for use. The contents of the am' 
pule are withdrawn into the syringe and injected intramuscularly, the 
usual antiseptic precautions being observed. Daily inoculations for one 
week will suffice. Where extensive pus pockets exist, it may be neces- 
sary to flush them with emetin solution. For this purpose, emetin hydro' 
chloride 1:10,000 will answer the purpose. 
Vaccine inoculations should be made by employing a vaccine corre' 
spending to the organisms present in the pyorrhea pockets, either stock 
or autogenous, usually streptococci, pneumococci, staphylococci and 
micrococcus catarrhalis, (Formula 40), 0.2 or 0.3 c.c. the first dose. The 
dose should be repeated at 5 or 7 day intervals and the dose gradually 
increased to 1 c.c. or more and the treatment continued until the entire 
inflammatory process is relieved. 
There has been much said and written concerning the importance of 
salivary calculus as an etiologic factor in pyorrhea. From our knowledge 
of germ activities in the production of renal calculi and gal I scones, there 
is no room for doubting that salivary calculi are the direct cause of de- 
posits from pus formations. These salivary calculi should be carefully 
removed, because they are a direct source for a continuous reinfection and 
also mechanically irritate the gum. 
Pyogenic bacteria complicate pyorrheal infections and aid in the break' 
ing down of body resistance, thereby lowering the local and systemic 
immunity. To resist the invading pyogenic bacteria, it is necessary to 
increase the defensive and recuperative power of the body and establish 
immunity. 
Therapeutic immunization with polyvalent bacterial vaccines in Alve' 
olar pyorrhea have passed the clinical test as recognized therapeutic 
immunizing agents. The treatment of pyorrhea with polyvalent vac' 
cines stimulates the metabolism and defense of the body which is neces- 
sary in overcoming the infection. of Vaccine Therapy 
99 
PYEMIA1 
RECTAL FISTULA2 
PTELITIS 
WHENEVER pus is found in the urine, a careful search for tubercle 
bacilli should not be neglected, and, if found, special treatment for 
a tubercle infection of the kidney instituted. In the absence of a tuber' 
cular infection, the usual infecting organisms are the colon bacillus, strep' 
tococci, staphylococci and pneumococci. Occasionally we find the bacih 
lus pyocyaneus. It is difficult to say just how these infections develop, 
whether the infecting organisms lodge in the pelvis of the kidney while 
they are being thrown off by this organ or whether the infection extends 
from the bladder to the kidney through the ureter. 
Whether bacterial examinations show a straight colon bacillus infec' 
tion or a mixed infection with the common organisms mentioned above, 
a combined colon bacillus vaccine containing these various organisms 
(Formula 35) is preferably employed because sooner or later it is liable to 
become a mixed infection if not cured in time. Treatment is usually 
started with 0.2 c.c. and the dose gradually increased to 1 c.c. or more. 
If the case is acute, as is often the case during pregnancy, inoculations 
should be made at 1 to 2 day intervals, and the dose rapidly increased to 
1 c.c. especially if no material reactions develop from the smaller initial 
doses. The results in these cases of pyelitis in pregnancy are remarkably 
good. Bacterial examination of the urine should be made at least every 
few weeks to determine the presence of bacteria. Treatment should be 
continued until the urine is free from infecting organisms. 
In cases of pyonephritis, the same vaccine is employed, but the kidney 
also being involved, it is necessary to employ measures toward aiding 
elimination the same as in cases of nephritis. 
RHEUMATISM 
RHEUMATISM is now generally regarded as being an infective 
arthritis. The fact that the removal of an infected tonsil or some 
other focus of infection was often followed by improvement or recovery 
of arthritic joints led many to believe that the joint involvement was due 
to toxic materials that gained entrance into the general circulation from 
the infected area. Rosenow's work (Journal A. M. A., September 12, 
1914), however, where he succeeded in isolating pathogenic organisms 
from the tissues of all classes of rheumatic joints conclusively demon- 
Rheumatism (Gonorrheal)3 
iSee Blood Infections. 
2See Abscesses. 
3See Gonorrhea. A Physician's Manual 
100 
strates that in rheumatic arthritis the infection actually exists in and 
around the joints themselves; the tonsil or other focus of infection merely 
serving as a port of entry from where the blood conveys the germs to 
the joints. Billings (Journal A. M. A., September 12, 1914), says: 
"The focus of infection may be located anywhere in the body. The usual 
site is in the head, in the form of alveolar abscess, deep tonsillar or peri' 
tonsillar abscess and chronic sinusitis. Cholecystitis, acute or chronic 
appendicitis, submucous abscess anywhere, salpingitis, vesiculitis, semi' 
nalis, prostatitis, etc., are examples of the local conditions. Furthermore, 
secondary foci in lymphnodes proximal to the primary focus and to 
systematically infected joints, muscles, etc., become additional sources 
of continued and more general infection. 'Overdentistried' teeth may 
cause or prolong alveolar disease. Tonsillotomy may add a sealing scar 
to the infected tonsillar stumps." 
The presence of a focus of infection always constitutes a lowered 
resistance to the causative infecting organisms otherwise the local infec' 
tion could not exist. This lowered resistance, in turn, makes it possible 
for germs that gain entrance to the blood stream from the infected focus 
to grow elsewhere, and the surgical removal of such a focus does not 
necessarily raise the immunizing resistance to the infecting organisms, 
nor does the surgical treatment of the focal infection eliminate the in' 
fected areas already established as joint involvements. Furthermore, in 
many cases of arthritis, the original focus of infection becomes entirely 
eliminated while the joint involvements continue. In the treatment of 
arthritis, the surgical treatment for the relief of pus accumulations is 
very important, but unless treatment is instituted which adequately 
raises resistance to the germs which cause the arthritis, not much penna' 
nent relief should be looked for. 
The streptococcus or strepto-pneumococcus group of organisms are 
the most common invaders. H. Greely (Medical Record, June 1, 1914) 
regards all arthritis inflammations as due to infection and ninety per cent 
of them caused by the streptococcus. Acute inflammatory rheumatism, 
chronic articular rheumatism and arthritis deformans, he considers as 
being due to the same cause but modified by the varying susceptibility 
of different individuals which determines the duration and severity of 
the disease. 
The streptococcus is an unstaple organism and sometimes changes 
from one type to another during the course of an infection. Rosenow 
has even succeeded in converting certain types of the streptococci into 
pneumococci and pneumococci into streptococci. Staphylococci, colon 
bacilli and other organisms also appear to be responsible for joint inflam' 
mations and no doubt, mixed infections exist in many cases. 
Recognizing the infectious character of the various forms of arthritis, of Vaccine Therapy 
101 
therapeutic immunization at once suggests itself as the proper procedure. 
Bacterial vaccines have so far proven themselves as the most efficient 
agents to this end. In the selection of a vaccine some advocate the use 
of an autogenous vaccine prepared from the principal infecting organisms 
found in some focus of infection. While unquestionable good results 
have been obtained by this method, yet it should be remembered that 
the organisms found in a focal infection do not necessarily correspond to 
the ones causing the arthritis. This original focus of infection from 
which the germs causing the arthritis originally migrated may entirely 
disappear and some new focus subsequently develop which has no con' 
nection with the existing arthritis. Furthermore, even in cases where 
the original organism is still present it may have become so modified and 
attenuated that it no longer is of special value as an immuno producer 
in the form of a vaccine. It is not an uncommon experience in chronic 
infections to find that polyvalent stock vaccines g've results where 
autogenous preparations fail. This is in all probability due to a mutual 
tolerance which, in time, develops between the tissue cells and the 
infecting organisms. If a vaccine prepared from such an organism is 
injected the same amount of tissue activity is not aroused as would 
take place from a stock vaccine prepared from active virulent organisms 
of the same type. Extensive experience shows that the best results are 
obtained from the use of polyvalent stock vaccines and mixed vaccines 
are better than single organism preparations. 
In making a diagnosis of rheumatic arthritis, it is very important to 
exclude a possible suppurative osteomyelitis, tuberculosis of the joint 
or a gonorrheal infection. Acute rheumatic arthritis is sufficiently 
distinctive in its clinical symptoms. Endocarditis is such a frequent 
complication in acute arthritis that its presence should never be over' 
looked. Early treatment is of utmost importance because if an immunity 
is established early, heart complications will be avoided. Wolverton 
(Merck's Archives, July, 1914) says: "In those cases in which I have 
used the 'Vaccine treatment' before there was cardiac involvement, no 
such involvement took place subsequently; any agent which has such a 
prophylactic value should at once commend itself. And this treatment 
is free from danger." In acute arthritis, a polyvalent stock streptococcus 
vaccine has been extensively employed but later experience shows that 
it is better to employ a combined streptococcus, pneumococcus, staphy' 
lococcus preparation (Formula 6). The streptococcus and pneumococcus 
are very closely allied organisms and evidently some cases of arthritis are 
due to a pneumococcus. By using the combined vaccine, infections by 
this organism are taken care of. Treatment should be started by giving 
the usual dose and repeating at comparatively short intervals, the same 
as in other acute infections. In severe cases where there is considerable 102 
A Physician's Manual 
temperature daily inoculations for several days are advisable. Improve- 
ment will be observed after the first or second inoculation as indicated 
by relief from pain and a reduction of temperature. After improvement 
is observed, treatment should be extended to three or four day intervals. 
In these acute cases, not much reaction follows the inoculations and for 
that reason the dose may be rapidly increased to i.o c.c. or more. Some 
new joints may become involved with severe acute symptoms but they 
will soon subside under the vaccine treatment. Infants and children are 
very amenable to this treatment and should receive from to the 
adult dose. Treatment should be continued for several weeks at five 
to seven-day intervals after all symptoms of the disease have subsided 
to guard against relapses. 
Subacute and chronic arthritis present themselves in an endless variety 
of forms. Some cases become chronic as the result of repeated uncured 
acute attacks while others come on insidiously and present chronic 
tendencies from the start. In these subacute and chronic cases, we find 
that an extensively mixed vaccine containing streptococci, pneumococci, 
staphylococci and colon bacilli (Formula 35) gives the best results. 
Treatment should be started by giving the usual initial dose 0.2 c.c. or 
3 minims, but must be given at longer intervals than in acute cases. 
From four to seven day intervals is often enough. Reactions from the 
vaccines are more marked here than in acute cases. Where considerable 
local irritation develops at the point of inoculation, the dose has been too 
large and should be followed by a smaller one. Where no material dis- 
turbance follows an inoculation, the dose may be rapidly increased to 
1.0 c.c. or more. Many cases show marked improvement after the first 
inoculation but others improve more slowly. In these chronic infections 
there is, as a rule, no advantage in crowding the treatment. Much better 
results may be looked for by persistently continuing the treatment for 
several months. This is particularly true of the deforming types of 
arthritis. These cases have a tendency to steadily grow worse, not 
being much influenced by drugs, baths, or local applications. Vaccine 
inoculations, however, will benefit them if the treatment is carefully 
followed up for a long period of time. Many cases will not show much 
improvement for three to six months but little by little some advantages 
will be gained. Treatment should be continued for a year or more. The 
first noticeable improvement will consist in the patient's appetite being 
better and his taking on flesh. With this general health improvement 
the joints also get better. Even if nothing more than staying the progress 
of the disease is accomplished, this in itself is worth while. With the 
proper application of vaccine therapy early in the course of the disease, 
the horrible deformities sometimes met with would be avoided. of Vaccine Therapy 
103 
RHINITIS, PHARYNGITIS, SINUSITIS 
MOST infections take place by microbic invasions of mucous mem' 
branes. The respiratory tract and mouth offer an extensive area 
of mucous membrane which is constantly exposed to attack by germs 
that may be present in the inhaled air or adhere to partaken food, and 
this makes infections of this part of the body most common. In fact, a 
large portion of the minor ailments met with in everyday practice and 
many serious diseases as well have their origin in the nose, throat or 
mouth. Acute rhinitis, pharyngitis, laryngitis or tonsillitis may be 
regarded as a trivial affair which usually subsides sooner or later without 
serious consequences, but dangerous extensions of infections from these 
small foci take place entirely too often to justify our neglecting them from 
the standpoint of immuno'therapy. 
In a patient who for some time has complained of slight fever asso' 
ciated with an erratic heart action, endocarditis is at once suspected, 
and if verified the trouble is usually traced to a tonsillitis or similar 
infection. The same may be said of rheumatic fever. Mastoid infections 
and otitis media with few exceptions have their origin in the throat. 
Sinus infections also have their origin in extensions from the nasal mucous 
membrane. Bronchitis and broncho'pneumonia follow "colds," and 
lobar pneumonia have the same origin. The clinical history in cases of 
nephritis often shows that the disease had its origin with a respiratory 
infection, when infecting organisms unquestionably gained entrance to 
the general circulation and caused metastatic infections involving the 
kidneys. Gastric ulcers in all probability are also due to metastasis 
produced by germs that gained entrance to the circulation from localized 
infections of the mouth or respiratory tract. When infections in the 
mouth, nose or throat exist a large number of the germs are constantly 
swallowed and may start localized infections in the various portions of 
the digestive tract. 
Among the common ailments met in general practice, acute infective 
processes of the upper respiratory tract respond most promptly to vaccine 
therapy. Few escape rhinitis, pharyngitis, laryngitis, "colds," but 
results from the use of medicines are so disappointing that comparatively 
few people consult a physician when thus afflicted. The impression 
that "nothing can be done for a cold" is quite prevalent because no 
definite method of treatment for these cases has been adopted by the 
medical profession as a whole. This inefficiency in the treatment of minor 
ailments has lowered the medical profession in the estimation of many 
welbmeaning, intelligent laymen. The argument is often advanced that 
if a doctor can not cure so trivial an ailment as a cold, how can he accom' 
plish anything when confronted with a serious disease. Naturally the 104 
A Physician's Manual 
physician who is able to give prompt and efficient relief when called on 
to treat minor ailments soon gains the confidence of his patients in the 
more serious troubles; and what is true of this esteem toward the indi- 
vidual physician applies equally to the medical profession as a whole. 
Probably 75 per cent of the prevailing infections are simply tolerated 
by the laity until spontaneous recovery takes place; often the infection, 
meantime, becomes chronic, being unaided by a physician, simply be- 
cause nothing sufficiently tangible is offered to warrant taking the 
treatment. Most people have found that throat lozenges or rhinitis 
tablets, at a cost of 5 or 10 cents, will give about as much relief as a 
prescription from a family physician, but we all know how sadly ineffi- 
cient these remedies are. If efficient treatment were administered these 
neglected ailments would be regularly taken care of by the medical 
profession, to the enormous benefit of the general public. Few people 
would tolerate a "cold" if they were aware of the prompt relief and 
efficient cures that may be obtained from the injection of bacterial 
vaccines by their physician. 
Much careful bacteriological research work has been done by many 
investigators to determine the responsible infective agent in these respi- 
ratory infections commonly called colds. A distinction must be made 
between the early acute condition and the later stages and complications. 
Pathologists have for a long time contended that the early acute symp- 
toms of a rhinitis do not conform to symptoms which are produced by 
pneumococcus and streptococcus infections. We also find that patients 
receiving a mixed vaccine practically identical to the one employed in 
the treatment of respiratory infections for chronic arthritis, for example, 
will develop an acute rhinitis while receiving vaccine inoculations but 
this rhinitis will disappear in a few days. This would indicate that 
while the patient is immune to pneumococci, streptococci, etc., there is 
a susceptibility to an infection which is responsible for these acute 
symptoms. So, most pathologists have come to the conclusion that the 
early acute symptoms of acute coryzas are due to an unknown organism 
probably a filtrable virus. This primary invader really serves the pur- 
pose of paving the way for pneumococci, streptococci, staphylococci and 
other organisms which in turn become the real offenders; being responsi- 
ble for prolonging the infection, causing involvement of the sinuses, 
middle ear, mastoids, etc. 
From this viewpoint it is perfectly clear that bacterial vaccines will 
not absolutely prevent these acute infections but will shorten their 
course and prevent complications. The pneumococcus, streptococcus, 
staphylococcus, micrococcus catarrhalis, influenza and Friedlander bacil- 
lus are the most common secondary invaders and are usually found in of Vaccine Therapy 
105 
In the fresh acute cases af rhinitis or bronchitis we are dealing with 
the primary infection and aim to develop an immunity in time to prevent 
the more serious infection by pneumococci, streptococci, etc. Here, as 
a routine measure, vaccine Formula 40 or 38 should be injected, beginning 
with 0.2 c.c. and rising, at intervals of two or three days, to 1.0 c.c. If, 
after a few injections, the acute symptoms have subsided, but the trouble 
continues with considerable mucus discharge, inoculations should be 
continued at three to five-day intervals. Where there is a copious dis- 
charge associated with a disagreeable odor the Friedlander bacillus is 
liable to be present, when Formula 36 should be employed. 
Subacute or chronic cases of catarrh-such as occur in patients in 
which the condition is quiescent for a greater part of the year and only 
lights up occasionally-call for the administration of Formula 40 or 38. 
If, however, they are characterized by an abundant secretion of mucus, 
the bacillus of Friedlander is probably present, and vaccine Formula 36 
is best given. The dosage is 0.3 c.c. increased to 1.0 c.c. at intervals of 
from four to seven days. 
Some people suffer from recurrent attacks of respiratory infections 
because no lasting immunity develops from a spontaneous recovery from 
the infection. In such cases a lasting immunity can be developed by 
treating the infection during the acute stages with vaccines and con- 
tinuing the treatment for several months with injections at weekly or 
biweekly intervals. Another attack may develop in time but as a rule 
it is not so severe and will yield promptly to further vaccine treatment. 
The results from the use of bacterial vaccines in the early acute stages 
are quite striking. As a rule relief is obtained within one or two days. 
If the vaccine treatment is not continued, however, the case is liable to 
relapse when the acute symptoms reappear. After the infection is 
brought under control injections should be continued at three to four- 
day intervals until all the symptoms have subsided. 
SINUS and antrum infections are due to extensions of the infection 
from acute nasal catarrh and naturally are due to the same organisms 
and from a standpoint of immunotherapy require the same bacterial 
vaccine treatment. From the fact that sinus infections when once estab' 
lished have a tendency to become chronic it is of utmost importance to 
have these infections cleared up as rapidly as possible. While instituting 
vaccine treatment it is also very important to make a careful examination 
to determine abnormalities which require surgical treatment. Proper 
drainage must be established and maintained and where antrum infections 
are due to an infected tooth socket the tooth should be extracted. A 
large majority of these cases are due to the common respiratory infecting 
sinus and antrum infections1 
iSee Rhinitis and Colds. 106 
A Physician's Manual 
organisms but occasionally the bacillus pyocyaneous, colon bacillus, and 
pseudodiphtheria bacillus are found. In the treatment of these cases a 
corresponding stock or autogenous vaccine should be employed. 
Prophylaxis1 
MANY people are subject to taking colds. In such cases it is advis' 
able to employ prevention. This is effectively accomplished by 
giving combined vaccine Formula 40 at weekly intervals, starting with 
0.5 c.c. and increasing to 1.0 c.c. for three or four inoculations about 
three times during a year. 
This, however, does not absolutely prevent contracting a cold, but it 
is found that if a cold is contracted, it will be of short duration and 
especially so if a few doses of the vaccine are given at two to three day 
intervals during the attack. In many instances it is necessary to give 
smaller doses at daily intervals for relief. 
SALPINGITIS2 
SCARLET FEVER 
THE unusual prevalence of scarlet fever demonstrates the inadequacy 
of isolation and disinfection as an efficient means of controlling in' 
fectious diseases. That the streptococcus is the important active patho' 
genic agent in this disease has been conclusively demonstrated by 
Schleissner (Wiener Klinische Wochenschrift, April 95, 1910), who 
found streptococci in practically pure cultures on the tonsils during the 
very early stages of nearly all scarlet fever cases. He also found strep' 
tococci in the blood in a large proportion of the 73 cases examined. 
The streptococcus found in cases of scarlet fever is the same, in cultural 
characteristics and other properties, as streptococci found in cases of 
epidemic sore throat and from other sources. This was forcibly brought 
out in a paper by Drs. Wohl and Detweiler (Interstate Medical Journal, 
Sept., 1916), in which they show identical characteristics of streptococci 
isolated from epidemic sore throat and scarlet fever cases. In their agglu' 
tination tests they found that blood serum obtained from convalescent 
cases of scarlet fever agglutinated streptococci isolated from cases of scar 
let fever, streptococcic fever or from a felon. Blood serum obtained from 
convalescent cases of streptococcic fever also agglutinated streptococci 
isolated from scarlet fever cases. These findings conform with the results 
of other investigators, both in this country and abroad. Nothing has 
developed which would indicate that the streptococcus isolated from 
cases of scarlet fever possesses any specific characteristics. 
That prophylactic immunization is the most effective measure in con- 
trolling infectious diseases has been conclusively demonstrated by immu- 
i See Rhinitis and Colds and Pneumonia also, 
a See Gonorrhea in Women of Vaccine Therapy 
107 
nizing in typhoid fever, cerebral spinal meningitis, cholera, bubonic 
plague, and other diseases. Since the streptococcus is the dangerous 
pathogenic factor in scarlet fever, prophylactic immunization to this 
organism is the most scientific and rational procedure. 
Concerning scarlatina prophylaxis, Wohl and Detweiler say: "For 
practical purposes, however, we must admit that the streptococci play 
the most important role in the clinical entity called scarlet fever." 
Once this is realized, proper attention to the destruction of the strep* 
tococci, either locally by disinfection of discharges from the nose, throat 
and ear, or by raising the constitutional resistance against them by vac* 
cination, would certainly lessen the incidence of the disease. The work 
of Gabritschewsky, and his other Russian associates, in immunizing with 
streptococcic vaccine the children exposed to scarlatina, is conclusive that 
it has a decided value from a prophylactic standpoint. A number of his 
fellow countrymen pursued a study along these lines, although but few 
have taken up the matter in this country. 
Smirnof observed that of 91 un vaccina ted children 37.3 per cent, deveb 
oped scarlet fever, and of 12 vaccinated children 3.93 per cent, developed 
it. The protection by repeated injections is shown by the following 
table: 
Vaccinated 
Cases 
Incidence 
Once 
1,295 
1.69 
Twice 
1,018 
0.19 
Thrice 
256 
0.00 
Kogan reported the vaccination of 62 children in an asylum during an 
epidemic of scarlet fever. The children remained immune from 1908 to 
1911, when a new epidemic broke out, and of these 62 vaccinated cases, 
only 2 contracted scarlet fever, or 3 per cent, while out of the 26 new 
non-vaccinated cases admitted to the asylum, 8 contracted the disease 
or 30+ per cent. 
Watters reports the successful immunization of nurses with strepto* 
coccic vaccine. Of those vaccinated, only 2.7 per cent, contracted the 
disease, while of the nonwaccinated 35.7 per cent, acquired the disease. 
To effectively protect against scarlet fever three doses of streptococcus 
vaccine should be given at five-day intervals. Formula 42 is admirably 
adapted for scarlet fever prophylaxis. It is polyvalent in composition 
and made up in proper suspension for convenient adjustment of dosage. 
The first dose should be 0.3 c.c., second dose 0.5 c.c. and third dose 1. c.c. 
We will admit that prevention is better than cure but since there are 
many cases of scarlet fever, the importance of treating them with bac* 
terial vaccines should not be overlooked. It is the consensus of opinion 
of all those who have used bacterial vaccines extensively, that the best 108 
A Physician's Manual 
results are obtained when they are employed in the early stages of acute 
infections. In streptococcus infections the greatest amount of irreparable 
damage is done during the early active stages of the infection; before the 
immunizing mechanism has had a chance to respond in immuno produc* 
tion. Live virulent streptococci do not influence tissue cells favorably 
for rapid antibody production, whereas killed streptococci-streptO' 
coccus vaccine-when injected into healthy tissues have a favorable in* 
fluence on tissue cells for rapid antibody formation. In other words, 
tissue cells respond more rapidly in establishing an immunity under the 
influence of killed organism injections than where exposed, unaided to 
the devitalizing influence of the live virulent organisms. For this reason, 
early treatment is very important. By early vaccine treatment, tissue 
cells are actively influenced for antibody production and by this means, 
enough antibody will be produced to stay the progress of the infection 
sufficiently to prevent serious complications. 
The staphylococcus is frequently a complicating factor in localized 
streptococcus infections in scarlet fever. For this reason it is well to use 
a streptococcus, staphylococcus combined vaccine in the treatment of 
scarlet fever. A streptococcus combined vaccine (Formula io or 6) is 
favorably employed. Treatment should be started as soon as possible, 
repeating inoculations at daily intervals and in extremely toxic cases the 
vaccine may be given twice daily. After the toxic symptoms have sub' 
sided, inoculations should be extended to 3 or 4 day intervals until the 
patient has recovered. The dose for adults is 1 c.c. Children should 
receive from oneTourth to one'half this amount. 
SCIATICA1 
SINUSITIS2 
SKIN INFECTIONS3 
SURGICAL PROPHYLAXIS4 
BACTERIAL Vaccines properly administered form valuable adjuncts 
and prophylactors in major and minor operative surgery. 
The beneficial results of surgical interference in inflammatory condi- 
tions associated with pus formation have been so generally recognized 
that many operators consider their duty in such cases ended when 
adequate drainage has been established. A self-satisfaction that every- 
thing possible has been done is often a great hindrance to progressive 
work. In operating on cases where pus exists there is always danger of 
the infection extending into the tissues opened up as a result of the 
operation. Many times pus cavities are deep-seated and extensive 
iSee Neuritis. 
2See Rhinitis. 
3See Furuncles, Eczema, etc. 
4gee Wound Infections. of Vaccine Therapy 
109 
operating is necessary to reach the seat of trouble. In all such cases the 
immunizing influence of vaccines is of unquestionable value. Many 
operators recognize the value of vaccines in septic wounds and give them 
after clinical symptoms indicate that the infection has extended. In a 
publication we notice that a surgeon had an autogenous vaccine prepared 
from streptococci and colon bacilli isolated from the removed appendix to 
be given to the patient "in case he needed it." Here is a case where 
the infection existed and if vaccines are of any value he needed it before 
clinical symptoms indicated a postoperative extension of the process 
to avoid such extension. A better method still is to give the patient a 
stock vaccine corresponding to the probable infecting organisms just 
after or preferably before and after the operation. This will avoid the 
necessary delay incidental to making autogenous vaccines and the 
patient will obtain the benefit of early treatment. This method has 
given us such uniformly satisfactory results that we can unhesitatingly 
recommend it as a routine procedure. 
Vaccines are advantageously used in major wounds from severe 
trauma, this includes compound fractures, etc., etc. Here the tissues 
have been cut, bruised and lacerated without the aseptic precautions 
observed on the operating table, making infections always more or less 
liable to occur. To give antitetanic serum when the wound was made 
under conditions making tetanus infection imminent is now recognized 
as a rational procedure. In accidental injuries staphylococcus and 
streptococcus and frequently infection by both organisms is always 
possible, and to give a prophylactic dose of combined streptococcus' 
staphylococcus vaccine is just as reasonable as the tetanus prophylaxis 
above referred to. 
Through the influence of Sir A. E. Wright, millions of doses of 
"mixed infection vaccine" have been prepared in St. Mary's Hospital, 
London, and in the British Government laboratories, and used in the 
army hospitals of England and France with the result of materially 
reducing the dangers of the common pus infections in innumerable 
wounds. 
Bacterial vaccines are more and more coming into use as prophylactors 
in operative cases where no indications of infective processes exist. 
It will not be long before the prophylactic vaccine inoculation will 
become a part of pre-operative routine just as the blood count and the 
urinary test are. The absolute harmlessness of the procedure is un- 
questioned, and the only thing that must be overcome is the conservatism 
of certain members of the profession. Such conservatism, however, 
cannot prevent the final recognition of the fact that vaccines may be 
advantageously used as prophylactors in surgical work. 
In abdominal surgery prophylactic immunization should be instituted 110 
A Physician's Manual 
prior to every operation, by the administration of a mixed stock vaccine 
containing the principal organisms found in abdominal infections. 
These comprise the streptococcus, the colon bacillus, the pneumococcus, 
and the staphylococcus. The procedure is absolutely harmless and can 
accomplish much good by raising the immunity and thereby preventing 
dangerous post-operative infections or extension of existing infections. 
Both Acute and Chronic 
TONSILLITIS 
INFECTIONS of the tonsils are common. Here the streptococcus is 
the most common invader. In making a clinical diagnosis of tonsillitis, 
the fact, that a membranous exudate resembling diphtheria is often found 
to be due to streptococci, should never lead one to neglect giving diph- 
theria antitoxin at once where a reasonable suspicion exists that the case 
may be one of diphtheritic infection and have the diagnosis verified by 
bacterial examination. If the symptoms indicate severe infection, a vac- 
cine should be given in conjunction with the antidiphtheritic serum, be- 
cause by this means active immunization will be hastened toward elimi- 
nating streptococcus involvement while the antitoxin is establishing a 
passive immunity toward a possible diphtheria infection. Furthermore, 
complicating infections by streptococci in diphtheria are not uncommon 
and by using a streptococcus vaccine in conjunction with diphtheria anti- 
toxin a definite purpose is served. We are confident, as a result of clinical 
experience, that in many cases of diphtheria where the inflammatory con- 
dition is extensive, involving lymphatic glands, the streptococcus is an 
important complicating factor which will be relieved by employing 
streptococcus vaccine in conjunction with antidiphtheritic serum. The 
same holds good with extensive throat infection with lymphatic involve- 
ment in cases of scarlet fever. 
While most cases of tonsillitis are due to streptococci, yet in some cases 
the pneumococcus is found, and the staphylococcus is commonly asso- 
ciated probably as a secondary invader. The micrococcus catarrhalis is 
so often found in crypts of inflamed tonsils that this organism may also 
be regarded as a pathogenic factor. 
From the bacterial flora of tonsillitis, it is clear that the same combined 
vaccine employed in respiratory infections (Formula 6 or 40) also applies 
here. The initial dose should be gauged by the severity and extent of 
the infection. Cases with fever and lymphatic involvement should re- 
ceive 1 c.c. and the dose repeated at 1 or 2 day intervals. In less severe 
cases, treatment is started with 0.3 to 0.5 c.c. If treatment is started 
early, before a necrotic center has developed, the infection may be aborted 
without pus formation. Usually marked relief is obtained within one or 
two days, when a rapid recovery will follow. of Vaccine Therapy 
111 
The importance of applying immunotherapy in acute tonsillar infec- 
tions cannot be overestimated when we consider the serious complica- 
tions which so often follow these cases when allowed to run the usual 
course. Heart infections, acute rheumatic arthritis, nephritis, appendi* 
citis, and gall-bladder infections only too often have their origin in 
tonsillitis. By treating the primary infection through the immunizing 
method with bacterial vaccines, these secondary complicating infections 
are avoided. 
Repeated infections of the tonsils disorganize them with a resulting 
enlargement and increased susceptibility to repeated infection. Such 
tonsils can serve no useful purpose and should be dissected out as soon as 
the acute infection has subsided. Such tonsils are always an open gate- 
way to infections and are liable to lead to serious consequences. 
TUBERCULOSIS 
THE vaccine treatment of tuberculosis assumes two distinct phases: 
Immunization towards controlling the tubercle infection and immu- 
nization to overcome infections by pyogenic organisms, which almost in- 
variably complicate tubercle lesions. 
The treatment of tuberculosis by the immunizing method has received 
an unusual amount of continuous attention from the time Koch brought 
out his tuberculin, twenty-eight years ago. To Sir A. E. Wright, how- 
ever, deserves the distinction of having placed therapeutic immunization 
in tubercle infections on a scientific basis. By means of his opsonic index, 
he demonstrated that tuberculins were employed in doses entirely too 
large to obtain immunizing responses. 
As a whole, there can be no doubt but that tuberculins are of thera- 
peutic value when carefully employed so as to avoid focal reactions and 
especially when used in combination with bacterial vaccines to combat 
mixed infections. 
The toxic properties in tuberculins are in all probability due to some- 
thing contained in the virulent tubercle bacilli. This objection has been 
overcome by our employing a non-toxic strain of tubercle bacillus in the 
production of Sherman's Non-Virulent T. B. Vaccine, Formulas 45 
and 47. 
This tubercle bacillus has been so attenuated that the injection of large 
doses of the live organism will not cause infection in guinea pigs and yet 
a vaccine prepared from these same tubercle bacilli when injected sub- 
cutaneously will stimulate efficient antibody formation for immunizing 
purposes as shown by animal experiments and the favorable results ob- 
tained in clinical cases. 
On account of its non-toxic character, this Non-Virulent T. B. vaccine 
is applicable in all stages of tubercle infection. Naturally, the best re- 
sults are obtained in the early stages, where uniform good results may 112 
A Physician's Manual 
confidently be expected. In moderately advanced cases, the results are 
also good, and, if treatment is persistently carried out, a large majority 
will be clinically, and apparently permanently, cured. In advanced cases 
the combined Non-Virulent T. B. and mixed vaccine treatment will cer- 
tainly give much relief, and in some cases will prolong life. 
In the treatment of tuberculosis, immunizing efforts must be directed 
simultaneously towards the tubercle infection with the Non-Virulent 
T. B. vaccine and the pyogenic infection with a mixed vaccine. This is 
most effectively accomplished by giving the tubercle vaccine alternately 
with the mixed vaccine. 
This avoids the possibility of confusing reactions. If the mixed vac- 
cine is injected with the tubercle vaccine, it is impossible to know if the 
reaction is due to the tubercle or mixed vaccine. 
Reactions from inoculations of the Non-Virulent T. B.vaccine vary, in 
some cases there being practically no reaction, while in others there is 
considerable. For this reason it is advisable to start treatment with a 
small dose. 
When giving a mixed vaccine in conjunction with the Non-Virulent 
T. B. vaccine, where possible, a bacterial examination should be made to 
determine the organisms present. This, however, is not always possible 
because in many cases the infection has not advanced to a point where 
there is a free discharge of the pus producing organisms. In such cases 
it is important when selecting a vaccine to associate the mixed infection 
with the site of tubercle infection. In pulmonary tuberculosis, for exam- 
ple, the organisms usually present in other lung infections will also be 
found in tubercle infections; in lupus, the usual skin organisms are also 
present. In pulmonary tuberculosis, the mixed infection most frequently 
consists of pneumococci, streptococci, staphylococci, and the micro- 
coccus catarrhalis. Tuberculosis of the abdominal viscera and pelvic or- 
gans is most frequently associated with colon bacilli, streptococci, pneu- 
mococci and staphylococci and would indicate the use of Formula 35. 
In lupus, staphylococci are the principal complicating invaders and would 
call for Formula 22. Tubercular joints are complicated by staphylococci 
and less frequently also by streptococci. This would require Formula 10. 
The dosage of the mixed vaccine would be the same as when employed 
in other chronic infections by the same organisms. Treatment is started 
with the usual small dose and gradually increased. 
In the treatment of these cases, it is best to start with the mixed vac- 
cine inoculations, using vaccine Formula 36, 38, 35 or 40, depending 
upon bacterial findings, the initial dose being 0.2 c.c. This is then fol- 
lowed in 3 to 4 days by the first dose of the Non-Virulent Tubercle Vac- 
cine 100,000,000 organisms 0.2 c.c. of Formula 45 or 0.1 c.c. of 47. The 
inoculations are then repeated at 3 to 4 day intervals, alternating the of Vaccine Therapy 
113 
mixed vaccine and the Non-Virulent Tubercle Vaccine, so that the pa* 
tient receives one dose of each vaccine each week. The mixed vaccine 
can be increased at each inoculation about o.i c.c. until full i.o c.c. doses 
are reached, this being about the maximum dose. The Non'Virulent 
Tubercle Vaccine can be increased about 100,000,000 organisms per inoc- 
ulation 0.1 c.c. of Formula 47 until a maximum of 1.5 c.c. is reached. 
These inoculations are repeated alternately at 3 to 4 day intervals until 
recovery or the case has been arrested. It is well to continue the vaccine 
therapy for some months after apparent arresting of the process to pre- 
vent relapse and assure permanency of result. Another criterion in dosage 
is to observe the size of the infiltrated area at the site of inoculation about 
18 to 24 hours after administering the vaccine. Having in mind grad- 
ually building up these maximum doses, it is well to watch the local reac- 
tion and in this way judge the increase, if any, which is to be adminis- 
tered at the particular moment. The local reaction should have an area of 
infiltration not to exceed approximately 1inches in diameter, but it 
seems necessary to have a little local reaction in order to get the best 
therapeutic response, particularly in the initial doses. Later a local reac- 
tion may not develop, in which case it would be well not to increase the 
amount at each subsequent inoculation more than approximately 0.1 c.c. 
even though there is no local reaction. Of course, the focal conditions 
should be watched carefully after each inoculation, and, if any focal reac- 
tion should develop, which is very doubtful, it would be well not to in- 
crease the dose until the patient's tolerance permits. The "redness" 
should practically disappear before administering the next dose. A con- 
venient method of spacing dosage is to give the mixed vaccine, say on 
Monday and the Non-Virulent Tubercle Vaccine on Thursday or Tues- 
day and Friday, etc.; in this way the dosage can be regulated conven- 
iently. In some cases where inoculations cannot be conveniently given 
oftener than once weekly, the mixed vaccine can be given in one location 
of the body and the tubercle vaccine at another so that the local reaction 
can be observed independently and the dosage of each be properly in- 
creased. Vaccine therapy is not contra-indicated in "temperature cases." 
It is in these cases that marked results are experienced in bringing down 
the temperature and eliminating the "night sweats." 
Treatment should be continued over a long period of time; at least 
three or four months, and where the condition has not entirely cleared up, 
it is necessary to continue the vaccine inoculations for a year or more. 
All other measures, such as fresh air, sunlight, rest, plenty of nourish- 
ing food, especially raw eggs and milk, should not be neglected. It is the 
combination of all of these elements that must be utilized to obtain the 
best results. 114 
A Physician's Manual 
THROAT IXFECTIOMS1 
THROMBOPHLEBITIS2 
TYPHOID FEVER 
NO step in advance in preventive medicine has been more spectacular 
than prophylaxis by means of typhoid vaccine and notwithstand' 
ing the positive results obtained it required fifteen years to obtain gen' 
eral recognition. This is another evidence that the medical profession is 
essentially conservative-too conservative-to render the best service. 
If typhoid prophylaxis were generally carried out throughout the country 
the same as in the army, typhoid fever would soon be a rare disease. 
Since such a measure could only be inaugurated by health authorities, the 
general practitioner can accomplish much by urging typhoid vaccination 
wherever possible. This should be particularly insisted upon in commu' 
nities where typhoid fever prevails and where individuals go on vacation 
trips. This applies to vacationists and tourists generally either during the 
summer in the north or during the winter in the south. 
A few years ago much was said concerning the advantage of giving a 
single dose of lipowaccine, but the use of this vaccine in the army service 
has shown that the reactions often are unnecessarily severe. These 
severe reactions are avoided by the saline suspension. Three doses at 7 
to 10 day intervals are necessary. The first dose should be 0.5 c.c. of 
Formula 46 or 30 and the two subsequent doses 1 c.c. each. 
From our experience we contend that no case of typhoid fever is effi' 
ciently treated without the use of a vaccine and the earlier the vaccine is 
given the better the results. No depressing effects or negative phase 
from the use of a vaccine in typhoid fever has ever been reported. The 
experienced practitioner, especially when typhoid fever prevails, usually 
recognizes the clinical symptoms early. A positive Widal appears too 
late to be relied on as a positive diagnosis before instituting vaccine treat' 
ment. A blood culture to determine the presence of typhoid bacilli will 
furnish an earlier positive diagnosis. Ordinarily the characteristic clini' 
cal symptoms will suffice. If vaccine treatment is started during the first 
few days of fever, a normal temperature may be expected by the twelfth 
or fifteenth day. A positive Widal seldom appears before the eighth day 
of fever. If vaccine treatment is then started, the patient is usually suffi' 
ciently toxic to retard rapid immunization with vaccine. 
Treatment should be started by giving about 250,000,000 or 0.3 c.c. of 
Formula 46 or 30 and repeated at 1 to 3 day intervals, increasing the dose 
by 0.1 or 0.2 c.c. each time until the temperature becomes about normal, 
then treatments should be extended to 4 or 5 day intervals and continued 
until convalescence is complete. 
1 See Tonsillitis and Rhinitis. 2 See Phlebitis. of Vaccine Therapy 
115 
The first indications of improvement are seen in a subsidence of nerv* 
ous symptoms and a decidedly brighter appearance of the patient. 
Complications may arise from mixed infections when mixed vaccines 
in conjunction with typhoid vaccine are indicated. Pneumococci, strep* 
tococci, staphylococci are present if bronchopneumonia develops, and in 
severe bowel complications these same organisms with the colon bacillus 
are primary complicating factors. So if such complications develop, 
Formula 35 should be administered in conjunction with the typhoid 
Formula 30 or 46. 
George H. Weaver, speaking of the early treatment of typhoid fever 
with typhoid vaccine, reports that: 
"When the treatment was commenced within the first week, the mean 
duration of the febrile period was sixteen days; when it was commenced 
in the second week, the mean duration was twenty one days; when it 
was commenced in the third week, the mean duration was twenty'three 
days. These figures show that vaccine therapy can shorten the febrile 
period." 
URETHRITIS1 
urinary infections2 
URTICARIA 
THIS obscure skin affliction is often due to eating certain kinds of pro- 
tein to which the person is sensitized. If it can be determined which 
protein is responsible for the condition, the patient may be desensitized 
by the hypodermic injection of preparations made from such a protein. 
Very often the cause of urticaria is very obscure but in such cases relief 
is often obtained by the hypodermic injection of a mixed vaccine. For- 
mula 35 serves the best purpose. Here the results are probably obtained 
from the nonspecific immunizing influence of the vaccine which causes 
the desensitization from whatever source it may be caused. The vaccine 
is given in the usual dosage employed in the treatment of chronic infec- 
tions. 
VARICOSE ULCERS 
IN the treatment of Varicose Ulcers, we have two essential conditions 
to deal with. Congestion, due to impaired circulation, and infection. 
Both of these factors must be dealt with to obtain the best results. To 
relieve the congestion, rest in bed with the leg elevated answers the best 
purpose, but many such people cannot afford the time to remain in bed. 
A suitable elastic bandage applied on rising and worn all day will do 
much toward relieving this congestion and will aid materially in the heal' 
ing process. 
iSee Gonorrhea. 
2See Cystitis, Nephritis, Gonorrhea. 116 
A Physician's Manual 
The usual skin cocci are commonly present and somehow the colon 
bacillus is also often found. Formula 35 will aid very materially in pro* 
curing healthy granulation so skin growth becomes possible and in cases 
of extensive ulcers, skin grafts will take and grow. The vaccine is given 
in the usual dosage employed in the treatment of chronic infections and 
should be continued for several months at weekly intervals after the ulcer 
is healed to guard against relapses. 
VULVITIS1 
VULVOVAGINITIS1 
THIS disagreeable ailment has been definitely traced to an inflamma' 
tory process due to chronic infection of the internal ear apparatus, 
more particularly the semicircular canals or the nerves leading thereto. 
The semicircular canals are known to be the organs of equilibrium. If 
these canals are irritated on either side, a disturbance of equilibrium takes 
place at once with a resulting dizziness. That this inflammatory condi' 
tion is due to infection is evident from the fact that these cases follow 
nonsuppurative inflammation of the middle ear; due to pus accumulation 
of the middle ear, aural suppuration and involvement of the nerve trunk. 
Another evidence that aural vertigo is due to infection leading to the 
internal ear apparatus or the semicircular canals themselves is the results 
obtained from therapeutic immunization. We have treated twenty mine 
successive cases with bacterial vaccines, and, as far as we have been able to 
follow them, all have remained well. In many cases marked improve' 
ment is observed after the first inoculation while in others treatment 
must be continued for some months before much benefit is obtained. 
This vertigo is often associated with tinnitus aurium, and while we have 
never seen the tinnitus improved, the vertigo has been cured. It has been 
observed that this vertigo is more severe during high blood pressure. This 
may be explained thus: Under high blood pressure the inflamed area 
would become more sensitive with a resulting increased vertigo. 
The streptococcus is the most frequent primary infective agent in mid' 
die ear inflammations and with its tendency to invade surrounding tissues 
is most likely to involve the internal ear also. So streptococcus vaccine 
is logically employed. A combined vaccine, however, that contains the 
organisms usually responsible for otitis media (Formula 6 or 40) probably 
serves a better purpose. Treatment is started with the usual dose env 
ployed in chronic infections 0.2 c.c. and gradually increased to 1 c.c., mak' 
ing inoculations at 5 to 7 day intervals. 
VERTIGO 
1 See Gonorrhea in Women. of Vaccine Therapy 
117 
WOUND INFECTIONS 
ABRASIONS of the skin from slight cuts, scratches, needle pricks, 
Xx tramping on a nail, etc., are a few of such common occurrences 
that as a rule they are disregarded and heal over without any special 
treatment, but often these trivial injuries become infected with virulent 
pathogenic organisms and a physician is only consulted after the infection 
has extended beyond the reach of local antiseptic treatment. In cases of 
more extensive injuries, a physician is usually called to take care of the 
fresh wound, but even in such cases the most vigilant efforts of the doctor 
will fail to cleanse the wound sufficiently to avoid infection. Wounds 
are often penetrating or lacerated to such an extent that cleansing to an 
aseptic condition is impossible. 
When treating wound infections, a possible tetanus infection must 
always be carefully considered. The character of the wound and the cir- 
cumstances surrounding the receipt of the injury may throw much light 
on this subject. A superficial wound that has not been tightly bandaged 
is not liable to contain tetanus bacillus, because the germ being anaerobic 
will not grow when exposed to the air. The tetanus bacillus is prevalent 
in rich soil or barn manure and injuries exposed to such filth should always 
be regarded as being in danger of tetanus infection. Penetrating wounds 
like those caused by toy pistols in the dirty hands of the average boy are 
always liable to tetanus infection. The injury, as a rule, is small and if 
disregarded may lead to serious consequences. Whenever there is the 
slightest suspicion that a tetanus infection may be present, an immunizing 
treatment of antitetanic serum should be given at once. Antitetanic 
serum has proven its value as a prophylactic agent while its curative 
value after symptoms of tetanus have developed is not so well established. 
After excluding a possible tetanus infection, the streptococcus must 
be regarded as the most probable dangerous infecting organism. Infec- 
tions by this organism are usually quite characteristic. Streptococcus 
infections have a distinct tendency to spread rapidly and in the early 
stages of the infection usually run along lymphatic channels, leaving red 
streaks extending from the site of infection. Staphylococcus infections 
of wounds are common, but as a rule, infections by this organism remain 
confined to the area immediately surrounding the infected wound. Occa- 
sionally, however, staphylococcus infections assume dangerous propor- 
tions. ' Microscopic examination of slides prepared from the pus pro- 
cured from these wounds will throw much light on the character of the 
infection and where possible cultures should be made to determine the 
character of the infection; but in no case should vaccine treatment be 
withheld until a positive diagnosis by bacterial examination is made. 
Clinical symptoms are usually sufficiently characteristic so a vaccine can 118 
A Physician's Manual 
be given on a clinical diagnosis and by this means secure the advantages 
which early treatment offers. Since staphylococci are common compli- 
cating factors in streptococcus infections, strepto-staphylococcus com- 
bined vaccine (Formula io) should be given at once and inoculations re- 
peated at i or i day intervals until the inflammatory symptoms subside. 
After that, the vaccine should be given at 3 or 4 day intervals until the 
infection has entirely subsided. If bacterial examination should show 
some unusual organisms present, a vaccine corresponding to the organ- 
isms found should be given or an autogenous vaccine employed. 
The results from early vaccine treatment in wound infections are strik- 
ing. Generally the inflammatory symptoms will subside within twenty- 
four to thirty-six hours after the first inoculation. If the vaccine is given 
after the infection has taken on extensive proportions, such striking re- 
sults are not observed, but if the vaccine inoculations are persistently car- 
ried out even such cases often improve rapidly. 
WHOOPING COUGH 
THE efficiency of whooping cough vaccine in the treatment and pre- 
vention of whooping cough is now generally recognized. 
The great danger from whooping cough is due to the possible develop- 
ment of broncho-pneumonia. That this broncho-pneumonia is due to a 
mixed infection in which the pneumococcus, streptococcus and staph' 
ylococcus are prominent factors in conjunction with the Bordet bacillus 
is well established. Furthermore, much of the bronchial disturbance 
during the ordinary run of the disease is due to the same organisms. Dis' 
regard of this fact has been responsible for many of the failures in at' 
tempting therapeutic immunization in whooping cough. Efficient thera- 
peutic immunization demands an immunizing agent that contains the 
entire variety of pathogenic organisms involved in the infective process. 
To give a straight Bordet bacillus vaccine in an advanced case of whoop' 
ing cough with extensive mixed infection is inefficient treatment. Fur- 
thermore, after the infection is once well established, we never can know 
whether a mixed infection will develop, even if not present. For this 
reason, since prevention is better than cure, it is advisable to employ a 
mixed vaccine containing in conjunction with the Bordet bacillus the 
other organisms commonly found in cases of whooping cough which is 
advantageously combined in Formula 43. 
Treatment should be started early by giving 0.3 c.c., and, if no material 
reaction follows, the dose should be increased to 1.0 c.c. within three or 
four treatments, making inoculations at 3 day intervals. In extremely 
severe cases, it is of advantage to work up the dose to 2.0 c.c. In some 
cases, not much improvement will be observed during the first or second 
week, while in many cases marked improvement will take place after the of Vaccine Therapy 
119 
first injection. Almost invariably at the end of the third week the cough 
will subside even in extremely bad cases. After the cough subsides, 
treatment should be continued for a month or more by giving the vaccine 
at weekly intervals. If this is not done, the cough is liable to return. In 
cases that have developed bronchopneumonia, it is necessary to push 
the treatment more vigorously by giving the vaccine at daily intervals 
and in extremely bad cases with high temperature, it is best to give the 
vaccine at 12 hour intervals. Extremely acute cases also require large 
doses, from .5 c.c. to 1.0 c.c. 
The prophylactic value of whooping cough vaccine is also well estab' 
lished. This prophylaxis is best accomplished by giving a straight poly' 
valent Bordet bacillus vaccine (Formula 37). The first dose should be 
0.5 c.c. and then two or three subsequent doses of 1.0 c.c. should be given 
at 3 to 5 day intervals. Reactions from this vaccine are moderate and 
cause little or no disturbance. 
Giving vaccines to infants and small children is most readily accom' 
plished by having the little patient lie across the nurse's lap with the 
buttocks exposed. While the nurse holds the legs with the right hand 
and the arms with the left, injection may be made, without any incon' 
venience, into the subcutaneous tissues of the buttocks. Appendix 
VACCINATION is an outgrowth of man's effort to protect him' 
self from pestilence by using nature's methods of defense," says 
Dr. G. W. McCoy, director of the Hygienic Laboratory of the U. S. 
Public Health Service. "Primitive man noticed that recovery from a first 
attack by most diseases gave immunity against other attacks; and, some 
2,000 years ago, he began to inoculate his fellows with smallpox when 
conditions seemed propitious instead of waiting for nature to do it at 
some time when conditions might be very unpropitious. 
"Inoculations against smallpox were made in India and in China as 
early as 300 B. C. Later, when the disease reached Europe, inoculation 
went with it, supplemented by a new method called 'selling smallpox'- 
exposing a well person to contact with one ill with the disease so that, if 
he survived, he would be proof against it. 
"Inoculation differs somewhat from vaccination as devised by Jenner, 
but the principle is the same. Moreover, long before Jenner's day, it was 
known that an attack of cowpox gave immunity from smallpox; and rec' 
ords show that men who had recovered from cowpox had themselves in' 
oculated with smallpox to make the proof conclusive. Jenner, however, 
as he himself says, 'placed vaccination on a rock' where he knew it would 
be immovable. 
"Before the days of vaccination, conservative estimates show that one' 
third of all persons had smallpox and one'tenth of all deaths were due to 
it. Today, smallpox is rare. Many physicians have never seen a case; 
and where vaccination is consistently practiced, no deaths from it occur. 
Formerly, smallpox was considered a children's disease; and it still is a 
child's disease-where infantile and school vaccination is neglected. 
Witness the Philippines, where, four or five years ago, after years of ne' 
gleet of vaccination, an epidemic swept away nearly 50,000 persons, a 
large percentage of whom were children under ten years of age. 
"In the United States, wellwaccinated communities show low small' 
pox rates-Maryland with 0.1 case per thousand population; New York 
with 0.025 per thousand, and the District of Columbia with 0.14 per 
thousand. Poorly-vaccinated states tell another story: Oregon with 1.45; 
Washington with 1.72; and Kansas with 2.0 per thousand population. 
"Some communities wait till an epidemic breaks out and then rush to 
vaccinate. This stops the disease-after it has caused many deaths and 
has 'branded' many survivors. Sixteen months ago, in Kansas City, an 
VACCINATION IS 2,000 TEARS OLD 
120 of Vaccine Therapy 
121 
epidemic of smallpox began, yielding 350 cases and 123 deaths; and a few 
months later another started in Denver and yielded 950 cases and 288 
deaths. Such epidemics always eradicate the opposition to vaccination in 
the community-for a time."-The American Journal of Clinical Medi' 
cine, July, 1923. 
THE SCOPE OF VACCINE THERAPY1 
C. E. Jenkins, M. R. C. S. Eng., 
Pathologist, Salford Royal Hospital 
THE utility and limitations of vaccine therapy are questions which 
resolve themselves into a consideration of two interdependent fac' 
tors-the patient and the vaccine. It will be convenient to discuss them 
together. All cases which can be treated by vaccines are divisible into 
three main groups; the division is of more importance than mere academic 
classification, for the success of the treatment will often depend upon the 
discrimination of the clinician or the bacteriologist in allotting a case to 
its correct group. The first group comprises the cases in which cure or 
alleviation of a disease actually present is desired. To the second group 
belong that large mass of healthy people who require a vaccine for pro' 
phylactic purposes-that is to say, to acquire protection against some dis' 
ease which may attack them at a future date. The third group is the one 
which causes confusion. To it belong the cases which require pro' 
phylaxis primarily, but which at the same time are in need of cure. 
The Suitable Cases 
Group i.-It is a commonplace that the two cardinal requirements of 
a successful vaccine are that the disease it is proposed to treat shall be a 
bacterial disease, and that the vaccine shall be prepared from the causal 
organism. Even so, success cannot be guaranteed. Other subsidiary 
factors, although separately of small moment, exert collectively a very 
important influence upon the final result. First, the patient's condition 
must be capable of improvement, for no vaccine can repair, or rather re' 
create, a tissue already completely destroyed. Thus a vaccine will fre* 
quently benefit a case of long-standing chronic bronchitis to the extent 
of abolishing the dyspnoea, asthmatic attacks, cough, and that anaemia 
which frequently accompanies the condition. But it cannot be expected 
to cure the emphysema, the presence of which is a standing and irremov' 
able threat of future trouble if the patient becomes too confident of his 
powers of resistance and therefore careless. It is hardly necessary to 
observe that such factors as age, opportunity of rest, and undermining of 
resistance by long toxic absorption all count in the ultimate result. Alco' 
An abstract of a post-graduate lecture delivered at the Salford Royal Hospital. 122 
A Physician's Manual 
holic excess is a welbknown predisposing cause of bacterial invasion, both 
acute and chronic, but it has often to be pointed out to the patient that 
whilst the vaccine may cure his present illness it is unlikely to confer 
upon him what he would regard as the high privilege of a permanent and 
absolute immunity from all the unpleasant effects of strong drink. 
Another type of case often benefited by vaccine therapy comprises 
those sufferers from a disease in which one sets out frankly to treat a sec' 
ondary infection or a complication, leaving the primary cause to the pa' 
tient to deal with as best he may. Such conditions as the valvular lesions 
of the heart complicated by chronic bacterial pulmonary infection are of 
this nature. The fact that in most cases the cardiac lesion had a bacterial 
origin is beside the point. The damage has been done, the causal organism 
has disappeared, and all one can do is to mitigate the damage. Pulmonary 
tuberculosis or what is called the "open" type is another example. Here 
the primary disease is complicated by secondary infection by the common 
parasitic organisms of the respiratory tract, and the patient's chance of 
recovery is not rendered any easier thereby. If the secondary sepsis can 
be removed, a better opportunity is afforded for fibrous healing to occur. 
The isolation of the causal organism may be simple or a matter of much 
difficulty, such difficulty lying in the identification of causation rather 
than in the trouble to obtain a growth of the suspected organism in a cub 
ture. The intestinal tract furnishes the most conspicuous example. 
There are many toxic conditions which are due to the faecal streptO' 
coccus, and a culture of the faeces occasionally yields a growth which 
puts the question beyond doubt. An instance was a profound toxaemia 
accompanied by an erythematous eruption and liquid stools of appallingly 
offensive odor. A culture yielded a mixed growth of the streptococcus 
and a diphtheroid bacillus, with complete absence of the colon bacillus. 
A vaccine produced a complete recovery. But the majority of the cases 
are not so simple. It is usual to find the streptococcus and the colon 
bacillus present, and the problem to be solved is to decide whether either 
of them can be fairly described as being present in abnormal numbers or 
as having unusual characters. An example of the latter was a purulent 
colitis of unknown origin in which two distinct types of colon bacillus 
were recovered. A vaccine made from the aberrant form was highly sue' 
cessful. It is obvious that each and every case must be decided upon its 
merits, and the bacteriologist must guard himself well against an imagin' 
ing of vain things. 
Group 2.-The conditions that govern the composition and use of 
prophylactic vaccines are of a simple order. It is required to protect a 
patient from the risk of contracting any disease or group of diseases at 
some future date. It is, therefore, essential that the vaccine shall contain 
all organisms likely to cause infection, and in stating this requirement one of Vaccine Therapy 
123 
may draw attention to the importance of using in the vaccine several 
strains of each of the organisms. The duration of the immunity so con- 
ferred is variable, but twelve months is the minimum for most organisms. 
The subject of immunity is one which the patient should have explained 
to him. All immunity is only relative, and whilst it is probable in a given 
case that the inoculated person will be absolutely free from attack, yet it 
is by no means certain, and the patient should realize that such is the case. 
On the other hand, it may be promised with some certainty that any 
attack that may occur will be mild in type and of short duration. 
Group 3.-Much the commonest clinical condition belonging to this 
group is recurring catarrh of the respiratory passages. The type of case 
which requires vaccine treatment for catarrh is large in numbers and 
shows much variety in the clinical nature of the most prominent symp- 
toms. The typical case complains of a nasal catarrh or a bronchitis that 
varies greatly in intensity with the weather and the season: occasionally 
he is quite free from it, but the slightest exposure brings it back as an 
acute attack to be followed by weeks or months of chronic rhinitis or 
bronchitis, the latter being commonly associated with asthma. The con- 
stant drain upon the patient's resistance gradually brings about a general 
lowering of his health, vigor, and capacity for work. 
The question of a vaccine is usually considered when the patient has 
reached this stage, and he generally presents himself for examination by 
a bacteriologist shortly after an acute attack. A copious nasal discharge 
or sputum is still present and seems to invite forthwith a culture and an 
autogenous vaccine. It is a mistaken policy. A purely autogenous vac- 
cine is the correct type to employ as a curative measure for the infection 
then existing, but if it is expected to exercise a prophylactic power against 
future attacks it implies that one expects all subsequent infection to be 
due to the same organism, and that the patient has a special susceptibility 
where that organism is concerned. A very little experience will suffice to 
demonstrate that, except in a few rare instances, this is not so. The pa- 
tient's weakness does not lie with a solitary organism; it is a general lack 
of resistance on the part of his respiratory tract against bacterial infection 
in general. Therefore, a vaccine should be designed to cover all the or- 
ganisms commonly encountered as infective agents of the tract, and since 
it is desirable to combat the immediate infection as well, a semi-autoge- 
nous vaccine, composed of the organisms recovered at the moment and 
combined with a good multi-strain stock vaccine of the other organisms, 
is the vaccine most likely on theoretical grounds to give the best results. 
Practical experience has convinced me that the theory is sound. 
This method of preparing a vaccine is particularly useful in the treat- 
ment of chronic rheumatism and rheumatoid arthritis, where the prepara- 
tion of a vaccine is always somewhat empirical in spite of such discoveries 124 
A Physician's Manual 
as a gratifying purity of streptococcal growth obtained from a pocket of 
pyorrhoea. The proportions in which a semi-autogenous vaccine is com- 
pounded afford scope for individual preference on the part of the bac- 
teriologist, but three-fifths of the autogenous organisms with two-fifths 
of the stock will be found very generally useful. 
Dosage 
The dosage of vaccines is still a controversial subject. It may be con- 
sidered with reference to three points-the amount of the dose, the in- 
tervals between doses, and the total number given. It is neither desirable 
nor necessary to produce a really serious constitutional disturbance. The 
therapeutic result will be no better at the end of the course, whilst an 
initial general reaction of considerable unpleasantness may make the pa- 
tient disinclined for any further injections. These considerations, there- 
fore, impel one to conclude that it is sound policy to give doses which 
produce at most nothing more than a few hours' "tired feeling" after each 
of them. The intervals between the doses should be from 5 to 7 days. 
A clinical improvement is often seen in a shorter time, but the patient is 
hypersensitive for three or four days after each injection, and may develop 
a profound reaction if the interval is made as short as two days. The 
number of injections should not exceed eight. Prolonged courses fre- 
quently produce a state in which the patient fails to react to any dose. 
The final degree of improvement shows itself about three weeks to a 
month after administration has ceased. If a second course is deemed de- 
sirable later, an interval of four or five months should elapse before com- 
mencing it. There are many types of vaccines, but only two need notice. 
The first is the old simple vaccine, most used at present; the other is the 
residual, or detoxicated, vaccine, which is challenging'the supremacy of 
the first-named. The residual vaccine has many practical advantages, and 
I have yet to see a case in which the old type is preferable, or even equal, 
to the residual vaccine in the improvement it produces. 
The Relationship of Vaccine Therapy to Other Forms of Treatment 
As a general rule, a vaccine is a last resort, only invoked when other 
means have failed or offer no reasonable prospect of benefit. But the fact 
that these other remedies are in themselves not sufficient should not cause 
them to be abandoned when vaccine treatment is started. Each rein' 
forces the other and contributes to the only result that matters-cure. 
This combined treatment is seen at its best in acute and chronic gonor- 
rhcea. The residual vaccine is the best single remedy, but it would be 
folly not to assist it with the older remedies appropriate to the condition. 
Lastly, vaccines are being used today with increasing frequency as pre' 
paratory remedies for increasing the prospect of success in operative of Vaccine Therapy 
125 
work where urgency is not indicated. At present this field of usefulness 
is almost confined to the surgery of the nose and throat, but the field 
might well be widened. It is scarcely necessary to add that the cases in 
this field belong to the third group, and that the most suitable vaccine to 
use is the semi-autogenous.-The Lancet-Sept. 9, 1922. 
ACUTE BRONCHO' 
PNEUMONIA 
Delivered at the General Hospital, Birmingham 
By W. H. Wynn, M. Sc. Birm., M. D., F. R. C. P. Lond. 
Hon. Physician to the General Hospital, Birmingham 
PNEUMONIA ranks first of all acute diseases as a cause of death in 
civilized countries. Its death-rate now exceeds that from pulmonary 
tuberculosis. It is no respecter of persons, attacking both the weak and 
the strong, and although Osler called it the friend of the aged, who 
through its aid escape the "cold gradations of decay," more persons die 
from it between thirty-five and fifty-five than at any other period. No 
disease is so great a foe to the hard-working business or professional man, 
who is not seldom taken off by it before he reaches the years of leisure. 
We can appropriately consider the treatment of influenzal broncho- 
pneumonia with that of acute lobar pneumonia, as the broad principles 
are the same, though there is some difference in details. The usual 
method of treatment of these diseases has been called expectant, and this 
should aim at placing the patient in the best environment for his fight 
and prescribing those measures which will support him until he succeeds 
or fails in his venture. Such expectant treatment has certainly succeeded 
better than the active bleeding and purging of an earlier period, but faced 
with a mortality of twenty per cent, in lobar pneumonia and thirty per 
cent, or more in influenzal broncho-pneumonia we must acknowledge 
that we are incompletely equipped and need new weapons. There has, 
in fact, apart from specific therapy and improvements in nursing, been no 
real advance in our treatment since the eighteenth century. In con- 
temporary accounts of an epidemic of influenza in 1782, we find the same 
discussions concerning the use of Peruvian bark, expectorants, diaphoret- 
ics, and opiates as still rage around their modern representatives. Much 
of our present treatment is merely traditional and without rational basis. 
Until some drug is discovered which, in therapeutic doses, will destroy 
the pneumococcus within the living body recovery from pneumonia can 
only take place by the patient providing antibodies to overcome the bac- 
teria and their toxins. It is to specific therapy that we must, therefore, 
look for aid, and I think that we do not look in vain. Without waiting 
for serum treatment to become practicable, lam convinced that we'have 126 
A Physician's Manual 
in vaccines a means, when used promptly and decisively, of aborting the 
disease and lowering its mortality. I first treated pneumonia and other 
acute diseases with vaccines in 1907, and the method which was evolved 
and was published in the British Medical Journal, March 13th, 1915, has 
borne the test of time and proved equally successful in its application to 
influenzal broncho-pneumonia during the recent epidemics. 
Early Diagnosis 
Vaccines, as with other methods of specific treatment, must be used 
as early as possible. They can give little or no assistance when the infec- 
tion has been allowed to go on to the point of cardiac and nervous ex- 
haustion. Their object is to control the infection before it gets out of 
hand, and they should not be used as a last resort in cases which are not 
doing well under other treatment. When given within the first twenty- 
four hours after the onset of fever, brilliant results are obtained, but with 
each hour that passes success is less certain. In this we have an exact 
parallel with the antitoxin treatment of diphtheria. Pneumonia, influ- 
enza, and other acute infections must be regarded as acute medical emer- 
gencies demanding prompt action, in the same way that a perforated 
duodenal ulcer and acute appendicitis are regarded as acute surgical emer- 
gencies. The abandonment of expectant treatment in surgery has led to 
a great saving of life. Few physicians have seen many cases of pneu- 
monia within twenty-four hours of its onset, but when they can offer as 
definite assistance as the surgeon, they will be called into consultation at 
a stage when such assistance will avail. Prompt action requires prompt 
diagnosis. Too often the diagnosis of pneumonia is not made until con- 
solidation of the lung is present. One is commonly told, "This man has 
been ill for three days with a high temperature, but it was only today 
that he showed signs of pneumonia," as though previously he had been 
suffering from some other disease. It is also implied that consolidation is 
a bad thing and that the patient had taken a turn for the worse. This 
confusion of the disease with one of its pathological manifestations is a 
great hindrance to early diagnosis. The early symptoms of acute pneu- 
monia are so striking that diagnosis should be possible within a few hours. 
The initial rigor, the rapid rise of temperature, hot dry skin, the pain in 
the side, the grunting shallow respirations make up a picture not seen in 
any other disease. Alterations in breath sounds can be found within a 
few hours, and I have seen blood-stained sputum within three hours of 
the onset of fever. With influenzal broncho-pneumonia, the picture is 
not so characteristic, but, although complications may gradually develop 
in the course of a severe simple influenza, it is more usual for them either 
to be present from the beginning or after a few days of mild fever there 
is a rapid rise of temperature and the case takes on a graver aspect. In of Vaccine Therapy 
127 
either disease, it should be possible to take prompt measures within 
twenty-four, or at most forty-eight, hours of the onset. We are given a 
margin of time in which the issue of life and death are in our hands. If 
we allow this opportunity to pass, the issue, in so far as it depends upon 
a conflict with the invading organisms, is mainly beyond our control. 
Whatever treatment be adopted, certain preliminary measures are 
fundamental. The patient's fate is mainly decided within the first two 
days. Much can be done to prevent the onset of symptoms which later 
we should be helpless to combat. Precise and detailed instructions must 
be given, especially as most patients are nursed by unskilled relatives. 
Before all things, I would place absolute rest and free ventilation. From 
the first, patients must be kept strictly in bed. Most patients object to 
use a bed-pan and, unless strict orders are given, it will be found that 
they continue to get out of bed as long as it is physically possible. Nurses 
and even doctors do not always appreciate the need for absolute rest. 
Too much effort is often caused by routine washings and scrubbings, 
reaching out for the sputum mug and feeding cup, sitting up to cough, 
etc. When rolling a patient gently over to examine the back, one is not 
seldom told, "Oh, he can sit up all right, he always does so for me!" One 
garment should be worn and much exertion is saved by slitting this down 
the middle, and so preventing an agonising struggle to get nightshirt and 
vest over the arms and head. 
Windows should be widely open night and day and the bed un- 
screened in the center of the room. The temperature of the room should 
not exceed 6o°, and the atmosphere should feel fresh, with air in constant 
movement. Fresh air is the finest circulatory tonic we possess. But with 
our care to avoid the close, stuffy, over-heated room, we must not go to 
the other extreme and expose patients to icy draughts of cold air. Dur- 
ing the initial stage and also at the crisis, the patient will feel chilly and 
abundant bedclothes are required, but when the fever is established, one 
sheet and blanket are sufficient. Gamgee jackets are in fashion, and a 
nurse will probably put one on unless definitely told not to. I fail to see 
the necessity for wrapping a patient whom we desire to lose heat in cot- 
ton-wool. Patients and their friends still think that pneumonia is caused 
by exposure to cold, and should be therefore treated by heat. Sleep will 
be promoted and restlessness allayed by attention to these common-sense 
details. 
A useful routine diet of milk (citrated if there is vomiting) and albumin 
water, 5 oz. of each alternately every two hours. Some of the feeds of 
milk can be flavored with tea or coffee, or malted milk given instead, and 
sugar should be added, especially in the form of cane or milk sugar. Water 
Preliminary and General Treatment 128 
A Physician's Manual 
or lemon-water up to four or five pints in the twenty-four hours, but in 
small quantities at a time, should be insisted upon. Unless definitely 
ordered, patients seldom get enough, and one is constantly told by the 
friends, "We did not like to give him cold water, although he has been 
craving for it, as we thought it dangerous." The laity still have much 
faith in beef-tea, especially in one well-advertised and expensive brand 
which contains three parts of coagulable protein in 1000. For the sake 
of the flavor, a little may be added to the albumin water, but otherwise, 
it should have no place in the sickroom. 
The hygiene of the mouth requires constant attention. Dentures 
should be removed. The mouth should be wiped out every two hours, 
and if necessary more often, with a rag moistened with a diluted watery 
antiseptic. Glycerine should be avoided because of its hygroscopic prop- 
erty. A liquid paraffin spray to the nose helps the patient's comfort. 
Three grains of calomel at the onset, followed by a saline, can be given. 
Thereafter, if skilled nursing is available, a morning soap-and-water 
enema can be given, if necessary for constipation, or failing that, a dose of 
sodium sulphate. No drug at present known will control the infection, 
but a mild diuretic, such as pot. citrat. gr. 30, liq. ammon. acetat. dr. 
4 aq. camph. oz. 1, four-hourly, is helpful. 
Vaccine Treatment 
I know nothing in the whole range of medical treatment so dramatic as 
the rapid defervescence which follows the injection of a suitable dose of 
vaccine to a patient suffering from pneumonia or influenzal pneumonia 
within twenty-four hours of its onset. The vaccine I have used is made 
from primary cultures or at most first subcultures. It should not be de' 
toxicated, or sensitised. For acute pneumonia the vaccine contains sev- 
eral strains of pneumococci, and for influenzal broncho'pneumonia equal 
numbers of pneumococci, streptococci, and influenza bacilli. Various 
formulae have been devised for this triple vaccine containing different 
proportions of the three organisms. I know no good reason for this, and 
have obtained the best results with a vaccine containing equal numbers 
of each. The important points are that it should be given early and insuffi' 
cient amount. In pneumonia, I give 100 millions pneumococci to an adult 
and in influenzal broncho'pneumonia 100 millions of each organism. For 
a child of twelve to fourteen, 40 to 50 millions should be given, and to a 
child of two or three, 10 to 20 millions. These doses have been arrived 
at after many years' experience, during the earlier part of which smaller 
doses were used and were found to be ineffective. I have seen much 
larger doses used with safety as I shall discuss later. When such a dose 
is used during the first day of the disease in the majority of cases the tern' 
perature falls to normal on the following day and no further treatment is of Vaccine Therapy 
129 
required. With each day's delay such rapid defervescence becomes less 
likely and the dose may have to be repeated. This can be done every 
twenty-four hours until the temperature has fallen. When injection is 
delayed until the fourth day or later, little can be expected from specific 
therapy. Toxins will then have already damaged heart muscle and nerve 
cells. The object of vaccine treatment is to prevent this damage; it can 
have no action upon heart failure or nerve exhaustion. 
The earliest case of pneumonia I have treated was a man of 40 who 
at 8 p. m. one evening was working in his garden, apparently quite well. 
One hour later he had a violent rigor and sent for his doctor who arrived 
at 11 p. m. His temperature was then 104° F. and respirations 36, he 
had pleuritic pain and grunting respiration. When I saw him in con' 
sultation just after midnight he already had blood-stained sputum. His 
temperature was then 105 °, respirations 38, and pulse 128. I injected 
100 millions pneumococci. This was followed by a fall of temperature, 
which reached normal at 4 p. m. the following afternoon, about nineteen 
hours from his first symptom. For a few days afterwards he had con- 
solidation of two lobes, with complete absence of symptoms. Another 
early case was that of a doctor aged 53, whom I saw one evening about 
12 hours after the onset of shivering. His temperature was then 105 °, 
respirations 36, and pulse 136. There was impaired resonance, with 
altered breath-sounds and fine crepitations at the base of his right lung. 
A dose of 100 millions pneumococcic vaccine was followed by a fall of 
temperature, and when I saw him at 10 a. m. next morning his tempera- 
ture was normal and the pulse-rate only 68. Again there was the strik- 
ing phenomenon of a patient with consolidation of a portion of the lung 
and an absence of symptoms. Many similar cases could be quoted. Of 
those inoculated during the first day the temperature became normal in 
twenty-four hours in 83 per cent and within forty-eight hours in 100 
per cent. Of cases injected during the second day 57 per cent had a 
normal temperature in twenty-four hours, 71 per cent in forty-eight 
hours, and 93 per cent in three days. But of those injected on the third 
day only 20 per cent were normal in twenty-four hours, 60 per cent 
within forty-eight hours, and 73 per cent within three days. In a series 
of 100 consecutive cases injected for the first time at various stages the 
following were the results. On the first day, 10 cases with one death. 
This was in a lady aged twenty-nine who was pregnant at full term and 
hourly expecting her confinement. She was injected within twenty-four 
hours and the temperature fell to 98.4° in six hours. Labor occurred the 
following day with much difficulty. She had consolidation of nearly the 
whole of the left lung and a patch at the base of the right lung. For a 
time the outlook seemed hopeful, but she died from heart failure on the 
sixth day. This is the only fatal case out of a large number injected 130 
A Physician's Manual 
during the first or second day. On the second day, seventeen cases, no 
deaths. On the third day, twenty-two cases with no deaths. On the 
fourth day, sixteen cases with three deaths (i a baby of 12 months, who 
had always been feeble, and another an adynamic case in a patient of 
65). On the fifth day, nine cases with three deaths. On the sixth day, 
seven cases with two deaths. On the seventh day, five cases with one 
death. On the eighth, four cases with no deaths; and on the ninth, one 
case with no deaths. Nine cases had an uncertain date of onset, but 
were injected late, and three died. Out of forty'nine cases injected 
within three days only one died, and this was complicated by labor; the 
remaining twelve deaths occurred in patients injected on the fourth 
day or later. All these were cases of severe pneumonia, such as are seen 
in hospital and consulting practice. They do not include the milder 
cases, so often seen in general practice, which give rise to no anxiety. 
It was a natural step from the vaccine treatment of acute pneumonia 
to that of influenzal broncho-pneumonia. Whatever be the true nature 
of the primary infection in influenza, there is agreement that the serious 
pulmonary complications are associated with the presence of strepto- 
cocci, especially of the haemolytic variety, and pneumococci, and that 
the influenza bacillus is commonly if not invariably present. Experience 
had previously shown that broncho-pneumonia of other origin would 
also yield to vaccine treatment. Influenzal broncho-pneumonia during 
an epidemic period, however, resembles lobar pneumonia in that an active 
stock vaccine can be prepared for immediate use, whereas with other 
broncho-pneumonias some time is lost in discovering the nature of the 
infection. 
The result of vaccine treatment of influenzal broncho-pneumonia can 
be illustrated by the records of 107 hospital patients injected during the 
first five days of their illness. These patients suffered from the severe 
type of the disease, and the term broncho-pneumonia is used to include 
a variety of pulmonary lesions-bronchiolitis, extreme congestion, col- 
lapse, oedema, pleurisy, and consolidation. Many had severe confluent 
broncho-pneumonia and others would be more rightly classified as in- 
fluenzo-pneumococcic or streptococcic septicaemia. Several were ad- 
mitted in a seemingly hopeless condition, and many had the characteristic 
heliotrope cyanosis. Of the one hundred seven cases, twenty-eight were 
injected on the first day of their illness, twenty-three on the second day, 
twenty-two on the third, twenty on the fourth, and fourteen on the 
fifth. I give the results in tabular form:- of Vaccine Therapy 
131 
Day of first 
injection 
Cases 
Recovered 
Died 
Temperature normal in- 
24 hours 
48 hours 
ist 
28 
a8 
0 
Per cent 
7i-4 
Per cent 
85.7 
and 
»3 
22 
I 
47-8 
46-5 
3rd 
22 
20 
2 
50.0 
72.7 
<th 
20 
15 
5 
30.0 
40.0 
J th 
x4 
12 
2 
35.7 
63-5 
- 
107 
97 
10 
50.0 
65.0 
The only death of fifty-one patients injected within the first two days 
of their illness occurred in a young woman of 29, who was admitted on 
the second day with violent mania and extensive broncho-pneumonia. 
She shouted and struggled incessantly. The first injection of vaccine 
was followed by a fall of temperature to normal in thirty-six hours, and 
the patient became more rational, but she died unexpectedly on the 
ninth day from pulmonary embolism. Seven out of the ten deaths 
occurred in patients who were not injected until the fourth or fifth day. 
Four were complicated respectively by mitral stenosis, advanced preg- 
nancy, meningitis, and asthma, and three others had considerable 
albuminuria. The ten deaths give a rate of 9.1 per cent. 
Analysis of the results emphasizes the importance of early treatment. 
Whilst 71.4 per cent injected on the first day had a normal temperature 
within the following twenty-four hours and in some there was complete 
defervescence in twelve hours, on the second day the percentage had 
fallen to 47.8, on the third day to 50, on the fourth day to 30, and on 
the fifth day to 35.7. Of the total one hundred seven cases, the tempera- 
ture fell to normal within twenty-four hours in 50 per cent. The 
youngest patient, a baby of three months, was admitted with a tempera- 
ture of 104.20, respirations 60, and a pulse of 160 or more. Two doses 
of millions vaccine were given with complete recovery. Another 
baby of nine months, with a temperature of 104°, respirations 60, and 
pulse 164, was injected on the fourth day with 10 millions and the 
temperature fell to 990 in less than twenty-four hours. The oldest 
patient, a man of 73, was given 60 millions on the first day and the disease 
was aborted. 
These effects of early vaccine treatment in aborting the disease are 
not peculiar to pneumonia. They can be seen with cerebro-spinal fever, 
typhoid fever, and streptococcic septicaemia, when early diagnosis is 
possible. We appear to be dealing with a general principle capable of 
wider application when we more thoroughly understand the mechanism 
of immunity. 
The chief obstacle to the general use of vaccines in acute disease has 
been the fear of producing a negative phase. Hence when vaccines are 
used it is too often in ineffective doses. The theory of the negative phase 132 
A Physician's Manual 
was evolved from the study of cases of chronic localized infections. 
Under such conditions the patient is "sensitised" and the injection of a 
small dose of vaccine may have a profound result. But in pneumonia 
the patient is not in the same state of sensitisation, and after quite large 
doses of vaccine there is no evidence of a negative phase. Although I 
have found 100 millions to be a sufficient dose when an active vaccine 
is used, I have seen much larger doses given. Recently, I saw in con' 
sultation a stout middle'aged man who, after four days' mild influenza, 
developed broncho'pneumonia with a temperature of 104.50. His doctor 
injected him by mistake with 1 c.cm. of the mixed antidnfluenza vaccine 
(St. Mary's Hospital formula) containing 1,000 millions pneumococci, 
500 millions B. influenzae, and 100 millions streptococci, the full dose for 
prophylaxis. I saw the patient eleven hours later; his temperature was 
ioi°, he had lost his distress, and was distinctly better. He had a good 
night and next morning had a normal temperature. This unintentional 
experiment, I think, supports my contention that there is no clinical 
evidence of a negative phase after injection of quite large doses of vaccine 
during the early stages of pneumonia. In typhoid fever the same fact 
is seen, for whereas the usual initial dose is 250'300 millions, some 
authorities give as much as 1,000 millions increasing to 2,000 millions 
of an ordinary, not detoxicated or sensitised, vaccine. 
Those unfamiliar with vaccine treatment are apt to think that whilst 
large doses can safely be given to patients with chronic disease, acute 
infections must be treated with very small doses. But the contrary is 
the fact; the treatment of chronic infections should be cautiously com' 
menced with quite small doses. It is easy to produce severe reactions 
with small doses in patients suffering from chronic bronchitis, asthma, 
arthritis, pyelitis, chronic septicaemias, and similar conditions, in all of 
which we are dealing with sensitised persons. 
It is difficult at present to give a satisfactory explanation of the striking 
effect of vaccines in pneumonia. We know that in this disease, anti' 
bodies are produced late and cannot be found in the first two or three 
days. It may be that the dead bacteria are more easily utilized as antigen 
than the living organisms owing to the latter producing aggressins which 
interfere with antibody production. The action differs from that pro' 
duced by intravenous injection of a foreign protein in that there is no 
rise of temperature and no rigor. At the same time the action of a 
vaccine does not seem to be so highly specific as that of a serum, for in 
my earlier cases a vaccine made from a single strain of pneumococcus 
produced results not appreciably different from a polyvalent vaccine 
containing typed organisms. Vaccines made from primary cultures are 
more powerful than those made from subcultures, and it seems to be of 
more importance to have an active vaccine rather than one less active of Vaccine Therapy 
133 
but containing all the types of pneumococci. I have found no advantage 
from using detoxicated vaccines. There is no object in using a dose of 
1,000 millions of a detoxicated vaccine when a dose of 100 millions will 
produce the same or a better result. Rosenow has used autolysed 
pneumococci in doses of 20 billions, but in twentyTour patients injected 
on the first day only five had a crisis on the following day, and the average 
duration of fever was 3-5 days. There is much evidence to show that a 
vaccine in which the organisms have been as little altered as possible in 
process of sterilisation has great advantages over others. 
Many attempts have been made to make a satisfactory antipneumo- 
coccus serum. Cole and his fellow-workers at the Rockefeller Institute 
have succeeded in obtaining an effective serum against type i pneumo- 
cocci, but it is highly specific and useless in infections caused by the 
other types of pneumococci against which, so far, no effective serum 
has been obtained. Unfortunately, these latter types are responsible for 
two-thirds of the cases of pneumonia and two-thirds of the deaths. 
Before serum can be used in the treatment of a patient, the type of 
infecting organism must be determined, and this requires access to a 
well-equipped laboratory and a delay of twelve to twenty-four hours. 
The serum must be given in large amounts up to 250 c.cm. or more, and 
it is injected intravenously. The injection of this large amount of foreign 
protein is frequently followed by general constitutional reactions. There 
may be a rise of temperature of 30, rigors, difficulty in breathing, and 
cyanosis, quite apart from the danger of anaphylaxis in patients already 
sensitised to horse serum. To avoid this danger an intra-dermal skin 
test should be performed, and if positive the patient must be desensitised. 
A week or more later there may occur the group of symptoms called 
serum disease, comprising fever, skin rashes, oedema, pains in the joints, 
and glandular enlargement. Reports on the use of serum in type 1 
pneumonias show a considerably reduced mortality. Cole in one hun- 
dred seven cases had a mortality of 7.5 per cent; Nichols in sixty-three 
cases a mortality of 8 per cent; Greenway, Boettiger, and Colwell in 
one hundred twenty-five cases 5-6 per cent; and Tenny and Rivenburgh 
14.7 per cent in sixty-eight cases. As with vaccine, the earlier the serum 
is injected the better the result, and it is of doubtful value in patients 
who are very ill in the later stages. Anti-pneumococcic serum is not 
antitoxic and is not comparable to anti-diphtheritic serum. It does not 
appear to have the same rapid effect as vaccine treatment given in the 
early stages. Apparently the amount of antibodies which can be sup- 
plied artificially is less than that formed by the stimulation of the antigen 
in a vaccine unless excessive doses of serum are injected. Although 
Serum Treatment 134 
A Physician's Manual 
serum treatment may become more practically useful in the future, in 
my opinion vaccine treatment gives more decided results and is free 
from the unpleasant and even alarming immediate and late effects often 
seen after the injection of serum. 
Foreign Protein Therapy 
Attempts have been made to abort pneumonia by the injection of 
foreign proteins such as milk, typhoid or gonococcic vaccines, phyla' 
cogens, peptone, etc., either intramuscularly or intravenously. Small 
series of cases have been reported, and they show that the immediate 
thermal reaction is often followed by general improvement and signs of 
beginning resolution. But the thermal reaction was often severe and 
even violent, and it does not seem justifiable to use these methods when 
better results can be obtained without these disadvantages. 
In the early stage the relief of pain and sleeplessness is important. 
Leeches, when they can be obtained, give quick relief to pleuritic pain. 
Light and frequently changed linseed poultices are also useful, but must 
not be allowed to embarrass breathing. Considerable muscular energy 
can be expended by raising a poultice weighing two pounds or more on 
the front of the chest forty times a minute. Care must be taken that the 
poultices are not kept in place by a tight binder, as is often the case 
when applied by the unskillful. Antiphlogistine answers the same pur* 
pose, but it is not unusual to see badly scarred chests after its use. In a 
few cases with very severe pain I have separated the pleural surfaces 
by the introduction of a small quantity of oxygen. This is not difficult 
to those accustomed to artificial pneumothorax treatment, and I was 
favorably impressed with the immediate relief given. Counterirritation 
in lobar pneumonia should not be continued after pain has been relieved, 
but in influenzal diseases with much congestion and bronchitis it can 
usefully be continued. Ten grains of Dover's powder in a saline draught 
will relieve both pain and sleeplessness. Paraldehyde is probably the 
safest hypnotic, and can be given in doses of i or 2 dr. in very sweet 
tea. But its highly nauseous taste does not add to the comfort of the 
patient and makes food distasteful. Opium has been regarded with dis' 
favor, but its use in the early stages of lobar pneumonia and later when 
there is firm consolidation, so long as there is no interference with the 
air entry into the other portions of the lung, is quite safe. In influenzal 
cases more care is required. In those with definite areas of broncho' 
pneumonia and absence of bronchitis or oedema it may be given for the 
first two or three nights, but in the diffuse cases with general bronchitis 
or bronchiolitis, oedema, or cyanosis it should be withheld. In the 
Symptomatic Treatment or Vaccine Therapy 
135 
severe cases with great excitement and struggling and in post-critical 
delirium hyoscin is the only drug which is likely to be effective. It 
should be given in doses of one-hundredth of a grain hypodermically. 
Although it has been much condemned, my experience with it has been 
fortunate. When it is ineffectual we may be compelled to give morphia 
as well, in which case it should be combined with atropine. 
Bronchitis kettles are not often seen with pneumonia but are used 
by some practitioners with influenzal broncho-pneumonia. The effect of 
saturating the air with moisture cannot be good for a disease in which 
the sputum is usually abundant, frothy, and watery. In cases with 
much bronchial secretion atropine may give great relief. If i/ioo gr. 
does not give the desired effect, it may be increased up to 1/30 gr. and 
repeated four-hourly for a few doses. But in the grave cyanotic influenzal 
cases with much respiratory embarrassment, I have found the most 
helpful treatment to be ammonium carbonate 10 gr. in a teacupful of 
milk every hour for six doses, repeating the course if necessary after 
omitting the drug for a few hours. This should not be given in lobar 
pneumonia. 
It will be found in textbooks that much space is devoted to the 
treatment of heart failure, but you will not find that any two text-books 
agree as to the remedies to be used. The fact is that though much can 
be done by early specific treatment, strict insistence upon absolute rest 
from the first, fresh air, and avoidance of overfeeding to prevent heart 
failure, we can do very little to treat it when present. Heart failure 
does not stand alone; it is but part of a general intoxication, and the 
circulatory phenomena are as much due to the action of toxins upon the 
medullary centers as to the poisoning of the heart muscle. With such 
a condition, drugs such as digitalis must be useless, and it is very doubt- 
ful if strychnine, camphor, caffeine have any action whatever upon the 
heart. An exception may possibly be made with pituitrin, 1 c.c. in- 
jected deeply into muscles for vasomotor failure, but little can be ex- 
pected from that in severe heart failure. Digitalis is used by many from 
the first in large doses with the object of retarding the pulse, but the 
heart does not fail because of its rapidity but because of its intoxication. 
Digitalis can only slow this rate by poisoning the heart and blocking 
too frequent auricular impulses. 
The heart can be best helped by giving it food and oxygen. The best 
food for the heart is sugar, and this can be given from the first as cane 
sugar, milk sugar, or honey along with the other foods. Intravenous 
injections of 10 per cent glucose are perhaps the most valuable of all 
remedies when circulatory failure has commenced. Oxygen is not in 
general favor because it is so badly administered. One still sees it given, 
in large hospitals as well as in private practice, by the futile method of 136 
A Physician's Manual 
holding a funnel some inches away from the patient's face. When 
administered through a Haldane's apparatus or through a rubber catheter 
passed into the nasopharynx it is of decided value in lobar pneumonia, 
where the majority of alveoli and bronchioles are patent. It is useless 
in the severe influenzal cases with cedematous lungs and blocked bron- 
chioles, but can then be given subcutaneously. 
Alcohol is the most used of all drugs in pneumonia and influenza, and 
has the sanction of some distinguished authorities. There is no scientific 
reason for its use, which is mainly based on tradition and the popular 
idea that it is a stimulant. Apart from its very fleeting stimulating effect, 
produced reflexly by the irritation of mucous membranes, we know that 
its chief actions are to depress the nervous system and to inhibit anti- 
body formation, neither of which is desirable in diseases whose toxins 
are also nerve depressants. The clinical experience cited in its favor is 
met with equally distinguished evidence against it. 
It must be acknowledged that the high mortality of pneumonia and 
broncho-pneumonia will never be reduced by attempts to treat poisoned 
organs incapable of response, but by early diagnosis and prompt measures 
to prevent intoxication by immediate specific treatment and common- 
sense nursing. Expectant treatment in the early stages is often followed 
by harmful drugging in the later. Although we have much to learn 
about the natural processes of defense against the organisms responsible 
for these diseases, we are not making full use of the knowledge already 
attained. We have now at our hands weapons by whose use the mor- 
tality of pneumonia and influenzal broncho-pneumonia could be reduced 
to one-quarter of its present height.-The Lancet Office, I, Bedford 
Street, Strand, W. C. 2. 
DR. H. H. KOONS (The Military Surgeon, April, 1920) after giving 
his experience with the use of mixed vaccines in pneumonia con* 
eludes as follows: 
"1. That a prophylactic dose of vaccine will confer immunity for from six to eight 
weeks. 
"2. That as a remedial agent, vaccine, if given at the onset, will materially shorten 
and lessen the severity of the attack and pneumonia will be a rare occurrence. 
"3. That vaccine given to a pneumonia patient will ameliorate the severity of the 
symptoms, hasten crisis, and cut the number of serious sequelae to a minimum. 
"4. That glucose, intravenously, combats acidosis, gives nourishment to the heart 
muscle, adds fluid to the body, and has a decided diuretic action." 
JEAN MINET, Vaccinotherapy of Acute Pulmonary Affections, Bull, 
et mem. Sod. med. d. h6p. de Paris, 38: 1557, Nov. 30, 1922 (Inter' 
national Survey of Medicine, Jan., 1923): 
"The author formerly used 'adapted' vaccines in pulmonary congestion and broncho- 
pneumonia. After estimating the relative proportions of the various infecting organisms 
contained in the sputum a corresponding mixture of stock emulsions was prepared, of Vaccine Therapy 
137 
containing about 500,000 germs per cubic centimeter, which represented the 'adapted' 
vaccine. Since then, in order to gain time, Minet has made use of a stock vaccine con* 
taining 100 million pneumococci, 50 million streptococci and 350 million staphylococci 
per cubic centimeter, for the treatment of pneumonia, pulmonary congestion and broncho- 
Fmeumonia, and the results have been as satisfactory as with the preceding type of vaccine, 
t appears advisable to use a mixed vaccine even in ordinary pneumonia owing to the 
frequent association of the above bacteria. The effects produced by this vaccine varied 
but were always favorable. Sometimes there was a violent reaction with expectoration 
of the type seen in acute edema of the lungs and high fever, followed by a rapid cure, 
while in other cases the lesions seemed to dry up suddenly. There was sometimes no 
apparent immediate action but the general condition of the patient seemed nevertheless 
to be benefited, a remarkable state of euphoria being produced in very severe pulmonary 
conditions. It is suggested that sometimes the vaccine may cause a rapid immunization 
of the organism and in others a favorable crisis through shock action. 
"In simple acute pulmonary affections with no cardiac, renal or other complications, 
the author always injects 1 c.c. of his stock vaccine in the supraspinous fossa and repeats 
this every day or every other day, until a cure is obtained. When the heart or kindeys 
are already affected by the infection, it is well to begin with 0.5 c.c. only, this dose being 
rapidly increased to 1 c.c. if the vaccine is well tolerated. In children it is advisable to 
begin with doses of 0.33 or 0.5 c.c." 
DR. ARTHUR DARE, 2025 Walnut Street, Philadelphia, in a com- 
munication, April 27, 1923, says: 
"Dear Dr. Sherman: 
"I am enclosing a stenographic copy of an address delivered at the Medical Officers' 
Training Camp, Fort Oglethorpe, Ga., July 17, 1918, reporting 423 cases of pneumonia 
and bronchopneumonia, treated with vaccine. Some of the important facts have been 
omitted, I find. The crisis in most of the cases of lobar pneumonia occurred on the fifth day 
of the disease. 
"All of these cases reported I personally examined and followed from admission to their 
discharge; I have the records made at the time, and have only embraced those that I can 
vouch for. 
"I have also a record of a number of cases of 'flu' treated at Camp Dodge, Des Moines, 
la., during the epidemic of 1918. Our organization. Evacuation Hospital No. 25, headed 
for France, was quarantined during this period, and I was placed on the pneumonia board 
and in charge of pneumonias with the medical chief of the base hospital. 
"This material has not been tabulated but it can be done when the time presents if it is 
necessary. The results were excellent. 
"I hope this material will be sufficient. 
Yours very truly, 
Arthur Dare." 
STENOGRAPHIC copy of the notes taken at an address delivered 
at the Medical Officers' Training Camp, Fort Oglethorpe, Ga., 
July 17, 1918, by Lieut. Colonel Arthur Dare, Medical Corps U. S. 
Army, Chief of Medical Service, U. S. General Hospital No. 14, Fort 
Oglethorpe, Ga.: 
"One of the big problems of the Medical Service has been the ACUTE RESPIRA- 
TORY DISEASES: 
"ACUTE PNEUMOCOCCUS INFECTION, OR LOBAR PNEUMONIA, runs 
its course in five days-when there are no complications. 138 
A Physician's Manual 
"The pneumonia that is secondary to measles, scarlet fever, meningitis, and occurring 
after surgical operations: BRONCHO-PNEUMONIA. 
"The cases admitted as ACUTE BRONCHITIS; fever; type undetermined and in- 
fluenza. 
"From a special investigation of lobar pneumonia, we found the type of pneumonia in 
the largest number of cases was Type IV, a very severe infection with consolidation of 
many lobes; the next most frequent was Type II; next Type I, and last Type III. 
"The broncho-pneumonia study gave pneumococcus, streptococcus haemolyticus, 
staphylococcus albus, aureus and citreus, micrococcus catarrhalis and influenza bacillus. 
"In the investigation of the influenza epidemic, occurring at Camp Forest, Fort Ogle- 
thorpe, Ga., completed and reported April 23,1918, laboratory research found the bacillus 
influenza in 80 per cent of infections. From throat culture; from sputum stains and culture, 
they ran nearly parallel-80 per cent. 
"Now to briefly outline our treatment of these cases, our laboratory, under the charge 
of Major Bergey, made up of a stock vaccine containing the bacteria most commonly pres- 
ent at that time, the object being to start an immunity as early as possible. An autogenous 
vaccine could not be made early enough to head off the complications. A PNEUMO- 
COCCUS COMBINED VACCINE containing pneumococci, 400 millions; strepto- 
coccus haemolyticus, 200 millions; staphylococcus, mixed albus, aureus and citreus, 400 
millions; micrococcus catarrhalis and B. influenza. 
"Every case upon admission, presenting physical signs of respiratory infection, was vac- 
cinated with 125 millions of this stock vaccine. A period of three days was allowed to es- 
tablish an immunity, then 250 millions were given, and three days later 350 millions. A 
fourth dose was rarely necessary. 
"Our pneumonia cases were treated in the open air, on the porches of the medical 
pavillions; they were guarded from cross infection by sheets between the beds, light 
masks were used in some cases where cough was pronounced, but strange as it may seem, 
cough was very much less noticeable than we had expected. 
"Our theory was, that if we could head off the pus, we could eliminate many of the 
complications and sequelae. 
"It was either coincidence, or good treatment by the Ward Surgeons and nurses, or 
the action of the vaccine that our mortality in cases of Lobar Pneumonia, Type I, II, III, 
IV, and a total disability period of 21 days-318 cases with 20 deaths, or 6.3%-105 cases 
Broncho-Pneumonia with 9 deaths, or 8.5%. A total mortality in all pneumonias-423 
cases with 29 deaths-6.3% mortality 
Cases of Pneumonia Associated with Pneumococci in Combination 
with Streptococcus Hemolyticus 
TYPE 
NO 
DEATHS 
MORTALITY 
I 
43 
3 
7-o% 
II 
54 
4 
7-4% 
III 
16 
2 
11-5% 
IV 
116 
6 
5-1% 
No Reaction 
89 
5 
5-6% 
BronchO'Pneumonia 
105 
9 
8-5% 
TOTAL 
423 
29 
6-3% 
"AU cases of Broncho-Pneumonia were treated with vaccine, and with such success 
that all patients with measles were given vaccine as a prophylactic upon admission, and 
either from coincidence or vaccine, we limited our development of Broncho-Pneumonia 
to such a noticeable extent, that it is routine treatment in this hospital to vaccinate upon of Vaccine Therapy 
139 
"It has been a source of interest in returning cases to duty with foreign troops, to 
observe the number of sound men who have had Pneumonia and Broncho-Pneumonias. 
The Influenza cases were vaccinated upon admission and the tonsils and throat treated 
with nitrate of silver solution, 40 grains to the ounce and the period of disability was 
four days on the average. 
"In treatment of these cases, the names of the patients were telephoned to the labora- 
tory upon diagnosis and treatment carried out by the laboratory promptly, and according 
to roster. 
"I was given permission by our Commanding Officer, Colonel Haverkampf, to limit 
the mortality in measles pneumonia which was climbing steadily. We have had his co- 
operation at all times. The Medical Department of the Army has permitted us to 
employ vaccine in Type II, III and IV pneumonias (for Type I pneumonia, Type I Serum 
was used), and we have had the co-operation of the laboratory, then under Major Bergey, 
and of the Ward Surgeons and the personnel of the hospital-the only possible way 
that success could have been obtained." 
(About 00,000 doses of Sherman's vaccine formula 38 was supplied to Camp Dodge, 
Des Moines, Iowa, at the time of the influenza epidemic referred to in Dr. Dare's letter.) 
X TAJOR J. PRATT JOHNSON, M. C., D. A. D. M. S., S. A. 
1VX M. C., Director Clinical Research Laboratory, Johannesburg, 
South Africa (American Medicine, March, 1919) goes into great detail 
concerning the advantages of polyvalent mixed vaccines in the preven' 
tion and treatment of respiratory infections and sums up his conclusions 
as follows: 
"1. Anaphylactic and anti-anaphylactic phenomena play a very important part and 
are valuable guides in vaccine therapy, especially in diseases of the respiratory tract. 
Serologic tests are not satisfactory guides or reliable indicators of established immunity, 
or of practical service in the carrying out of treatment with vaccines or sera. 
"a. The very important part played by symbiosis in bacterial infections of the 
respiratory organs cannot be too strongly emphasized. The clinical results of therapeutic 
and prophylactic inoculation with mixed vaccines lend strong support to these views. 
"3. A constitutional weakness in the elaborate defensive organization against invasion 
by the causative micro-organisms of respiratory diseases indicates a pneumo-catarrhal 
diathesis. This constant diminished resistance can be successfully reversed by specific 
immunization with a highly multivalent mixed vaccine prepared from numerous recently 
isolated virulent strains of those pathogenic bacteria commonly conveyed in the air 
breathed. Non-specific treatment is of no avail. 
"4. Roughly, less than 25% of cases diagnosed as pneumonia in general practice are 
due primarily to infection with pneumococcus, the proportion varying from time to time. 
In all cases of pneumonia, however, the condition is sooner or later a mixed infection in 
which any of the causative bacteria of respiratory diseases may be present. M. catarrhalis 
and streptococcus are the commonest in South Africa. Pneumococcus, B. Friedlander, 
B. influenzae, streptococcus mucosus capsulatus, staphylococcus, B. septus are also re- 
garded as important organisms in the etiology of pneumonia. 
"5. Whatever theoretical objections may be raised to this statement, the clinical 
results in practice, both of therapeutic and prophylactic inoculation for pneumonia, with 
a mixed vaccine, afford overwhelming evidence as to the soundness of these views. The 
mixed vaccine used is prepared from 150 virulent isolated strains of M. Catarrhalis. 
streptococcus, pneumococcus, streptococcus mucosus capsulatus, B. Friedlander, B. in- 
fluenzae, B. septus and staphylococcus. Each organism is represented in a curative 
therapeutic dose, the actual dose used being somewhat less than the amount required 
when each organism is used separately. 140 
A Physician's Manual 
"6. These views have been strongly confirmed and widely tested on a very large 
scale in South Africa during the prevailing epidemic of Spanish influenza, the very heavy 
mortality being due almost entirely to pneumonia. The mortality from pneumonia has 
been greatly reduced by therapeutic inoculation with mixed vaccines. Similarly prophy- 
lactic inoculation with larger doses of this mixed vaccine has reduced the incidence of 
influenza and prevented pneumonia, fatalities in individuals inoculated twice being rare. 
"7. The failure of preventive inoculation against pneumonia with various pneumo- 
coccus vaccines is due to a false or incomplete conception of the etiology of the disease 
broadly diagnosed as pneumonia. This want of success is not due to faulty dosage of 
pneumococcus vaccine, or the absence of unidentified strains of pneumococcus. If pneu- 
mococcus vaccine was of definite value proof would have been forthcoming long since in 
view of the numerous experiments which have been carried out on a large scale. 
"8. This failure is due to the fact that the etiologic significance of other micro- 
organisms has not been recognized. The organisms in addition to pneumococcus are 
M. catarrhalis, streptococcus, streptococcus mucosus capsulatus. B. Friedlander, staphy- 
lococcus, B. influenzae and B. Septus. That the incomplete and inaccurate views in regard 
to the etiology of pneumonia have survived so long is due to the modern development of 
water-tight compartments in medicine. The clinician is not a bacteriologist. The 
bacteriologist is not a clinician. 
"9. Prophylactic inoculation with mixed vaccine prepared from the organisms enu- 
merated will enormously reduce the incidence of pneumonia and other respiratory diseases 
(excluding tuberculosis) and largely abolish the mortality from these diseases. The actual 
composition of the vaccine and proportion of each organism represented in the mixed 
vaccine used should be decided from a close and extensive study of the bacteriologic flora 
found in respiratory diseases." 
ADVANTAGES OF MIXED POLYVALENT VACCINES 
IN PNEUMONIA 
DR. LEWIS K. NEFF, Clinical Professor of Medicine, University and 
Bellevue Hospital Medical College, and Doctors A. G. Sala and 
K. M. Kera. 
"During the last weeks of January, 1922, at the time of the prevalence of epidemic influ- 
enza in New York City, we commenced the treatment of a series of cases of pneumonia at 
Harlem Hospital by the use of mixed polyvalent vaccines as an adjunct to our regular 
treatment. We have looked over the cases so treated, and have tabulated some notes in 
the accompanying charts. Some words of explanation and comment are, it seems to us, 
in order. 
"The plan of vaccine administration was as follows: One initial dose of 1 c.c. of Sher- 
man's mixed vaccine No. 38, containing Influenza Bacillus 200,000,000, Streptococcus 
100,000,000, Pneumococcus 100,000,000, Micrococcus Catarrhalis 200,000,000, Staph- 
ylococcus Aureus 200,000,000, and Staphylococcus Albus 200,000,000 was given subcu- 
taneously, followed by a similar dose in 6 hours. Four more doses of 1 c.c. each were then 
administered, 12 hours apart. The subcutaneous injections were made in a different re- 
gion of the body each time, following the premise that the fresh, unburdened cells of the 
new locality would be best apt to manufacture antibodies under the vaccine stimulus. Fol- 
lowing this initial course, if the temperature was still up, vaccines were usually continued 
in 2 c.c. doses, 12 hours apart. In some few cases, this second course was not instituted, 
even with the temperature still up, to see if any untoward febrile reaction might follow' 
the stopping of the vaccines. On the other hand, in a few other cases, with the tempera- 
ture fairly well done, vaccine treatment was kept up, to see what febrile reaction, if any, 
might be elicited by such treatment. of Vaccine Therapy 
141 
"As soon as a case came to the ward, diagnosed as pneumonia by the admitting physi' 
cian or ambulance surgeon, the chest was examined, and if the physical signs, together 
with the respirations and blood count confirmed the diagnosis, vaccine treatment was 
immediately begun in some cases, not instituted at all in other 'control' cases, or post- 
poned in a few other cases, where it was desirable for purposes of investigation to see what 
the patient could do with his own unaided immunizing powers. 
"A white and differential blood count was done in each case before the first dose of vac- 
cine was ever given. Other blood counts were made later. We think enough counts 
were made in each case to give an insight into the patient's powers of cellular defense. 
"A general survey of the kind of cases we had to work with, is desirable. Our pneu- 
monias came in after they had been ill for a little time, usually three days, and most of them 
had received no medical attention previous to their entrance to the hospital. These cases 
were also treated during the prevalence of epidemic influenza. It is now generally regarded 
that epidemic influenza is due to an unknown organism, probably a filtrable virus, which 
lowers the resistance to the pneumococcus and other organisms usually responsible for 
pneumonia. So, when epidemic influenza prevails, it is often difficult to estimate how 
much of the temperature and other toxic symptoms of a patient are due to the unknown 
virus of influenza. Now, whether lobar pneumonia be a pulmonary affair or a mixed sep- 
ticemia with pulmonary localization, the antibodies that bring about the patient's success- 
ful defense, must do their work at the seat of the disease. Antibodies produced away 
from the lungs must be carried thither by the circulation. The lack of medical attention 
at the onset of the disease and for some time thereafter is obviously another handicap to 
the success of whatever treatment is instituted in the hospital. 
"Pneumonia being a self limited disease with a definite course, it ordinarily shows such 
fixed mortality 25-35%, that any new drug, vaccine or serum, before laying claim to a def- 
inite place in its treatment, must do any or all of these things, (1) hasten the crisis, (2) 
prevent the spread of the pneumonic process, (3) offset complications in the lung itself and 
the pleural cavity (4) offset complications elsewhere, e.g., pneumococcus meningitis, otitis, 
peritonitis, etc. (5) increase the body's immune bodies and thereby reducing the mortality 
rate. 
"We may now analyze the effect of the vaccine treatment on different features of our 
cases so treated. 
"(a) Temperature. The gentleman who so kindly furnished the vaccine for trial in our 
wards, claimed that in the ideal case, there ought to be a considerable fall in the tempera- 
ture chart after three 1 c.c. doses of vaccine. The ideal case is the one where the adminis- 
tration of vaccine is begun as soon as the disease begins. From this point of view, none 
of our cases were ideal. Nor were ideal results obtained. We have purposely charted the 
T. P. R. after the third dose of vaccine. There was a definite fall in some cases, but quali- 
fiying remarks are necessary. 
"Case V. On sixth day of disease when vaccine treatment was started, temperature 
102.6°, pulse 130, respiration 42. Here the fall in temperature to 98° and the crisis after 
three doses of vaccine came all on the seventh day of illness, a favorable crisis day in 
pneumonias. 
"Case VIII. Case came in hospital with entire right lung involved. Started vaccine 
treatment on third day of disease with temperature 105°. Two first doses were given at 
6 hour intervals and four more doses at 12 hour intervals up to morning of sixth day. Tem- 
perature down to 102.8°. Vaccine discontinued for two days, temperature ranging be- 
tween 101.4° to 103°. Oneighthday temperature went up to 103.8°. Three double doses 
of vaccine given at 12 hour intervals and by the tenth day temperature 98.2°. Vaccine 
discontinued. Temperature stayed down 4 days. Lower left lung then became involved 
and temperature suddenly went up to 104°. One double dose of vaccine given but pa- 
tient soon died. Since the temperature came down after the first six doses of vaccine, 
again rose after discontinuing vaccine for two days, came down to normal after three 142 
A Physician's Manual 
double doses and remained down for four days. The question arises: would the temperature 
have gone up again and the left lung become involved if the vaccine had been continued, 
say, at daily or twice daily intervals after a normal temperature was obtained? 
"Case XIX. Where this course was pursued, indicates that by pursuing this method 
this case might have been saved. 
"Case IX. This patient's temperature on fourth day of illness when admitted to hos- 
pital was 104° and dropped to 98° in 24 hours, was 99.20 after the third dose of vaccine, 
then went to 102°, on the sixth day subsequently temperature was never higher than 
101.5° and gradually returned to normal on twelfth day. Vaccine was given at 12 hour 
intervals during fifth, sixth and seventh days; none given during eighth day, two double 
doses given ninth and tenth days and one double dose given on eleventh day. 
"Case XI. Admitted to hospital on sixth day of illness, temperature 104°. Vaccine 
treatment started on seventh day; first two doses 6 hours apart and four more doses 12 
hours apart. Crisis came between first and second dose. There was a subsequent rise to 
103.6° on tenth day but no spreading of the pneumonic process, with an uneventful re- 
covery. 
"Case XIII. Was admitted on second day of illness, lower left lobe involved, temper- 
ature 103.2°, pulse 119, respiration 24. Started vaccine treatment 15 hours after admis- 
sion; on third day of illness, two 1 c.c. doses, 6 hours apart and four 1 c.c. doses 12 hours 
apart and two doses 2 c.c. each. Temperature on day vaccine treatment was started up to 
10$.4°, then gradually dropped down to 101° on the fifth day, on the sixth day up to 104° 
with a crisis on seventh day and normal temperature. Vaccines discontinued on sixth day. 
On eighth day temperature 104.2° with reinvasion of left lung. Vaccine again started in 
2 c.c. doses 12 hours apart, temperature on eleventh day went up to 105° for a short time, 
then by evening of twelfth day temperature 98.4°. Vaccines discontinued twelfth day. 
Reinvasion on thirteenth day with temperature 103.50. Vaccines again given in 2 c.c. 
doses at 12 hour intervals, giving seven doses with a gradual decline in temperature to 
100°. Patient died three days later. The fact that the temperature declined with a crisis 
and a reinvasion took place with a rise of temperature two different times after vaccine 
treatment was discontinued is significant. The question naturally arises whether these 
reinvasions would have taken place if vaccine treatment had not been discontinued. Fur- 
thermore, since the temperature went up to 105.4° at 8 a.m. on the third day of illness, 
before the first dose of vaccine was given, it is a question whether this patient would have 
survived more than a few days without the vaccine. As it was, under the vaccine treat- 
ment, the illness was prolonged with several prospects of recovery. 
"Case XIV. Came in hospital with signs of 'grippe.' Developed consolidation of left 
lower lobe on second day in hospital, after temperature came down to 100°. Vaccine 
treatment started on third day in hospital with temperature, giving two doses 1 c.c. 6 
hours apart and four doses 12 hours apart, followed by four 2 c.c. doses 12 hours apart. 
There was a drop after the third dose to 101.4°, then up to 104.2° on third day of pneu- 
monia. Crisis on fifth day of pneumonia with uneventful recovery and no spreading of 
pneumonia process. 
"Case XV. This was a truly ideal case. Had started with 'grippe' symptoms four 
days before admission to hospital. Definite signs of pneumonia in left lower lung detected 
about 24 hours after admission to hospital. Without definite signs, on the strength of the 
temperature and blood count 1 c.c. of vaccine was given two hours after admission. Sec- 
ond dose 6 hours later, followed by four doses at 12 hour intervals. Vaccine treatment was 
started with a 104° temperature. After the third dose, it dropped to 99.6°, went to 104° 
for a short time next day, then rapidly came to normal on-fourth day in hospital and made 
an uneventful recovery. 
"Case XIX. This case was admitted on fourth day of illness with a temperature of 
103.8°. Vaccine treatment was started on admission, giving 1 c.c. and another dose 6 
hours later and four more doses 12 hours apart, followed by six more doses of 2 c.c., 12 of Vaccine Therapy 
143 
hours apart. Temperature came to roo° after third dose, then up to ioi.8° on third day, 
followed by crisis. Further vaccine administration produced no febrile reactions. Recov- 
ery uneventful. No spreading from right lower lobe. 
"Case XXIII. Took sick with 'grippe' symptoms 6 days before admission. Onset of 
pneumonia determinable. Vaccine given 5 hours after admission. Six doses of vaccine 
given in usual manner in 3 days. Temperature dropped from 103.8° to 98° after fourth 
dose followed by rise to 102° and 102.8° and drop to 99.2° about 10 hours after sixth dose. 
After that never over 100.2°. Never over 99.8° in last five days. No spreading from right 
lower. 
"Case XXVIII. Admitted to hospital on fourth day of illness. Lobar pneumonia, left 
lower, temperature 104.4°. Has T. B. sinus in neck and T. B. glands in neck. No T. B. 
found in sputum after 15 examinations. Vaccine treatment started at once. Six 1 c.c. 
doses given in usual way. After third dose temperature ranged between 103° and ioi°. 
Vaccine discontinued for two days then, four doses 2 c.c. with Sherman's Non-virulent 
T. B. Vaccine in it. Temperature between 101° and 99° during ninth and tenth day. 
Vaccine discontinued. Became normal eleventh day. Up to 102° on twelfth day and sep- 
tic temperature after that. 
"In no case has there been a rise of temperature or increased pulse rate that could be 
ascribed to the vaccine injections. This applies to the cases when the vaccine was given 
during high temperature as well as when given after the temperature had come down. All 
in all, the temperature and pulse curve in vaccine treated cases as compared with the ordi- 
nary pneumonia curve is lower. This is well illustrated by working out an average curve 
of the charts of the eighteen cases treated in the male ward and the eight cases treated in 
the female ward which recovered, starting the curve on the first day of vaccine treatment, 
which w'as an average of 4.5 days after illness started, and comparing it with the average 
curve of the four charted cases that recovered which received no vaccine as shown by 
composite charts 1 and 2. The average temperature of the twenty-six cases on the first 
day of vaccine treatment was 103.1°, by the end of the second day 101.8°, by the end of 
the third day 101.6°, on the fourth day 100.5°, on the fifth day 100.1° and then steadily 
declined to normal. The average pulse on the first day was 115, the second day 105, third 
day 105, fourth day 98, fifth day 98, sixth day 90, then down to normal within a few days. 
This steady decline in temperature and pulse rate beautifully illustrates the steadying in- 
fluence of the vaccine on the temperature and heart action. The combined curve on the 
composite chart No. 3 of the four charted cases that recovered without vaccines, on the 
other hand, shows an increase of temperature and pulse rate during the first day and a con- 
stant high pulse rate compared to the temperature throughout the illness. This steadying 
influence of the vaccine on temperature and heart action is even shown on the average 
curves in the five charted cases that died as shown by the composite chart No. 4. Here the 
temperature and pulse curve show a constant tendency to run lower, until the vaccine in- 
jections are discontinued, when they go up. The average temperature and pulse curve of 
the three cases that died without receiving vaccines (chart IV) certainly shows a greater 
irregularity in temperature and heart control with a much earlier fatal termination. 
"(b) In the twenty-two cases where the vaccine was administered, only four showed a 
spreading of the pneumonic process. 
"Case VIII. Came in with whole right side involved, signs in left lower first twelve 
hours before death and four days after vaccine treatment had been discontinued. 
"Case XII. Spread from left lower to whole right lung. Vaccines were discontinued on 
sixth day, crisis with normal temperature took place on seventh day. Reinvasion with 
high temperature on eighth day. Vaccine treatment again started with double doses on 
ninth day. A second crisis on twelfth day. High temperature again developed with 
spread from left lower to whole right lung and death occurred three days later. 
"Case XXI. Spread from right to left base. 
"Case XXII. There was a reinvasion here on the eighth day after vaccine was stopped. 144 
A Physician's Manual 
Name 
Composite Chart No. 1 
HARLEM HOSPITAL 
-Division. 
History No._ 
.Ward. 
Month 
Day (if Month. 
Day of Alness. 
Bm Da-V' 
4X 
5 
6 
7 
8 
9 
10 
11 
12 
13 
PCLS£ 
Tem». 
103*1 
Temp.' 
-103' 
120 
110 
102- 
■102' 
100 
101- 
-101 
90 
100s- 
•100' 
80 
99- 
-99' 
70 
93i 
js" 
Resptration. 
PULSE 
TEMPERATURE. 
Composite Chart of 26 Vaccine Treated Cases Cured 
Average days ill before treatment started 
Composite Chart No. 2 
HARLEM HOSPITAL 
-Division- 
History No._ 
WartL 
Name 
AfontA 
Day of Month. 
fitness. 
Hour of Day- 
Temp. 
130 
120 
104*- 
103~ 
-104' 
-103 
110 
102 s- 
-102' 
100 
101- 
-lor 
90 
ioo- 
100 
80 
99s- 
Respiration- 
PULSE 
TEMPERATURE. 
Composite Chart of 4 Control Cases Cured 
Average 5% days til before treatment started of Vaccine Therapy 
145 
Name 
Composite Chart No. 3 
HARLEM HOSPITAL 
-Division. 
History No.. 
.Ward. 
Month. 
Day of Month. 
Daifqfftlness. 
Hour of Day. 
235 
3 
4 
5 
6 
7 
8 
9 
10 
Pulse 
T tMP. 
104- 
13C 
TfMP. 
-104' 
103- 
J20 
-103' 
102s- 
110 
-102' 
101- 
100 
-10T 
100s- 
90 
-tool 
Respi ration. 
PULSE. 
TEMPERATURE 
Composite Chart of 5 Vaccine Cases, Died 
Average 335 days ill before treatment started 
HARLEM HOSPITAL 
History No. 
Name 
Composite Chart No. 4 
-Division. 
_ Ward.. 
Month. 
Dav e/Konlh, 
JTai cT'Zlrtess. 
Uowref Day. 
F j«.$C 
3 
4 
I 
6 
7 
8 
J. 
JO 
11 
12 
TCmp. 
104- 
130 
"104* 
103- 
120 
-103 
102- 
no 
101- 
100 
-102* 
40f 
100- 
90 
-100* 
/torpirctum. 
PULSE. 
TEMPERATURE. 
Composite Chart of 5 Control Cases, Died 
Average 3 days til before treatment started 146 
A Physician's Manual 
"(c) There was no empyema in our vaccine cases. As a matter of fact, empyema in our 
ward this year has not been common. 
"(d) The only case of otitis developed in a patient who had had several vaccine admin* 
istrations. Case XXVII. 
"(e) A glance at the different blood counts shows clearly that there was in all vaccine 
cases a definite rise of leucocytes in the blood, this leucocytosis persisting even after vac* 
cines were stopped, and in some cases even when the temperature had been down for a 
few days. The average number of leucocytes in twenty-two cases on admission to the hos- 
pital was 21,663. After vaccine treatment for several days, this rose to an average of 
25,095, an increase of 15 per cent. In four control cases, the leucocyte count on admission 
was 21,525. This is approximately the same as the vaccine treated cases on admission. 
After several days' stay in hospital, count dropped to an average of 17,250, a decrease of 
about 20 per cent. This would show an advantage of leucocyte activity of 35 per cent in 
favor of the vaccine treated cases. 
"There was in no case any violent reaction from the vaccine. Even in cases where the 
vaccine injections were kept up after a decided fall in the fever chart, there was no rise in 
temperature with chill or any other expression of body reaction to foreign protein or toxin. 
"The mortality in the vaccine treated cases was 16.3 per cent. In the cases treated 
without vaccines, the mortality was 42 per cent. 
"Conclusions: In view of a more favorable mortality rate and absence of violent reac- 
tions and increase of leucocytes, the advantages of the routine use of mixed polyvalent vac- 
cines in the treatment of pneumonia are apparent. 
PREVENTION OF PNEUMONIA AND other 
RESPIRATORY INFECTIONS 
NEWSPAPER dispatches have recently stressed the effort made by 
the Medical Corps of the army to prevent pneumonia and other 
respiratory diseases by a system of voluntary vaccination, along the same 
lines adopted in the matter of typhoid vaccination, in 1909. The Medico' 
Military Review, November 1 and 15,1921, a very interesting publication 
issued from the office of the Surgeon General, for the information of medi- 
cal officers, contains a free discussion of the problem confronting the army 
and the efforts at present put forward for its solution. A letter from Col. 
J. F. Siler, of the Surgeon General's office, calls particular attention to the 
fact that no claims as to the value of this measure have been made, the 
intention being simply to work out some practical method of procedure 
which will minimize the occurrence of this disease in the army and at 
the same time which will contribute to the advancement of prophylactic 
medicine. 
Those who have served in the Medical Corps of the army will recall 
the ever present dread of respiratory diseases, and the extreme steps taken 
for their prevention. Reliance has been primarily on general sanitary 
measures, such as the hygienic treatment of the nose, mouth and throat, 
of the recruit particularly; early isolation of cases; frequent inspection 
during epidemic periods; detection and isolation of carriers; adequate 
floor space in barracks; avoidance of crowding; proper ventilation; con- 
trol of promiscuous expectoration; cleanliness, of the hands particularly, of Vaccine Therapy 
147 
and so on. With all of these precautions painfully carried out, the preva' 
lence of respiratory diseases has been at times alarming. It has, therefore, 
appeared to those in authority essential that some more specific treatment 
be made available. It is not possible for soldiers to avoid contact with 
each other, as in civil life. 
In the spring of 1920, observations were begun as to immunity con* 
ferred by attacks of influenza. The conclusion from incomplete data was 
that the disease itself did confer a degree of immunity, which, while tem' 
porary, was of some moment and served materially to reduce epidemics. 
Coincidentally efforts were made to produce immunity by the use of 
appropriate mixed vaccines, which seemed to afford some protection. In 
the fall of 1920, the administration of a pneumococcus vaccine was begun 
as a voluntary measure. While untoward conditions, as related to oppor- 
tunity for scientific investigation, prevented the accurate conclusions 
desired, very interesting results were recorded. For one thing, and for' 
tunately, the prevalence of pneumonia was greatly restricted over pre' 
vious years. At Fort Meyer, Virginia, every other organization was 
vaccinated. There were five cases of pneumonia at that post during the 
season, all in the unvaccinated group. At Camp Meade, with a total 
strength of 2,319, 445 were vaccinated. Only one case of pneumonia 
occurred there, that being in the unvaccinated group and following 
measles, and the admission rate for other respiratory diseases was 94.38 
per 1,000 in the vaccinated group and 97.65 per 1,000 in the unvaccinated 
controls. At Camp Travis, Texas, no pneumonia occurred in 1,366 vac* 
cinated soldiers, while in a group of 14,296 not vaccinated there were 
nineteen cases. In other words, there was one case for every 752 not 
vaccinated and no cases in 1,366 vaccinated. As pointed out, these re' 
suits are not conclusive, but they are interesting. We may further ob' 
serve, that these efforts and observations may differ considerably from 
those offered as extenuation of the use by the profession of certain stock 
vaccines, urged by the manufacturers as a complete armamentarium in 
the treatment of respiratory diseases. 
The vaccine used by the army now contains, according to Circular 
Letter No. 118, office of the Surgeon General, 6,000 millions of bacteria 
to the cubic centimeter, the total comprising 1,000 millions each of Types 
I and II of the pneumococcus, 1,000 million each of the two most common 
pathogenic types of the hemolytic streptococcus (Dochez and Avery) 
and 2,000 millions of the influenza bacillus (Rivers spinal fluid). Type 
III pneumococcus has been omitted because of its rarity. The influenza 
bacillus has been added because it acts as a pathogen for the respiratory 
tract, regardless of whether or not it is the cause of influenza. 
Elaborate plans are being laid by Surgeon General Ireland for securing 
accurate data and reliable control, and it is to be hoped that results will 148 
A Physician's Manual 
be comparable to those obtained in the matter of typhoid prophylaxis. 
Research workers in civil life are not favored with the opportunities for 
investigation available to the army surgeon, and their work will be defi' 
nitely aided by the data secured from this source.-Editorial Comment 
Texas State Journal of Medicine, December, 1921. 
SIR A. E. WRIGHT (The Lancet, March 29, 1919), among other 
things under the subheading "Results of Vaccine Therapy," says: 
"The most dramatic and convincing-convincing because here no other therapeutic 
measures are employed as adjuncts-are the successes obtained in streptococcal lymphan' 
gitis, in streptococcal cellulitis-I am thinking of those cases which have already been 
incised without striking benefit-and in conjunctival phlyctenules." 
Under Non-Specific Immunity he says: 
"Let us just glance at the prospects which are here opened up. In the foreground 
stands the question of non-specific immunization. That immunization is always strictly 
specific counts as an article of faith; and it passes as axiomatic that microbic infections 
can be warded off only by working with homologous vaccines; and that we must in every 
case before employing a vaccine therapeutically, make sure that the patient is harboring 
the corresponding microbes. I confess to having shared the conviction that immunization 
is always strictly specific. Twenty years ago, when it was alleged, before the Indian 
Plague Commission, that antiplague inoculation had cured eczema, gonorrhoea, and other 
miscellaneous infections, I thought the matter undeserving of examination. I took the 
same view when it was reported in connection with anti-typhoid inoculation that it 
rendered the patients much less susceptible to malaria. Again, seven years ago, when 
applying pneumococcus inoculations as a preventive against pneumonia in the Transvaal 
mines, I nourished exactly the same prejudices. But here the statistical results which 
were obtained in the Premier Mine demonstrated that the pneumococcus inoculations 
had, in addition to bringing down the mortality from pneumonia by 85 per cent, reduced 
also the mortality from 'other diseases' by 50 per cent. From that on we had to take up 
into our categories the fact that inoculation produces in addition to 'direct' also 'col- 
lateral' immunization. This once recognized, presumptive evidence of collateral immuni- 
zation began gradually to filter into our minds. Among, I suppose, many thousands of 
patients treated by vaccine therapy in private and in hospital, it happened every now 
and then that a patient was treated with a vaccine which did not correspond with his 
infection, and that the patient indubitably benefited. Again, it was not an uncommon 
experience for the subjects of a very chronic infection (such as pyorrhoea) who were 
treated first by a stock vaccine, and afterwards with an auto-vaccine, to assert that they 
derived more benefit from, and to ask to be put back upon treatment by, the stock vaccine." 
DR. FREDERICK P. GAY, Professor of Pathology, University of 
California Medical School, Berkeley, Calif., in a special article pre* 
pared under the auspices of the Council on Pharmacy and Chemistry, 
says: 
"It was natural from the beginning of the present pandemic of influenza that, with 
the apparent assurance that Pfeiffer's bacillus was the veritable cause of the disease, 
attempts should be made to produce an active protective immunity against this micro' 
organism. With a growing conviction that no very extraordinary results were being 
attained, and with the discovery of other bacteria both in the complicated and in the un* 
complicated cases, it was likewise reasonable that a mixed vaccine containing the most 
representative bacteria should be tried. We may now discuss the data that have accrued 
from these attempts, and try to evaluate them. of Vaccine Therapy 
149 
"A great deal of writing has been done on this subject, but much, perhaps the greater 
part of it, is of little or no value as evidence from which to draw conclusions. This 
doubtful mass of literature ranges all the way from opinions through clinical impressions 
to well arranged statistical material drawn from careful observation. The latter data 
themselves are again of unequal value; some of them represent results checked by only one 
or more of the essential controls, whereas others, a very few, fulfil the criteria of rigid 
experimentation. The discussion may be clarified by outlining what I myself should 
regard as complete data from which conclusions as to the value of preventive vaccination 
should be drawn; they are those recommended by the Special Committee of the American 
Public Health Association. These recommendations prescribe that the groups of vacci- 
nated and unvaccinated individuals should be essentially the same in number; that the 
relative susceptibilities of the two groups as regards age and sex, exposure to infection 
and attacks of the disease should be the same; that the degree of exposure after vaccination 
should be of the same duration and intensity for each group, and finally that the groups 
should be exposed concurrently during the same period of the epidemic curve. It is 
realized that very seldom will the data offered fulfil all these prerequisites. 
"Two main types of vaccine have been employed in the prevention of influenza: first 
of all, a vaccine composed of influenza bacilli most of them comprising numerous strains, 
and secondly, a mixed vaccine containing the organisms most frequently found in fatal 
cases of influenza, that is to say, in addition to the influenza bacillus, pneumococci, strepto- 
cocci, staphylococci, and at times certain other organisms. We must consider our results 
first in relation to the types of vaccine employed, and again in respect to the effect of 
these vaccines, on the one hand in preventing influenza, and on the other hand in pre- 
venting its complications. 
"The vaccine composed of influenza bacilli alone has been found by a few observers 
apparently to exert beneficial effects in preventing the incidence of the disease, notably 
by Duval and Harris and by Wallace. Other observers with perhaps even more carefully 
controlled experiments, such as McCoy, Murray and Teeter, and Wadsworth, attribute 
not the slightest preventive action to this vaccine. 
"When we come to consider the use of mixed vaccines, we find at once more valuable 
and more enthusiastic reports as regards their preventive value. A whole series of 
observers-Rosenow, Cadham, Eyre and Low, Kraus and Kantor, Cary, and Minaker 
and Irvine-have apparently demonstrated a distinctly diminished incidence of influenza 
in the vaccinated as compared with the unvaccinated, and the particular writers to whom 
I have referred have for the most part carefully controlled their cases by a group of 
unvaccinated individuals. But it is not so certain in every instance that they have ful- 
filled the other requirements already outlined. McCoy, on the other hand, finds no 
beneficial effects from the use of a mixed vaccine in prevention. 
"Mixed vaccines have been used, not only preceding exposure to influenza, but also 
during the course of the disease in the hope of preventing its complications. There is 
a steadily growing body of information, some of it of apparently considerable critical 
value, that would seem to indicate that a mixed vaccine containing streptococcus and 
pneumococcus in addition to influenza bacilli will notably decrease the pneumonia compli- 
cations of influenza. Among the observers that may be mentioned are Kitano, Armitage, 
Dever, Boles and Case, Bezancon and Legroux, and Cadham. 
"Cary, and Roberts and Cary, have not only prevented the occurrence of pneumonia 
by the use of mixed vaccine, but have actually produced a rapid cure of pneumonia during 
its course, particularly when the vaccine is administered intravenously. The striking 
results that they claim for this treatment they properly attribute to a non-specific protein 
reaction, such as has been obtained by other observers in typhoid fever and acute rheu- 
matism. The non-specific nature of the result is rendered more certain by similar bene- 
ficial effects produced by Cowie and Beaven, who used a typhoid protein in place of the 
mixed influenza vaccine with equally good effect." WORKS 
No. Inoculations 
1 Inoculation 
2 
Inoculations 
3 Inoculations 
No. of 
Men 
No. Men 
Rptd. 
Sick 
No. 
Days 
Lost 
No. Men 
Inoc. 
No. Men 
Rptd. 
Sick 
No. 
Days 
Lost 
No. Men 
Inoc. 
No. Men 
Rptd. 
Sick 
No. 
Days 
Lost 
No. Men 
Inoc. 
No. Men 
Rptd. 
Sick 
No. 
Days 
Lost 
Steel 
436 
42 
581 
411 
45 
517 
485 
30 
331 
513 
7 
71 
Wire 
390 
40 
702 
235 
18 
272 
345 
15 
234 
420 
6 
110 
Cuyahoga 
492 
10 
227 
595 
20 
291 
507 
6 
85 
296 
1 
16 
Cent. Fees 
78 
6 
87 
179 
20 
282 
209 
10 
237 
206 
2 
31 
TOTAL 
1396 
98 
1597 
1420 
103 
1362 
1546 
61 
887 
1435 
16 
228 
Per Cent Men Sick 
7.02 
7.25 
3.94 
1.11 
Deaths 
5 
4 
2 
0 
Death Rate Per M . 
3.58 
2.81 
1.29 
o 
A TABULATED REZORT OF PREVENTIVE INOCULATIONS CONDUCTED BY DR. GEO. EDWARD FOLLANSBEE, 
AMERICAN STEEL AND WIRE COMPANY 
October 22, 1918, Inclusive-Influenza Immunization Begun Oct. 21, Concluded Oct. 29 
It will be observed that this work was done early during the influenza epidemic of 1918. 
OBSERVATION ON 5797 EMPLOYEES 
CLEVELAND, OHIO, AT THE 151 
DR. W. O. SHERMAN, of Pittsburgh, Pa. (Journal A. M. A., Dec. 
21,1918) gives one of the most valuable reports on the prophylactic 
immunization in epidemic influenza because it was carried out on a large 
scale in the 1918 epidemic from the beginning of its early development 
and in the Pittsburgh district, Sherman's Formula 38 being supplied and 
says: 
"At the Homestead plant, there were 1,687 °f the employees who were not inoculated; 
588 of those, or 30 per cent, contracted the disease. The number of deaths was forty-two, 
a percentage of 2.5. There were 5,964 who received one inoculation; of these, 213, or 
3.5 per cent, developed the disease. There were nine deaths among these, or a percentage 
of 0.15; 5,222 received two inoculations, and 714 developed the disease, or a percentage 
of 3.2 with four deaths. The death rate was 0.08. There were 4,720 that received three 
inoculations; sixty-six of these, or a percentage of 1.4, contracted the disease. There 
were no deaths in those with three inoculations. There were 4,007 who received four 
inoculations at the one plant, and these data are accurate; 108, or 2.8 per cent, contracted 
the disease, and there were two deaths, giving a death rate percentage of 0.05." 
From this report it will be observed that the incidence of those con- 
tracting the disease and the mortality rate dropped very materially after 
the first inoculation. As compared with the uninoculated in the Home- 
stead plant, there were proportionately twenty deaths per 1,000 em- 
ployees, whereas among the inoculated receiving one inoculation there 
were only 1.5 deaths per 1,000 persons. Among those receiving two in- 
oculations, there were 1.3 deaths per 1,000; those receiving three inocu- 
lations, no deaths and those receiving four inoculations one death per 
2,000. 
DR. JOHN H. SLEVIN, Detroit, Mich., (Ohio State Medical Jour* 
nal, May, 1921) says: 
"It is my experience that there is no method of treatment for erysipelas, which has 
proved to be clinically curative, until the advent of vaccine therapy. 
Inefficiency of Local Treatment 
"I have found no indications for internal medication in erysipelas, and Osler says there 
are none. In fact, all the text-books I have consulted damn with faint praise the internal 
treatment which each seems to find it necessary to suggest. 
"Under local treatment, Osler says: 'Of local applications ichthyol is at present much 
used. The inflamed region may be covered with salicylates and starch. Perhaps as good 
an application as any is cold water which was highly recommended by Hippocrates.' 
The most recent publication that I have seen, which is Moorhead's 'Traumatic Surgery,' 
says: 'Local measures have been recommended almost without number and cures often 
ascribed to them with about as much basis as if they had been similarly used to hasten 
the desquamation of scarlet fever, measles or any other disease of self-limited type.' This 
agrees exactly with my opinion. 
"Of local methods thought to act as cures I may mention the injection of antiseptics 
in front of the advancing margins. 
"I early learned that the streptococci advance irregularly ahead of the typical margin 
and in the few cases in which I saw it used the effect was ludicrous, the disease appearing 
beyond the injected area on schedule time. Sloughs due to the injection have been 
reported. One method that appealed to me theoretically and to which I gave a thorough 152 
A Physician's Manual 
trial was painting the involved area and a w'ide margin beyond with 85 per cent phenol 
later neutralized with alcohol. The successes were in no greater proportion than by 
palliative treatment and I stopped it after getting a superficial necrosis on the tip of the 
ear in one case and almost at the same time having a doctor, who had repainted his mother's 
leg because my application had not checked the advance report that she was voiding 
smoky urine containing casts and albumin. Once I saw a sort of lattice fence painted 
with 95 per cent phenol around the indurated margin. The erysipelas jumped the fence, 
roamed awhile and disappeared, leaving the fence to be erased by painstaking and pain- 
giving dressing. I have not used it myself. A somewhat similar method was painting 
a stripe or boundary board with iodine or silver nitrate about the inflamed area. To my 
eye it made a jarring color scheme and evidently increased the patient's subjective burning 
without affecting the course of the disease. 
"It seems to me that the most objectionable treatment and apparently the one most 
frequently employed, outside of hospitals, is besmearing the patient's inflamed area with 
grease containing some mixture of ichthyol. This causes neither subjective nor objective 
relief, is a dirty malodorous mess that firmly adheres to the tender skin and makes a nasty 
scab during desquamation, especially where hairy surfaces are involved. Other oint- 
ments vary from the above chiefly in color. They are objectionable because difficult and 
painful to remove. 
Value of Bacterial Vaccine Therapy 
"In the last few months I have had a series of twelve cases of erysipelas under my care 
treated with bacterial vaccines which I wish to report. Six women, all past 40 years; 
six men, all past 30 years. The men had all been intemperate, indulging in alcoholics and 
therefore were most unfavorable cases. The women all gave a history of previous attacks, 
lasting from one to five weeks. In no cases were more than ten doses of vaccine given 
at daily intervals until cure was effected and in seven of the twelve cases cure was effected 
after the exhibition of the sixth daily dose of vaccine. In the cases where the patients 
had been afflicted previously, they all were charmed by the rapidity of recovery. 
"The most recent case, that of a lady, initials W. H., age 65, had suffered two previous 
attacks, one of eight weeks and the other of six weeks duration. She was quite delirious 
when I was called. Eyes closed completely and face and head swollen out of all resem- 
blance to herself. Temperature 104°; pulse, 140; respiration, 26. Made complete re- 
covery after the tenth dose of vaccine and after the fourth dose patient remarked how 
wonderfully quick, as compared with former experiences, her return to the borderland 
of health was and she added that this attack in its very incipiency was the most severe 
and serious attack of all. 
"In conclusion I wish to emphasize the therapeutic importance of bacterial vaccines in 
the treatment of erysipelas. There can be no question or clinical doubt of the value of 
a remedy that answers the provisions of two cardinal laws, in the practice of medicine, 
namely, 'Do no harm' and return your patient to health 'quick, entirely and pleasantly'." 
DR. BURT R. SHURLY, Professor and Director of the Department 
of Rhinology, Laryngology and Otology, of The Detroit College of 
Medicine and Surgery, in a private communication dated May 26, 1923, 
says: 
"My dear Doctor: 
"Ever since the manufacture of mixed vaccines began and Dr. E. L. Shurly returned 
from a personal study with Wright of London, I have personally been greatly interested 
in endeavoring to determine the full value of vaccine therapy. 
"After reading, and studying and making use of considerable experience, I am con- 
vinced the stock vaccines have a decided place and value. It is true that this must be 
scientifically censored from time to time and that rather than give a shot-gun preparation of Vaccine Therapy 
153 
in a wild sort of way for any condition that might be infectious, we endeavor to get a 
bacteriological status for our therapeutics. We have been working along these lines 
long enough to standardize and stabilize our method. 
"I do believe that in some infections of the respiratory tract in well selected cases, 
vaccine therapy is of great value. It must be safe-guarded by the most careful diagnosis 
and of course principles of surgical drainage must ever come foremost. 
"The results 1 have had are the reasons for my confidence in this selective therapeutic 
procedure." 
Very truly yours, 
Burt R. Shurly. 
DR. WM. SCHEPPEGRELL, President of the American Hay-Fever- 
Prevention Association, Ex-President, American Academy of 
Ophthalmology and Oto-Laryngology, Chief Hay-Fever and Asthma 
Clinic, Charity Hospital, New Orleans, La., in a communication, May 
21, 1923, concerning the use of mixed vaccines, says: 
"Dear Dr. Sherman: 
"Replying to yours of the 17th instant. 
"In my book on 'Hayfever and Asthma, Cause, Prevention and Treatment,' I make 
the following statement: 
"If the patient applies for treatment during an attack of hayfever, the pollen extracts 
are usually ineffective, and a vaccine should be used. 
"Our reason for using the vaccine during severe paroxysms is that at this time the 
patient is suffering, not only from the effects of the pollen protein, but also from the 
great increase in the pathogenic micro'organisms resulting from the lowered resistance of 
the respiratory membranes. 
"The autogenous vaccines are preferable, provided they can be obtained of the proper 
standard and purity. When there is any doubt regarding this, the stock vaccines of 
unquestioned reliability should be given the preference. 
"Further experience has caused no change in our views on this subject." 
Very sincerely, 
Wm. Scheppegrell, M. D. 
DR. J. FRANCIS WARD, Brooklyn, N. Y., Consulting Physician 
Craig Colony for Epileptics, formerly chief of Tuberculosis Service, 
Base Hospital, Camp Upton, N. Y., May 23, 1923, in a communication 
savs: 
"G. H. Sherman, 
"Dear Doctor Sherman: 
"In immunizing against hay fever, I always ascertain the pollen that is responsible 
for the protein sensitization and endeavor to complete my pollen prophylaxis a few 
weeks before anticipated onset of the disease and follow with your formula 36 completing 
my immunization about the time of the usual attack. This I term pollen vaccinodmmuni' 
zation. 
"With prophylaxis I have had most gratifying results and uniform immunity. If I 
do not get a patient until after the onset of the disease, I use the indicated pollen and 
your formula 36 mixed vaccine and designate it pollen-vaccino therapy. In asthma, I 
endeavor to ascertain if the disease is due to pollen protein sensitization or is largely a 
microbial asthma. If I class the disease as strictly microbial asthma, I use your formula 
36, but if I find pollen protein sensitization a factor, I use both the indicated pollen protein 
Detroit, Mich. 154 
A Physician's Manual 
and your formula 36 and I anticipate adding in the future formula 45 or 47 in cases of 
long standing, when I do not get desired results with the aforesaid treatment. 
"The symptoms and pathology of whooping cough are the same as those of hay fever. 
In whooping cough, it is the upper respiratory tract, which is affected-the trachea and 
glottis. The majority of whooping cough cases occur in April, May, June, July, August, 
September and October, the season at which plant pollination is at its heighth. 
"In prophylaxis and treatment, I endeavor to find the pollen protein present and add 
this to your formula 37 or 43. For prophylactic immunization, I advocate your formula 
37 largely with the appropriate pollen protein (when found)-and in treatment, your 
mixed formula 43 with the indicated pollen protein, if found. 
"Past experience emphasizes the urgent necessity for the control of whooping cough 
in the dangerous years of childhood." 
Very truly yours, 
J. Francis Ward, M. D. 
THE VACCINE TREATMENT OF ASTHMA1 
IN a paper on the subject published in "The Journal of Immunology," 
July, 1923, Francis M. Rackemann and Lillian B. Graham summarize 
their work on the subject as follows: 
Summary 
1. The method of making autogenous vaccines and of treating 
patients with emphysema, chronic bronchitis and with bacterial asthma 
is described. 
2. Ninety patients have been treated with autogenous vaccines. A 
predominating organism was found and used in 29 cases with good 
results in eleven and fair results in eleven. In sixty-one cases, there 
was no predominating organism but a selection from several autogenous 
vaccines was made on the basis of the local reactions following the test 
dose. Good results occurred in thirteen and fair results in fourteen. 
3. Forty -one patients have been treated with stock vaccines, like- 
wise selected on the basis of the local reactions, with good results in 
sixteen and fair results in twelve. 
4. Whatever vaccine is used the fact that good results occur only 
in those cases where the various doses of the vaccine are followed by 
local reactions at the site of inoculation is definite and striking. 
5. The importance of the local reaction plus the fact that the results 
with stock vaccines are as good or better than those with autogenous 
vaccines gives rise to the impression that the action of all vaccines in 
asthma is non-specific. 
6. Of the entire series of one hundred thirty-one patients, 9 or 7 
per cent have been "cured;" 31 or 22 per cent have been definitely bene- 
fited; 13 or 10 per cent have been helped somewhat; 24 or 18.5 per cent 
have been relieved temporarily but 54 or 41 per cent have not been 
relieved at all. 
i From the Medical Services of the Massachusetts General Hospital. of Vaccine Therapy 
155 
7. Although good proof of a cure brought about by vaccines is 
lacking, vaccines do good in many cases. And at least until we know 
more of the fundamental pathological physiology of asthma, their use is 
reasonable and justifiable. 
DR. J. LESLIE DAVIS (Pennsylvania Medical Journal, Feb., 1922) 
says that for some time he had only paid halfhearted attention to 
vaccine treatment of sinus and ear infections until a few days prior to 
his own illness he had read a very favorable report which impressed him 
sufficiently to give the vaccine treatment a trial in his own case. 
In August, 1914, he developed an acute ethmoiditis of "a most viru- 
lent and fulminating type" on both sides. Within twelve hours, a pro* 
fuse purulent discharge had developed which soon became pure pus. 
He made a microscopic examination of the discharge and found numerous 
streptococci and staphylococci. Without waiting for an autogenous vac' 
cine, he procured a mixed stock vaccine, containing these organisms and 
started treatment at once. This was within thirty hours after the onset 
of symptoms. He says: "Within twenty Tour hours after the injection 
of the vaccine, every symptom seemed conservatively fifty per cent bet' 
ter." The vaccine treatment was continued. By the fifth day of the 
disease he says: "The discharge had entirely ceased, the nasal congestion 
had subsided sufficiently to permit of free respiration and I felt practL 
cally well." His usual method of other treatment was meantime also 
employed. 
The favorable results in his own case induced him to give the vaccine 
treatment with mixed stock vaccines further trials and as a result of seven 
years' experience says: 
"I shall state at the outset that my own experience, during the past seven years, with 
vaccine therapy as an aid in the treatment of sinus and ear infections, particularly with 
stock vaccines in acute cases, has been most satisfactory and has established in me a 
confidence in their value which no amount of conflicting testimony could easily shake. 
"During those seven years I have tried to keep reasonably familiar with the literature 
upon the subject, and in my practice to be ever watchful for the much heralded dangers; 
but with each passing year I have continued to gain increasing reassurance with regard 
both to the safety and to the uniformity of results derived from vaccines administered, 
not promiscuously, nor as a specific, but as a most important accessory measure in the 
treatment of all acute suppurative infections of the sinuses and of the middle ear and 
mastoid. 
"Supposing, however, that if in my earlier reading I had run across only such articles 
as were written by some of the ultra-conservative, warning of the grave dangers con- 
nected with the administration of any vaccine, or of the absurdly unscientific procedure 
of treatment with mixed stock vaccines and of the utter folly of expecting beneficial 
results from the latter, I likely should have concluded that my own results were purely 
'dumb luck' and that I had miraculously avoided wholesale manslaughter. On the other 
hand, had I missed those articles and found only the opposite extreme I might have 
wondered whether or not I was criminally neglectful in not having treated all my patients 
for everything with vaccines. 156 
A Physician's Manual 
"That may be an exaggerated characterization of the extremists, whose influence, after 
all, may be very necessary factors in the evolutionary stages of any new principles toward 
an eventual consummation of rationality. That between the two extremes, however, 
there lies a middle course, which any careful physician may follow with safety to a definite, 
desirable end in the treatment of a frequent and ofttimes serious type of disease, I believe 
there is ample evidence to sustain. Furthermore, I believe that the best interests of the 
public will be served when the general practitioner, the family physician, urban and rural, 
as well as the specialist, discovers that stock vaccines can be used to a degree of safety 
equal to that of the majority of the most frequently employed official pharmaceutical 
preparations, concerning which there is no question of propriety, and that there are 
certain classes of acute infections which respond to vaccines more effectually than to any 
other known treatment and in proportion to its early administration, for, as a rule, the 
family doctor is the one who sees those conditions first." 
In conclusion he says: 
"Since it is undoubtedly true that the longer the delay in administering the vaccine, 
the greater the difficulty in effecting a cure of acute sinus and ear infections, I maintain 
that the commercial producers and distributors of vaccines of high quality are rendering 
the medical profession an admirable and, let us hope, also dignified and ethical service." 
MILLER urges immunization of children against whooping cough. 
In Akron, Ohio, use was made of bacterin of a strength of 5 billion 
Bordet bacilli to 1 c.c. in doses of 2 billion followed by 4 billion three 
days later. In Miller's opinion the proper strength for either prophy- 
laxis or treatment is at least 5 billion to the mil. Failures with Bordet 
bacillus in the treatment of cases are due entirely to insufficient dosage 
administered at too-long intervals. A safe principle in the use of whoop- 
ing cough bacterin is, "the younger the child, the larger the dose re- 
quired.' However, no case has failed to respond if the injection was 
given not later than forty-eight hours after the preceding one and the 
dose doubled each time. Miller believes that public health authorities 
are justified in promoting immunization against whooping cough just as 
they are urging immunization against typhoid fever.-Journal A. M. A., 
October 29, 1921. 
VACCINE IN THE TREATMENT OF WHOOPING COUGH 
PERHAPS one of the most justly dreaded and serious diseases of child- 
hood is whooping cough, not even so much for its immediate effects, 
although it is a disease of high mortality, but more so for its complications 
and sequelae, particularly tuberculosis, and debility. Until the discovery 
of the specific agent of this disease-the Bordet-Gengou bacillus-noth- 
ing could be done by way of prophylactic treatment, and the active treat- 
m ent hadto be entirely empirical and was largely unsatisfactory. In any 
event, the disease is highly infectious, and isolation must be carried out 
rigidly, even against suspected cases, for it is they who are always the 
most potent factors in the spread of disease. For successful prophylaxis 
or satisfactory treatment of active cases early diagnosis is essential; and 
PROPHYLAXIS OF WHOOPING COUGH of Vaccine Therapy 
157 
until diagnosis is established, the sputum and the vomitus must be pap 
ticularly guarded from contact with others. Infection with whooping 
cough is by the so-called droplet method, and if contacts can be kept free 
from the patient's discharges, there is no likelihood of infection. Because 
other catarrhal diseases often give paroxysmal coughs, a positive diagnosis 
can be made only from culture. 
"The vaccine treatment should be instituted the moment the disease 
is suspected. When the paroxysms are fully developed, treatment is not 
satisfactory. Failure from the vaccine treatment for whooping cough 
when diagnosis is not made from cultures is often due to the fact that the 
paroxysmal cough is not due to the Bordet-Gengou bacillus. The influ- 
enza bacillus is particularly likely to cause it. On the other hand, there 
are many strains of the Bordet-Gengou bacillus, and a pure culture of one 
strain will be of no avail in treatment when infection is caused by another 
strain. The administration of pertussis vaccine is harmless, and there is 
no danger of producing by it any anaphylactic reactions, and so an in- 
crease of symptoms, rather than amelioration of them. While the treat- 
ment of the disease with the vaccine during the paroxysmal stage is not 
as satisfactory as in the earlier stages, yet the severity of the paroxysms 
is much lessened and the disease much shortened. The dosage used in 
active or in prophylactic treatment is practically identical. In active 
cases it may be continued for a week or ten days-injections every other 
day. Usually dosage is commenced with five hundred million. Then 
one, two and three billions every other day in succession. The adminis- 
tration of the vaccine to all who are exposed will be found to reduce con- 
tact infection in a very large degree. There is no reason why with isola- 
tion and prophylactic dosage to every possibly exposed child, the disease 
should not eventually be reduced to a negligible number. 
"While ordinarily pure cultures are used in the preparation of the vac- 
cines, some of the proprietory vaccines are polyvalent, composed of the 
Bordet-Gengou bacillus, the influenza bacillus, the streptococcus, the 
staphylococcus. 
"Finally, in condemning failures with the use of the vaccine in the 
treatment of the active cases, it must not be forgotten that when the use 
of the vaccines is commenced late in the disease, the damage to the body 
or the inception of complications and sequelae have already set in, which 
the vaccine treatment can neither remedy nor repair.-Editorial, Boston 
Medical and Surgical Journal, April 4, 1918. 
DR. HERMAN M. APPEL and Otto J. Bloom, New York (Archives 
of Pediatrics, March, 1922) after considering the problem of caring 
for whooping cough cases in conclusion says: 
"In a disease so dreadful as whooping cough and so fatal in its immediate, and so 158 
A Physician's Manual 
disastrous in its late consequences, whose etiology and epidemiology are known, and yet 
whose mortality is constantly on the increase and against which all methods have proven 
of so little use, any new means .of combating it is worthy of all serious consideration, 
especially when such means is logical and founded on etiologic groundsIn a 
low-grade toxemia, however, such as whooping cough, the injection of the vaccines will 
throw the balance in favor of the body as is clearly demonstrated by the fact that after 
the third and fourth injections, there is an aggravation of the clinical picture; which at 
the same time gives an impetus to the further production of antibodies and from then 
on, the body is able to take care of itself and improvement is noted. Such a means we 
have in whooping cough vaccine. In those cases where it has failed to give satisfaction, 
it is probable that the strain of organism used in the vaccine was different from that 
producing the disease, or that a mixed vaccine was not used since secondary invaders 
are always present with the pertussis bacillus, or that an inert vaccine was used or the 
dosage not sufficiently large. In the closing paragraph of the Weekly Bulletin of the 
New York City Health Department for November 6, 1920, the Department urges the 
prophylactic inoculation of children in institutions and states that it may mean the saving 
of many lives and that the reaction to the vaccine is negligible; while health authorities 
of other cities advocate the use of mixed vaccine both for prophylaxis and especially for 
treatment. The average duration of the disease, as given by authorities, is from 45 to 
100 days-with vaccines, the duration has been cut down to about 30 days, the severity 
has been mitigated, complications prevented and mortality reduced. Should its prophy' 
laxis and cures be far from. 100 per cent, any remedy that accomplishes all the above is a 
better remedy than any that has hitherto been put forward and should be used. Pertussis 
vaccine has done all this and has, therefore, established itself as a definite scientific entity 
of almost, if not actual, specific value in the treatment of whooping cough." 
DR. HARRY S. BERMAN, Director of Whooping Cough Clinic, 
Detroit Dept, of Health (City Health Bulletin, Detroit Depart' 
ment of Health, May, 1921) in part says: 
"If any apparently healthy child is brought in soon after exposure to a case of pertussis, 
two doses of vaccine are given as a prophylactic measure, one week elapsing between 
injections. The vaccine employed is that of the Bordet'Gengou baccillus and the dosage 
is approximately two and four billions for the respective doses. If evidences of a cold are 
manifested in the patient, a vaccine combined with the common pyogenic bacteria is 
employed, and injections are repeated at intervals of three days or more 
"It is unfortunate that some physicians refuse to encourage the use of whooping cough 
vaccines, while others discourage the parents when it is requested, thus forcing them to 
seek assistance at the various clinics. 
"It is the method of these clinics to refer the case back to the family physician, but 
the mother sometimes states that her doctor will not administer the vaccines, and she 
has come to the clinic for that reason. 
"Many physicians hesitate to give vaccines to children owing to the possible anaphy- 
laxis. This danger has been overestimated. No unfortunate results have been observed. 
"Children tolerate vaccines exceptionally well. The younger the child the less the 
fear for any reaction. Newborn babies tolerate the maximum doses of vaccines equal to 
that of an older child without apparent bad effect. Physicians are prone to give too small 
a dose to produce results, fearing that a large dose may cause an unfavorable reaction. 
"I can, therefore, safely recommend the administration of pertussis vaccines to children 
of any age. Physicians should insist upon giving the vaccine treatment in known infec- 
tions and urge its use as a preventive among exposed susceptible children." of Vaccine Therapy 
159 
PROFESSOR JOHN O. POLAK (Journal A. M. A., Nov. 22, 1911, 
p. 1739) in part says: 
"Autogenous vaccines of a single strain have given me unreliable reactions. This, I 
think, can be explained by the fact that the coccus is attenuated in its strength and, after 
it has produced its first reaction, the leucocytes become more or less accustomed to the 
particular variety of coccus, and are less liable to effect a defense than when a vaccine 
of polyvalent strain is introduced. 
"Mixed vaccines of reliable laboratories have given better results than when a single 
variety w'as used. This has been shown repeatedly in the blood-picture when an autog- 
enous vaccine of single strain used in large doses, even up to 500,000,000, has failed to 
increase the leucocyte count or diminish the polynuclear percentage, the mixed vaccines 
of several strains have promptly produced a marked leucocytosis. Even colon bacillus 
infections, such as the infection of a pelvic hematocele by the colon bacillus, have yielded 
more promptly to mixed vaccines of polyvalent strains than when a single autogenous 
germ has been used. 
"One characteristic which has been noted throughout all of our experience is that, 
even before any definite effect has been noted on the temperature, the well-being of the 
patient seemed to be improved by vaccine injection." 
PROFESSOR J. DANYSZ, Chief of Service, of the Pasteur Institute, 
Paris, in his book on "The Evolution of Disease" shows the value of 
mixed stock vaccines prepared from organisms isolated from the large in- 
testinal content in the treatment of a large variety of diseases. The fact 
that he isolates the organisms from the intestinal content does not signify 
anything. A colon bacillus isolated from the feces would certainly not be 
a better organism to prepare a vaccine from than a colon bacillus which is 
isolated from an appendicular abscess or a colon bacillus peritonitis. 
Pneumococci, streptococci and staphylococci which are responsible for 
infections of the upper respiratory tract are constantly being swallowed 
with saliva and food. There is no evidence that their passage through 
the digestive tract will improve them in their properties for immuno pro- 
duction when made into a vaccine. This so-called entero-antigen pre- 
pared by Professor Danysz is for all practical immunological purposes 
identical with Sherman's combined colon bacillus, streptococcus pneu- 
mococcus staphylococcus vaccine (Formula 35). 
In describing results obtained under the sub-heading of General Reac- 
tions, page 175, Danysz says: 
"The first striking phenomenon after the first, or the first few injections or ingestions 
of an autogenous or heterogenous preparation, is the rapid change in the patient's general 
condition. A direct action on the nervous system is nearly always observed which is 
shown by lassitude, a need for sleep, relaxation and rest, a general lull which is in no wise 
disagreeable, which may last several hours, rarely two or three days, and is usually 
followed by a long period (several weeks or months) of surprising exhilaration. The 
patient feels himself 'being born again,' he feels a surprising need for physical and mental 
activity, and can undertake without fatigue, work, which a few days before would have 
seemed beyond his strength. Sometimes, the period of lassitude is so short and slight 
that the period of exhilaration seems to appear all at once. In other, less frequent cases, 
the first doses of the preparations are followed by headaches which may last for several 
hours, by chills, or by a slight rise in temperature. Still more rarely, the symptoms of 160 
A Physician's Manual 
the disease are seen to increase slightly. Asthmatics may have a more violent attack, the 
itching dermatosis are aggravated, psoriasis plaques become darker; but these aggrava- 
tions never last long, are not contra-indications for further treatment, and are always 
followed by appreciable and rapid improvement. At the most, it may sometimes be 
necessary to diminish the dose. If this is necessary, only r/ro or even r/ioo is given." 
All these beneficial effects from a combined colon bacillus vaccine have 
been recognized for a long time and were designated as the tonic influ- 
ences of vaccines. I. M. Mullick (Calcutta Medical Journal, Aug. 1911. 
page 41) gives a detailed report of the increased metabolic activity in a 
variety of cases, as indicated by increased elimination of waste products 
as found in the urine during the twenty-four hours. In part, he says: 
"These facts certainly give us some light as regards the changes within. Very probably 
it is this: (1) That vaccines stimulate metabolic activity, increase elimination of waste 
and build tissues; (2) That they hasten catabolism, especially of weak and unhealthy 
tissues and help the building of healthy ones. Even in old people, this is evidenced; but 
in the young, with their tissues in a higher state of vitality, this vital response is the 
DR. V. DABNEY Tor\ Medical Journal, Feb. io, 1912, page 
275) offers a plausible explanation of the tonic effects of vaccines, 
by means of Ehrlich's side chain theory and, in part, says: 
"Naturally when the toxins are numerous, numerous receptors are pre-empted by 
them, and the metabolism of the body suffers proportionate detriment. Thus, by destroy- 
ing these toxins, the vaccine renders available for food assimilation receptors heretofore 
occupied with toxin assimilation. The apparent effect of vaccine therapy on metabolism 
seems to bear out this theory." 
In an editorial in The Bacterial Therapist, (Jan. 1915), the writer said: 
"The general tonic effects of a vaccine may readily be demonstrated by giving a few 
doses of a combined vaccine, Streptococcus, 100,000,000; Pneumococcus, 100,000,000; 
Staphylococcus Aureus, 300,000,000; Staphylococcus Albus, 300,000,000; Colon Bacillus 
200,000,000, in a case where general tonics are usually prescribed. It will be found that 
a feeling of well-being soon develops, associated with a keen desire to take food and a 
good digestion and assimilation to take care of it. With a demand for an increased food 
supply well taken care of, tissue cells have a better opportunity to develop and eliminate 
diseased conditions. In the treatment of chronic localized infections, with vaccines, we 
are often in doubt whether the beneficial effect obtained is due direct to its immunizing 
influence or to a general tonic effect. In many cases, no material improvement in the 
infected area will be observed until the general health has materially picked up, as shown 
by an increase in body weight and other evidences of general improvement, after which 
the lesion begins to clear up." 
Professor Danysz has employed this mixed vaccine prepared from or- 
ganisms isolated from the contents of the large intestine in the treatment 
of many diseases including dyspepsias, constipation, enteritis, chronic ap' 
pendicitis, sigmoiditis, urticaria, eczema, psoriasis, scleroderma, asthma, 
emphysema, rheumatism, dysmenorrhea, leucorrhea, mild chronic albu' 
minuria, disturbances of the menopause, neurasthenia, melancholia, in' 
somnia, migraine, general fatigue and cases of localized tuberculosis, of 
skin and other parts of the body. All these conditions have been cured or 
markedly improved by the administration of this vaccine.