Am.  Jour.  Pharm. 
May,  1914. 
Autogenous  Vaccines. 
215 
or  two  of  caution  to  most  carefully  consider  the  best  ways  of  killing 
the  bacteria  without  impairing  .their  immunizing  properties.  This 
can  only  be  accomplished  by  a  thorough  knowledge  of  and  observ- 
ance of  the  thermal  and  chemical  death-point  of  each  group  of  organ- 
isms :  a  knowledge  that  will  tell  you  which  bacteria  should  be 
killed  by  heat  and  which  by  chemical  measures,  or  by  a  combination 
of  the  two.  If  by  heat,  at  what  temperature  and  for  how  long 
sustained  ?  If  by  chemical  sterilization,  by  what  chemical  and  in  what 
strength?  I  have  known  many  an  autogenous  vaccine — otherwise 
quite  appropriately  selected  bacteriologically  and  otherwise  fault- 
lessly prepared — to  be  inert  and  to  fail  absolutely  therapeutically 
for  no  other  reason  than  that  the  thermal  and  chemical  death-points 
were  not  carefully  ascertained.  And  I  doubt  not  that  this  applies 
equally  to  many  stock  vaccines. 
Have  we  in  vaccine  therapy  a  means  sufficient  to  combat  all 
types  of  bacterial  infections?  I  would  answer  emphatically  "no," 
and  I  would  add  that  harm  may  often  come  from  their  indiscriminate 
use  and  in  the  hands  of  the  inexperienced  and  careless. 
In  epidemic  meningitis,  in  typhoid  fever,  in  pneumonia,  in  gen- 
eralized bacteremia,  with  or  without  ulcerative  endocardial  lesions, 
the  use  of  vaccines  for  curative  purposes  has  not  been  attended 
with  great  success,  although  occasionally  a  case  is  seen  in  which 
amelioration  in  severity  of  symptoms  has  taken  place  which  rightly 
or  wrongly  has  been  ascribed  to  the  use  of  the  vaccine.  I  am  by  no 
means  yet  convinced  that  their  use  in  such  cases  is  unjustifiable, 
and  believe  that  we  may  yet  arrive  by  experience  at  some  method 
of  establishing  proper  dosages  and  proper  intervals  of  injection 
for  this  class  of  acute  fulminating  infections  that  will  produce 
better  results. 
The  most  suitable  field  for  vaccines  and  the  field  in  which  the 
most  brilliant  results  have  been  obtained  lies  in  treatment  of 
diseases,  acute  or  chronic,  that  have  a  local  focus  of  infection,  such 
as  furunculosis,  carbuncles,  abscesses,  various  bone  infections,  such 
as  osteomyelitis,  various  skin  infections,  such  as  acne  vulgaris, 
infected  sinuses,  pyelitis,  empyema,  various  infections  of  the  mouth, 
such  as  pyorrhoea  alveolaris,  infections  of  the  nose  and  nasal  pas- 
sages and  various  post-gonorrhceal  conditions,  and  various  con- 
ditions of  the  respiratory  tract. 
And  now  a  final  word  as  to  why  vaccines  fail  in  the  hands  of 
many  workers,  even  in  the  above  field  of  election — chiefly  because 
