Postulates. To fulfil this law we should be able to isolate the organisms in pure culture, to cultivate them under artificial conditions then to reproduce the lesion by inoculation into susceptible animals and to continue indefinitely by inoculation from healthy animals, and prove that no other organism will produce the lesion.

Then again the opsonic index so counted upon has proven unreliable and Wright himself does not now insist upon its determination. "One of his assistants, Mathews, has recently made a statement that in a great number of cases the determination of the opsonic index is out of the question."-Citrons Immunity.

All that has really been accomplished with vaccine therapy in Pyorrhea has been the raising of the natural resistance of some patients. Even if we had no other effective treatment this would be a doubtful procedure, when we consider the dangers attending the inoculation. Aside from the discomfort and possible nausea that often occurs during the negative phase,

there

is the ever present danger of anaphylaxsis. As we learn from investigators that one millionth of a gram of proteid injected into the blood stream will sensitize a guinea pig fatally and that one ten millionths of a gram, when injection is repeated into the human circulation, may cause grave symptoms, (C. C. Voelker in Items of Interest, March 1912,) we begin to realize what it means to inject "alien proteid" into the precious Life Stream. Anaphylaxsis is the antithesis of prophylaxsis, so it is possible to produce the very reverse of what we desire, so I say, even if there were no other treatment for Pyorrhea the use of vaccines, with accompanying dangers seems hardly justifiable. In fact the vaccines have not even justified themselves. The most earnest pro-vaccinationists admit that local treatment should accompany the vaccine treatment and both Dowsett, of London, (Proceedings XVII Int. Cong. of

Medicine 1913) and Viney (Dental Cosmos 1914, pg. 833). While attempting elaborate defenses of vaccine therapy admit that their own real successes were only when local treatment was incidental to the inoculations. On the other hand we have consistent local records of numberless cases showing the positive results in health improvement accomplished solely by proper instrumentation and prophylactic treatment, which incurs no danger of nosystemic disturbance.

Dr. R. G. Hutchinson, Jr., of New York City, reports: A case was under treatment, both vaccine and surgical, by a fellow practitioner for between two or three years. Apparently, a cure was effected. The patient applied to me for treatment Sept. 23, 1912. The condition then was more acute than it had been at any former time and it was necessary to extract one of the molars. The support being practically all gone, and the pulp having died as a result of the Pyorrhea, an abscess had resulted. There were large quantities of serumal calculus which had never been removed, deep on the roots. Excessive stress at certain points caused motion of individual teeth in occlusion, and there was a profuse discharge of pus. The patient was in an extremely low condition of vitality and of a highly nervous temperament. The occlusion was ground at certain points, and surgical treatment was begun on September 27, 1912. The case was dismist Oct. 24, 1912. The following February light scaling and polishing was given, and on March 24, 1914, the second Prophylactic treatment was given. The mouth is now in a perfectly healthy condition.

Dr. Paul R. Stillman, of New York City, reports a case as follows:

Mrs. H. Married one year, age approximately 25 years. Has Pyorrhea since school days. All teeth involved to some extent but those most advanced were the R. L. L., L. L. L., and L. L. C. These

three teeth were flowing pus copiously and were very loose. All the teeth responded to treatment and are normal except these three.

Treatment: The lower anterior teeth were made fixt by a grass line splint, which was removed every week. While the volume of pus was somewhat reduced after sterilizing and filling the root canals, no encouraging signs of convalescence was noticed. Her husband, who is a physician, consented to the administration of vaccines which were made and introduced by a pathologist. Adminstration was followed by temperature and nausea acting 24 to 48 hours.

Prognosis. The left central and lateral are doubtless septic; have advised extraction. The vaccine has had little or no effect on the pus flow, which is still copious.

And so I could continue ad finum. With the more positive effective local treatment available why subject the delicate chemical balance in the bodies of our patients to that more or less serious disturbance of their physical economy.

The most forceful argument I can use is the warning of the great Sir A. E. Wright himself:

"So long as we, as a profession, go on hankering after the impossible, so long as we demand of every new therapeutic method that it shall after the method manner of a magic wand achieve the marvelous with little labor, and that it should give its best results even when it is applied in a blind empirical manner, so long will disillusion continue to dog the steps of medicine."

"It would therefore be well that in connection with vaccine therapy we should appreciate the limitations which are inherent in the method, and the labor which its proper conduct may entail, and further that we should distinguish between the cases where we may hope to achieve certain and easy success, and

the cases where success, if achieved at all, must be dearly bought."

"It follows that if we are not immediately successful in destroying all the infecting micro-organisms-and in such immediate success can hardly be expected except in the case of incipient infection-we have to make up our minds to go in for a program of periodical inoculations-just as a gardener who undertook the task of clearing the weeds out of a neglected garden would make up his mind to renew his efforts week by week until his purpose was accomplished. And just as in gardening, no one is surprised if the weeds spring up again, so in connection with bacterial infections recrudescence and fresh reinfections must be expected where a residue of microbes are left in the body, and where the channels thru which infection originally found entrance are left open and unguarded."

So says the greatest vaccinationist of them all.

DR. HOWARD T. STEWART, of New York City:

We are almost all agreed, I think, upon the subject of vaccines. The dental profession have not wanted to believe in vaccines, to begin with. The thought is somewhat repulsive to them. I think the general consensus of opinion is that it has practically become useless, and that we are practically agreed on that. as far as the practical value is concerned. Along that line I want to call attention to the work of Dr. Arthur H. Mary, of New York City, whose investigations I have been watching carefully during the last two years. Dr. Mary took up this vaccine treatment in an enthusiastic way, as a pioneer, was probably as early as any man in the profession to apply it vigorously. He pursued this treatment for a considerable length of time. He got what he thought were fine results, and he did get fine results so far as the treatment of Riggs Disease was

concerned. During the first three or four years he wrote several articles on the subject, and enlisted the sympathy of the medical profession to a large extent, and was getting a great many patients sent to him. It is a little hard for a man under those circumstances sometimes to change his mind and give up his opinion and say it is of little or no value. But I know that Dr. Mary began to suspect that, with his improved technic and operative procedures, the results were due mostly to those procedures, and he began in a very conscientious way to test the fact. I know of no man who has gone to so much trouble to test this thing, to see whether his results were actually due to the vaccine treatment in any measure or not, and he has finally come to the conclusion, and so announced, that the vaccine treatment is useless. I thank you (Applause).

DR. OAKMAN, of Detroit:

I cannot let this question of vaccines go by without having a word to say. When you say that vaccines are of practically no value, it seems to me the men making this statement do not know whereof they speak. Vaccines in my hands have been one of the finest agents I have ever used. Cases of necrosis of the jaw, sinus trouble, antrum troubles and other pus conditions about the body have been lessened by the use of vaccines, and when you state that they are of very little use, I will say that I believe it is being overdone in the treatment of pyorrhea. The idea of shooting a patient full of from 200,000,000 to 750,000,000 of bacteria, when it can be done by manipulative and instrumental skill is bad. But I believe in the treatment of pyorrhea that vaccines have a place. As I was telling my good friend, Dr. Hunt, coming down on the street car, I have had the blood pressure drop 40 points, where the blood pressure was at 210, the patient taking a long rest

reduced it to 185 and eventually to 180, and he thought that would be his blood pressure from that time on; but after a chronic case of pyorrhea was treated, inside of six weeks he said, "I haven't felt as well since I was a boy," an intelligent man. That is only one of other similar cases, where the drop in temperature has not been as great as 40 degrees but has been very appreciable. I have had cases where they felt that senile degeneration was taking hold of them. One man was 53 years of age, and I could not arrest the pus after an operation, could not arrest the flow. One injection of an autogenous vaccine,

made from this yellowish-greenish pus and the prodigiosis began to lessen in 46 hours, and the second injection eliminated the pus completely, where it had been an open wound for five weeks. It seemed like an antrum condition. It was in the region of the antrum but the antrum was not involved. I want to make a plea for the sane use of vaccines. I do not think that over ten per cent of the cases of pyorrhea, possibly a little more, are cases that it is feasible to use vaccines in, but when you knock vaccines right off the boards, you are going too far. As a rule, the dental profession are a little loath to take up these things, but now it is my practise, in every suppurative case, a chronic suppurative case, to always get the blood pressure, and I notice marked changes in my patients. I hope before you condemn the use of vaccines you will consider it very carefully. I thank you. (Applause).

DR. SARAZIN, of New Orleans:

Mr. Chairman, ladies and gentlemen. I think we should thank Dr. Patterson for sounding the fog horn in time. The tendency to go into a line of treatment, the real value of which still remains unproven, is a dangerous one, and attention should be called to it in ample time. I do not know that we can apply the

same therapy to pyorrhea conditionswhich I prefer calling Riggs' disease, because the name covers more ground than does "pyorrhea"-I do not know that we can compare pyorrhea conditions with other septic conditions which are of a more acute nature. The condition of pyorrhea is essentially chronic, and in chronic conditions, where health is needed by the general system, it is not the health which may be needed by stimulation but it is really the health by fortifying. I doubt that any case of pyorrhea could ever be benefited by the use of vaccines alone. I have never heard a case reported where the vaccine treatment has merely been tested, with the omission of the proper local surgical treatment. If such a thing has been done, our faith in the value of the vaccine treatment would necessarily be strongly influenced, if not compelled. As I said before, it is not a question of stimulation by means of vaccines, but it is really the necessity of fortifying the entire blood current and its quality which is needed. To my mind, with other local surgical treatment, the virulency and the quantity of the emanating foci of infection are lessened, the phlagocites and the leucocites of the blood are able to battle the invaders which come thru the absorption of infection by the blood currents and thru absorption following the digestion thru the alimentary canal, and as soon as the infection is reduced the blood is enabled to battle against the invaders and overpower them. On the other hand, as long as the septic conditions from the mouth are so extremely numerous and virulent, then the phlagocites and leucocites of the blood are unable to dispose of them and destroy them. Therefore, when we need the help of systemic treatment, it is not really the vaccines we need. It is a means of improving the quality of the blood at the same time as we improve its circulation so as to fit those

tissues which are so placed in the human anatomy as to necessarily receive a lesser amount of arterial pressure than do the tissues placed below the heart. I do firmly believe that we should thank Dr. Patterson for sounding the alarm in time. I do not doubt the feasibility of getting good results from vaccines in acute conditions, where the effect of vaccines may be not only marked but may prove very beneficial; but when we come to a chronic condition such as pyorrhea then I believe we are working in the wrong direction if, still groping in the dark, we make an excessive use of such a mode of treatment. I have thoroly tested the value of vaccines. I started with stock vaccines, made cultures of autogenous vaccines, and have gone as far as to make dynamics of autogenous vaccines, in order to satisfy myself that there might or might not be some degree of help obtained from the vaccine treatment, but have been forced to the conclusion that in no case did I receive any help from the vaccine treatment, and that the success, whenever it occurred, was due primarily to the local surgical treatment, and in a secondary manner to whatever systemic treatment was indicated in the case, for we cannot in all cases apply the same line of treatment; it will depend entirely upon the nature of the systemic disturbance, whether the systemic disturbance may in some cases have preceded the pyorrheal conditions, as, for instance, in diabetis, or whether the systemic disturbances have caused manifestations of septicemia in one form or other. I thank you. (Applause).

DR. PATTERSON: I haven't anything to add. I feel very much gratified that the men who have discust the paper SO thoroly agree with me, and as none of those who oppose the sentiments of the paper have spoken I hardly think we should lengthen the discussion. I am pleased to be endorsed by such

able men. Indeed, I consider and you consider, I know, that some of the papers written in the discussion were written by more able minds than my own but were not written by those who have had more experience. My mind has been open for many years, since new methods have been suggested for the alleviation of this very distressing trouble-my mind has been open and I have watched carefully and my conclusions are as embodied in my paper. I do think that very much harm is being done, especially in our part of the country, for in Kansas City more vaccines are given for the treatment of pyorrhea than in any town in the world so far as I know. Daily many inoculations, every day of the week and of the month, performed regardless of physical condition, regardless of tests for conditions which should be looked into carefully, and I have in my feeble way here and there sounded a note of warning in regard to the giving of vaccines for the treatment of a

condition of pyorrhea or any similar condition. I am not entirely a disbeliever in vaccines, but I am talking about vaccines for pyorrhea. Dr. Oakman spoke about the relieving of the blood pressure and its dropping down to a certain point, but he did not say that was without local treatment. You and I, who have been treating pyorrhea constantly for years and years have reduced the blood pressure just as rapidly as the vaccines dare do it, in 48 and 72 hours, or in less than a week. We have seen anemic people, pallid people, subject to faulty metabolism, in a few days almost "rise and walk" when they couldn't do it before, without any vaccines at all; the flush come back to the fact, to springiness to the step and the happiness over their spirits, without the vaccines. So when he speaks about the blood pressure being relieved so rapidly, you and I have done the same thing without any vaccines at all. I thank you. (Applause).