2nd. Case of Mrs. B., age about 38.

She described case as follows: "I have taken the vaccine treatment for a year, and my gums are growing worse, so I have stopt the vaccines. At first the injections were made twice a week and after that once a week, resting a month about the middle of the year."

"The injections were made on back of neck and it was made sore and stiff all the time until I was afraid of permanent injury and abandoned the treatment."

I found Sup molars with deep pockets and discharging pus copiously. Local treatment gave complete relief in one week.

THIRD CASE.

(Related by Mrs. B.)

My neighbor, Mrs. S, became discouraged with local treatment and on account of the pain for Pyorrhea and took the vaccine treatment from a specialist who also scaled the teeth.

After the second treatment her lips and face broke out in blotches and the upper arm where the injections were made became hard and sore. She continued the treatment, however, the operator saying, "that the response would come sooner or later." Gums became no better and treatment was dropt.

FOURTH CASE.

(Mrs. F., age about 46 years.) Upper molars and right upper central incisor affected with Pyorrhea Alveolaris Right to a very considerable extent. central incisor splinted to right lateral incisor.

Micro-organisms found mostly Staphy loccus and Streptoccus.

No mechanical or medicinal treatments until after several inoculations of autogenous vaccine. Improvement marked at the end of two to three weeks after patient had had three or four inoculations. Patient continued to improve and was discharged at the end of about three months, very markedly benefited.

FIFTH CASE.

(Reported by Dr. Lobenstein.) (Mr. T. age about 38 years.)

Decided Pyorrhea Alveolaris. Patient heavy cigar smoker, teeth decidedly unclean and neglected, several poorly fitted gold crowns and one one-tooth bridge, producing severe irritation.

Crowns removed, teeth properly cleaned, less smoking indulged in and patient inoculated with P. D. & Co.'s mixt injection, "Phylacogen." Six to eight inoculations over a period of some six weeks. At the end of this time the mouth of the patient was in excellent condition and the tissues were normal. Recession of gums well marked. But gums normal color and density. Physical condition much improved.

Case A.-Lady, age 65. Toxin made from Pyorrhea pockets, some six or eight injections used, reaction not severe, patient decided she was getting no satisfactory results and refused further treatment, so far as I could tell there was practically no improvement in her case.

Case B.-Son, age about 45. Taken same time, who claims he was cured and spoke very highly of the treatment, came to have his teeth cleaned, found Pyorrhea pockets, same as before treatment, inflammation somewhat reduced but in very short time returned with Pyorrhea abscesses which had to be opened, last I saw of this patient still had a very bad case of Pyorrhea.

Case C.-Merchant about 60 years old took toxin injections made from various pockets, had normal or should say usual reaction, however, his whole system was in a very bad condition, skin of very de Results cidedly jaundiced appearance. were absolutely negative. Resulting in extraction of all his teeth within the year following.

Case D.-Banker was treated with mixt infection Bacterial vaccine, a stock solution of a prominent chemical

company, this case I had more direct contact with during treatment than any of the above, the injections were made in the back, every other day, there was a slight chill, followed by slight temperature, about six hours after injections, lasting a few hours only, some 15 or 18 injections made, at no time did the Pyorrhea condition improve; on the contrary the edges of his gums about the teeth seemed more irritated and sore than before treatment was started, and finally decided that he would go back to old method of treatment, health was much improved by the vaccine treatment, this much is beyond dispute, but no improvement in the Pyorrhea was noted at all.

You will notice I have had no real cures under my observation, on the other hand have had reports of some wonderful cures of Pyorrhea, but so far it has not been my fortune to see them.

(Signed)

R. M. SEIBEL, D. D. S.

CONCLUSIONS.

If Pyorrhea Alveolaris can be permanently relieved by intelligent painstaking and persistent attention to instrumentation local therapeutic and subsequent scrupulous determination on the patients part to divorce the teeth and their surrounding tissues from any form of local irritation or infection-(and the writer asserts that possible) then the vaccine treatment whether by autogenous or stock preparation is unnecessary and unscientific.

If faulty metabolism is present in a patient, or systemic complication exists which invites the infection of tissue by micro-organic life processes and thus defeats the efforts of nature to remove obstacles-then those systemic conditions should be at once corrected-but in the case of the treatment of Pyorrhea-not by vaccines-but chiefly in nature's simplest remedies of food and plant, fresh air, exercise, deep breathing, refreshing

sleep, absence of consuming care and worry.

When will man get to know that nature's eliminatives are the only dependable ones, and that drugs are only for emergencies.

Discussions.

T. Sydney Smith, Palo Alto, Cali.

I am deeply interested in the subject which Dr. Patterson has presented to us, and I think he has made a wise choice in selecting the vaccine subject at this time.

His paper shows that he has given this matter much careful thought, and I agree with him in the main regarding the use of vaccine therapy in the treatment of pyorrheal conditions; but I must take exception to his opening statement "that nothing new can be said about pyorrhea."

As a matter of fact, most of the things which have placed the treatment of pyorrhea on an accurate and scientific basis are very new, so new, that we are only beginning to realize the importance of them.

Dr. Patterson has pointed out that even the most extreme advocates of vaccines for the treatment of pyorrheal conditions all admit that they merely assist the local surgical treatment in bringing about the cure. I believe that a better understanding as to the exact part they play in this treatment will help us all to use them more conservatively, if we resort to them at all.

We must remember that upon examining a pyorrheal pocket we find that a cleavage has occurred between the supporting structures and the root, thus forming a pocket which contains a number of distinct strains of micro-organisms existing symbiotically with each other. On the root side of this lesion we find the denuded cermentum, either coated with quantities of precipitated calcium salts, or presenting a pitted surface filled with the dead terminal ends of the per

icemental fibres, and innumerable quantities of bacteria. It can readily be seen that nothing short of securing a vital reattachment between the separated soft tissues and the cementum, which has this unfavorable surface, can in any sense of the word be accepted as a cure. It can also be seen, that if it were possible to increase the bactericidal action of the tissues by stimulating them with vaccine until the last trace of bacterial life would have been destroyed, we would not have changed the surface of the cementum in any marked degree. We certainly would not have the condition which is absolutely necessary to permit a re-union to take place. What is required is the surgical removal, not only of all the calcarious deposits, but also of the dead pitted surface, using extreme care not to cut deep enough to expose the lacunae and canuliculi in the deeper portions of the cementum. Having accomplished this, all of the freshly exposed tissues including the blood, must not be disturbed by introducing even a normal salt solution into the wound. They must be left in undisturbed contact for a sufficient time for Nature to heal and unite them.

The question naturally arises, what becomes of the remnant of micro-organisms which our surgical treatment must leave in the wound, and would not the use of vaccines be of great assistance in destroying them?

For answer I will say that we are dealing with chronic infections, and I believe, in spite of repeated statements to the contrary, that the continued presence of these organisms, where they are constantly surrounded by unhealed tissues and broken blood vessels, has forced the blood and fixt cells to fortify themselves with antibodies, to meet not only all of the invading organisms, but even their specific degree of virulence. The rapid and perfect healing which follows our surgical treatment is proof of this.

Again bacteriological tests frequently

show the presence of pathogenic organisms in these pockets, having a degree of virulence which would cause a dangerous infection if introduced into the tissues of one who had not previously been their host. Yet experience shows that no increased infection follows in these cases, when they are carried into the deeper tissues by our surgical instruments.

I admit that a greater production of antibodies might be produced by stimulating the tissues with autogenous vaccines; but I ask is it rational or scientific to do so, until we have first tried perfect surgical treatment?

If we employ vaccines at all, I believe that they should be autogenous in order that they may produce antibodies which are exactly suited to the degree of virulence of the various strains of bacteria found in any given case.

In my discussion of Dr. Medalia's paper, published in the Cosmos, February, 1913, I called particular attention to the absolute specificity existing between an antibody and its antigen. I believe, however, that we cannot produce a perfect autogenous vaccine at the present time from pyorrheal lesions, owing to the difficulty of including anaerobic strains. Since perfect surgery will cure pyorrhea without the aid of vaccines, if the teeth are vital, it is difficult to tell how much benefit is derived from adding them.

Dr. Patterson has quoted from Alfred Russell Wallace, who says:

"Vaccines will undoubtedly rank as the greatest and most pernicious failure of the century."

I believe this is too extreme a view to take, as the results which have followed the use of antatiphoid vaccine proves; but we certainly must be on our guard not to be caught by the wiley advertising schemes of the manufacturers. not be duped in this case as we were with their antiseptic remedies.

We must

I wish to call special attention to the unreliable nature of the reports, which

are being given from time to time, by the men who advocate the use of vaccines. They speak of the teeth in each mouth collectively, and assert that they have cured so many patients, but do not go into detail as to the exact condition of each tooth, before and after the treatment.

Men with experience know that the separated tissues cannot be re-attached to pulpless pyorrheal roots. We also find some multi-rooted teeth, with such narrow bifurcations that we cannot prepare them correctly without surgical instruments. The best we can possibly do in these cases is to give paliative treatment. Therefore, we may cure some teeth, and simply relieve others in the same mouth. These men have made no mention of these conditions in their reports of cured

cases.

I believe exact measurements should be taken of each tooth at the time they are operated on, and a record kept of the pulpless ones. The record should show the number of millimeters from the incisal edge to the septal points, the cemento enamel line, the margin of the gum overlying the pocket, and also to the bottom of the pocket. If after the treatment, these measurements are again taken the slightest change in any of them may be detected. Reports of this character would have a scientific value, which they do not now possess.

Before closing, I must refer briefly to one more point in Dr. Patterson's paper. He says, "In the treatment of pyorrhea alveolaris, we are not dealing with a condition that per se endangers life."

I feel that in making this statment, he refers strictly to the local aspect of pyorrheal pockets. For the fact is now generally recognized that some of the most serious diseases, which occur in other parts of the body are caused by organisms which are carried by the blood stream from these and similar septic foci.

I believe it will be found that pyorrheal lesions are more dangerous than diseased tonsilar crypts. They certainly furnish as good cultural conditions for transmutation as do tonsilar crypts, while the organisms are in closer contact with broken blood vessels, and the lymphatic protection is less perfect.

In addition to these more unfavorable conditions, we must add the pressure of mastication, which would tend to force the organisms into the tissues.

I would advise all to read an article dealing with the transmutation of the diplo-streptococci, by Rosenow, published in the January number of the Journal of infectious diseases. It will help us to realize the dangerous character of these lesions, which it is our duty to prevent and cure.

A. F. James, Chicago, Ill.

For the most part I agree with Dr. Patterson's ideas. I wish to call attention particularly to one point which I have never seen mentioned in literature. That is regarding the real effects of vaccines upon the organs and tissues of the body. In a structure as complicated and extensive as the human body, it is quite a difficult thing to trace the effects of a given poison or injury unless the havoc wrought is immediate, and the injury is so very extensive as to cause gross anatomical lesions. Thus damage may often be occasioned by some procedure without our being aware of the fact. This is probably the case with the introduction of heterologous or foreign protein into the blood stream. For example, Longcope* experimented by injecting small doses of horse-serum and egg-white into dogs, cats, rabbits and guineapigs which had been previously sensitized to these proteins. He found that these foreign proteins caused injury

*W. T. Longcope, "Production of Experimental Nephritis by Repeated Proteid Intoxication." Journal of Experimental Medicine, Dec., 1913, Volume XVIII, No. 6.

to the cells and various organs and tissues of the bodies of these animals.

The reactions were inflammatory in character. After intraperitoneal injections in the peritoneum and after intravenous injections in the livers of rabbits and cats the changes are especially marked, and changes were also found in the myocardium (heart muscle) and kidneys of all groups of animals.

While egg-white in large doses is injurious to the kidneys of animals, its toxity is greatly increased thru previous sensitization of the animal. While the quantity of heterologous protein contained in the bodies of dead bacteria which are injected in a dose of vaccine is very minute, yet we must remember that the individual who is being treated for pyorrhea has probably been previously sensitized by the circulation in the blood of the same kind of bacteria which is contained in the autogenous or stock vaccine. While I know of no published reports that nephritis has been observed following the administration of vaccines, it must be remembered that such an effect can only be determined upon careful examination. For instance, in chronic interstitial nephritis, no albumen or casts may be apparent for three or four days, and it would be necessary to collect the total quantity of urine past in the 24 hours and examine this for a number of successive days in order to be sure that the urinary findings were negative. Furthermore the surest evidence of chronic interstitial nephritis (one form of Bright's Disease) is probably a continued high blood pressure. Hence it would be impossible to determine the fact of nephritis existing without taking observations of this kind. It is probable that there are few of those who are administering vaccines who have taken the precaution to make such a careful examination of their patients as indicated above. If this were done before administering the vaccine and again after the expiration of some months, such examination

might reveal the fact that the vaccine which was supposed to cure or benefit the pyorrhea has in reality produced Bright's Disease, Heart Disease, Sclerosis of the liver or other serious disorder. While I have no cases which I am at liberty to cite at this time I desire to call your attention to this point in order that others may be interested in making observations along this line so as to learn what are the real effects coming from the administration of vaccines.

In a conversation I had with Dr. Hartzell this noon he regretted very much that he could not be present. He wisht me to put him on record here as saying that it was no less than criminal for a man to use vaccines until he had removed all local foci, and then only when the system need aid or stimulation in its reparative process. He wisht this to be stated very emphatically and I wish to go on record with him.