16,1 Fernandez: Focal Dental Infections 93 
was also found in oral infections, this is not recognized as the 
cause of pyorrhoea, as Bass and Johns claim. 
It is a scientifically proved fact that the gastric juice is 
not a barrier against the passage of bacteria and pus into the 
stomach and the intestines. Microorganisms in the mouth may 
be swallowed, as actually happens, and they reach the stomach 
without all of them being destroyed, and thus gain entrance 
into the intestines, causing under certain conditions throughout 
their course local affections such as gastric ulcer, appendicitis, 
etc. 
Another route of dissemination from mouth infection is by 
way of either the lymphatic or the circulatory channels; hence 
the presence of focal infections of remote origin, as Hartzell, 
Henrici, and Leonard have shown in their clinical investigations 
already referred to. 
There are localized infections of the tonsils, and others, that 
may coexist with pyorrhoea and dental abscess; treatment for 
their eradication does not cure the disease if not properly at- 
tended to. 
A thorough treatment of the teeth by the dentist, with ex- 
traction if necessary, was enough to eradicate all symptoms 
and other disturbances observed in patients. In instances where 
a conjoined local treatment by the dentist and the use of vac- 
cines by the physician were available, improvement was rapid, 
especially when autovaccines were employed. 
L. S. Medalla thinks that there is room for vaccine therapy 
in all cases of acute and subacute dental abscesses; and that, 
by the employment of this method, a good deal of suffering 
among patients and the loss of their teeth have been avoided. 
In the use of autovaccine the necessary precautions must be 
taken to obtain the purulent material aseptically, without con- 
tamination. An autovaccine prepared under such conditions al- 
most invariably brings about a surprising and rapid disappear- 
ance of the symptoms, which may not be observed if one is 
careless in the preparation of the vaccine. 
Hartzell and Henrici believe that the elimination of the focal 
oral infection is very much more important than the use of 
vaccine, and they consider this as a mere adjuvant treatment 
in some cases. 
The limited number of cases observed by me corroborate the 
facts which I have quoted here, in regard to the treatment. 
Case 1. — W. T., adult, American, married, male, suffering 
for some time from lumbosacral and articular pain, the char- 
