PNEUMOCOCCAL VACCINES 505 



ment was begun. In the paper there was no mention of type deter- 

 minations of the infecting pneumococci. 



In a detailed clinical report on the use of a mixed vaccine in 

 over two hundred pneumonia patients studied during the period 

 1922 to 1926, Lambert 776 published the following fatality-rates: 

 In cases treated within the first forty-eight hours of the disease the 

 figure was 5.8 per cent ; for those patients receiving the vaccine in 

 the first seventy-two hours the percentage was 9.8 ; when treatment 

 was first instituted when the disease had been present for seventy- 

 two hours or more 26.2 per cent of the patients died, giving a fa- 

 tality-rate of 21.2 per cent for the entire series of cases treated 

 with autolysate as against a rate of approximately 40 per cent for 

 the untreated controls. 



The significance of the results is somewhat obscured by the fact 

 that the vaccine which Lambert employed, in addition to contain- 

 ing forty strains of pneumococci of the first three types and Group 

 IV, also included four times as many other organisms such as 

 streptococci, staphylococci, Micrococcus catarrhalis, and Pfeif- 

 fer bacilli. Whatever specific effect there was could be attributed 

 to the pneumococci in the vaccine, while such influence as the bac- 

 teria of heterologous species may have had on secondary invaders 

 might conceivably have contributed to the results. Lambert's rec- 

 ommendation that stock, mixed vaccines be used removes this form 

 of therapy from the domain of scientific treatment and places it in 

 the realm of empiricism. In Park's Harben Lecture, 1056 already 

 quoted, he stated that a vaccine composed of several types of 

 pneumococci and of other bacteria of respiratory origin in the 

 treatment of lobar pneumonia was without appreciable effect. 



Barach's 76 series of cases was small but his report may be in- 

 cluded as lending some, though slight, support to the claims of ad- 

 vocates of vaccine treatment in pneumonia. Barach gave to twenty 

 patients intravenous injections of monovalent vaccines represent- 

 ing both heat-killed cultures of pneumococci of Types I, II, and 

 III and filtrates prepared from suspensions of the same organisms. 



