Billeder på siden
PDF
ePub

seemed visionary, too good to be true, even to the most enthusiastic, yet of late years we have made such rapid strides with our system of vaccine therapy that even the most skeptical can see a ray of light on what formerly seemed a dark and gloomy horizon.

All of us are and have been vaccine therapeutists. This statement may seem annoying, yet it is true. When we apply heat as in fomentations, massage as in friction, Biers' hyperaemic treatment, stimulating lotions, etc., we are natural vaccine therapeutists; these applications assist nature in two great ways, first by hyperaemia, second by autoinoculation. When we induce hyperaemia by these methods we assist nature first by irrigating the infected area with plasma and leucocytes and secondly by autoinoculation or washing the bacterial products into the blood stream and stimulating the tissues to the formation of antibodies. Although we induced hyperaemia and consequently brought about autoinoculation, a weapon of nature's armamentarium, did we know we did it, or why we did it? Did we apply our fomentations at such intervals as to best provide for the formation of antibodies, or did we calculate our intervals of autoinoculation of our cases so as to maintain most successfully their toxic immunity? No. We, with our natural vaccine therapy, did none of these things. Now we are striving to profit by our mistakes in the past and with a sound, scientific, well established principle to work with, viz., vaccine therapy, success is bound to greet us on all sides.

In our treatment of infectious diseases by vaccine therapy as elaborated by Wright, we use small, infrequent injections of killed bacteria similar to the organisms causing the disease. These injections stimulate the production of immunizing substances, or in other words, increase the specific opsonins and the formation of antibodies. Since the opsonins are in the blood stream, naturally they will act most advantageously when the infection is of such a nature that the blood comes thoroughly in contact with the bacteria. Hence, the vaccines work better in deep seated infections than in superficial ones. For example, in urethritis, the gonococci are on the surface of the urethra and are but slightly affected by the opsonins. In tuberculous peritonitis the abdominal cavity is full of serum

from which the opsonins have all been used up. By operating and removing the serum an inflow of fresh serum, rich in antibodies and opsonins occurs with resulting speedy recovery. In pleurisy, with effusion and empyema, aspiration or drainage is frequently all that is necessary. Wright insisted that in carrying out the vaccine treatment one should be guided by the opsonic index, but most observers maintain that it is not practical and that the best results are obtained in doses and in selecting the proper intervals between the doses by careful clinical observation based on sufficient experience. Whether we should use an autogenous or a heterogenous vaccine has also been a much debated question. Since an autogenous vaccine gives us the exact kind of bacteria as the one causing the trouble, it is undoubtedly scientifically correct. Yet a number of observers have reported equally as good results from the heterogenous or stock vaccines as from the autogenous, and since the gonococci, tubercle and typhoid bacilli from different cases seem so much alike, an autogenous vaccine for these conditions is not considered necessary. Where we have a number of different strains of a germ, as, for example, the streptococci is said to have as many as seventy different strains, an autogenous vaccine is undoubtedly the better, yet for such infections we have polyvalent or vaccines of a number of strains put up in stock form. Where the infection is mixed, of course a mixed vaccine will be indicated. In regard to selecting the best site for the injection, if we adhere to the theory of Wright that the formation of opsonins in the tissue arise at the site of injection and that the largest production of antibodies occurs at that point, we will choose a site of healthy tissues as close as possible to the point of infection.

[ocr errors]

Immediately after the injection of the vaccine there follows a period in which there is a decrease in the amount of opsonins caused by their being used up by the dead bacteria injected, immediately following this we have an increased production caused by the bacterial poisons stimulating the tissue cells to a more elaborate production of opsonins. The first stage we term the opsonic negative and the second the opsonic positive. The opsonic negative stage, while it actually exists, should never manifest itself clinically; if it does it is a warning to

the physician that he has been giving the patient toxic instead of physiologic doses.

The best results from vaccine treatment have been obtained in cases of infection due to the pyogenic cocci. In acne, cellulitis, carbuncles, furunculousis, septicaemia and erysiplas, the results have been remarkable, in fact in all conditions where the pyogenic organisms seem to be the trouble makers, wonderful results are reported. The following are results of ninety-seven cases treated by vaccines at the Massachusetts General Hospital last year. Twenty-four cases of general infection, eighteen of which were puerperal, all recovered. Twenty-two cases of septic abdominal wounds due to colon bacillus, staphylococcus and streptococcus, all recovered. In some of these cases the wounds persisted for some time with no improvement until the vaccines were given. Forty-one cases of local sepsis, twenty-five due to streptococcus, all recovered.

While very few encouraging reports have been heard from the gonococcus vaccine in urethretis for reasons already given, yet in the metastatic infections which were formerly such a bug bear to the physician, the results have been more encouraging. In gonorrhoeal arthritis especially the results have been good, for in the majority of cases the symptoms are ameliorated and the joint restored to its former function. Of two hundred and forty-six cases reported, one hundred and twenty-six were cured, ninety-one improved and twenty-nine not benefited.

Although much harm was done with Koch's tuberculin when it was first given to the profession, it is now being recognized as a great aid to the treatment of tuberculosis. The severe reaction which occurred in some cases from toxic doses and inexperience gave it a pronounced set back. Trudeau, in speaking of it, says: "It stimulates the defensive resources of the system, is a valuable aid in the treatment of the disease and the lives of thousands of cases of incipient tuberculosis and even of advanced cases, when chronic in type, as well as cases of surgical tuberculosis, may in many instances be saved or prolonged by this treatment without any change in their environment.

Although the value of the pneumococcus vaccine in pneumonia has been doubted by many, yet there are a number of observers who report considerable success from its use. Musser and Norris, in Osler's Modern Medicine in forty-three thousand four hundred and fifty-five cases found the average mortality of pneumonia to be 21 per cent. In one hundred and forty-nine cases treated with pneumococcus vaccine, the mortality was 13 per cent.

The results following the general use in the United States Army of typho-bacterin have proven its prophylactic value beyond the shadow of a doubt. The treatment consists of three injections of the vaccine. First, one containing five hundred million bacteria; ten days later, one billion, and ten days later another dose of a billion. As a result not only do very few immunized subjects get typhoid but when they do it is of a very mild form, with a very small mortality percentage. Within the last three years sixty thousand United States soldiers have been given the three inoculations; but twelve cases of typhoid fever developed among them and no deaths.

In the English Army it was given a practical test. Of twelve thousand soldiers living under the same environment, six thousand were immunized, six thousand not immunized. Among the immunized but one-seventh the number of cases of typhoid developed and one-eleventh the number of deaths followed as compared to those not immunized.

Within the last three years bacterial vaccines have been used very extensively and to-day there is an abundance of literature upon the subject. Most writers no longer consider them an experiment, or something to resort to when all other medications have failed, on the contrary, by many they are considered a first thought. While they have not reached that stage of perfection in which they can be classified as specifics or cure-alls, yet I feel sure that if the same thought and attention is given to serum and vaccine therapy as to drug therapy, our results will not only be infinitely better but we will be colaborers in the solution of a problem which will confer an inestimable benefit to mankind.

FOREIGN BODIES IN THE RESPIRATORY TRACT.

BY DR. E. U. BUCKMAN, WILKES-BARRE, PA.

READ MARCH 13, 1912.

The respiratory tract, for the purpose of my discussion, is the nose, pharynx, larynx, and trachea, and I shall confine myself principally to the upper portion of this tract, as I have had no personal experience with foreign bodies in the trachea or bronchi. This accident does occur, and very excellent work has been done in bronchoscopy and the removal of foreign bodies from the trachea and Bronchi by Prof. Killian, of Frieberg, who was the first to remove foreign bodies by upper bronchoscopy; Ingals, of Chicago, who was one of the first Americans to adopt bronchoscopy, and Jackson, of Pittsburg, who has probably devoted more time and attention to this work than any other American.

All of these men have devised special instruments for this bronchoscopic work, but few specialists possess either the instruments or the necessary skill to use them.

The accident of foreign bodies in the bronchi is rare. In a rather large throat and nose experience I have never met such a case. Killian has collected 164 reported cases, but eighteen of which occured in his own practice.

In the upper air tract, however, the accident is rather frequent. The anatomical structure is such that foreign bodies must, as a rule, become lodged before they pass the larynx. Only by a very strong inspiratory effort can a body of any appreciable size be drawn past the vocal cords.

Accidents of this character occur almost always in children, from the well known tendency of children, especially very young ones, to put everything into the mouth. Needles and pins most frequently lodge in the throat, probably because other bodies can be swallowed more readily. Bones and chunks of meat are not unusual in adults, but they are rather difficult to see and are usually coughed up.

I have been called upon many times to look for bones in the throat, and I have found and removed several, but it is rather

« ForrigeFortsæt »