CHAPTER XII

_THE BACTERIAL VACCINES_

In his paper in _The Lancet_, the pioneer in the use of pollen extracts, Freeman, observed that "many cases of supposed hay fever" were simply acute bacterial catarrhs. He excluded hay fever by the lack of any reaction when timothy extract was dropped into the eye. The bacterial infection was proved by culture from the eyes and nose, usually yielding the staphylococcus. The final proof was the cure of the patient by an autogenous vaccine made of the offending microbe. In the past few years, this observation has been confirmed and many cases of cure of "hay fever" by bacterial vaccines have been reported in the journals. The bacteria were chiefly staphylococci, rarely the pneumococcus or the micrococcus catarrhalis.

Oppenheimer and Gottlieb report cases of mixed hay fever where the skin reacts to pollen but the pollen extract failed to cure. In these cases, they found a bacterial catarrh of the eyes and nose. They suppose a vicious circle, the catarrhal inflammation and the hay fever sensitiveness mutually interfering with each other's recovery and they succeeded in curing the patient by using the appropriate pollen extract and the bacterial vaccine at the same time, believing that while the pollen extract was raising resistance to the pollen poisoning, the bacterial vaccine was raising resistance to the bacterial catarrh.

While hay fever is not strictly a catarrhal inflammation, the cure of hay fever by curing a coexisting catarrhal rhinitis or conjunctivitis seems easily possible. The surgeons taught us long ago that some cases of "hay fever" need nothing but good drainage of the nose, which they secured by freeing the nose from obstruction. Every physician sees mild cases of hay fever recover on various popular catarrh treatments. The tablets sold by homoeopathic pharmacies, containing iodide of arsenic, naphthalin and quillaya, cure many cases of hay fever and these are the same drugs that cure catarrhal rhinitis. It is easily possible that my old inheritance, rosin weed, cures hay fever by curing the coexisting catarrh; for it was a famous remedy among the eclectics for catarrhal inflammation of the nose, throat and bronchial tubes.

If, then, operations or remedies that cure catarrhal rhinitis cure also some cases of hay fever, there is nothing inherently improbable in expecting the bacterial vaccines to cure some cases of hay fever, for the vaccines have made many cures of catarrhal inflammation. However, the physician using them should understand that they are not specific drugs against the pollen anaphylaxis but against a supposed catarrh or bacterial infection. He will be well advised to control the treatment by taking cultures from the nose to make sure that the bacteria are there, determine the variety present and, if possible, have an autogenous vaccine made up for treatment.

I have no personal experience with the vaccines in the treatment of hay fever, though I know their value in ordinary catarrhal conditions. As remarked in the chapter on Pollens, I have succeeded with the milder methods of rosin-weed, faradism and ichthyol. However, bacterial vaccines are much safer than pollen extracts, the technique of their use is not as complicated and they are well worthy of trial in refractory cases if bacteria are demonstrated in the eyes and nose. I might remark here that this demonstration will seldom fail; for you can get a culture of the staphylococcus from almost any nose.

=The Word Vaccine.= Used in connection with the treatment of hay fever, the word _vaccine_ is confusing, for it has been applied to two totally different kinds of medicine, the bacterial vaccines and the pollen extracts. Physicians intending to use _vaccines_ in the treatment of hay fever should make sure which they are using; for the methods and dosage of the one are quite different from those of the other. Sir Almroth Wright, to whom the whole world is indebted for his work in preventive medicine, started the trouble by calling his killed bacteria _vaccines_, having in mind the prevention of bacterial diseases as the familiar vaccine prevented small-pox. Now, _vacca_ is Latin for cow, _vaccinia_ is properly cow-pox and the virus of cow-pox that we use in vaccination against small-pox is properly called _vaccine_. With a paucity of vocabulary unexpected in an Irishman, Wright called his killed bacteria _vaccines_ because he used them to prevent disease, using the word as synonymous with _preventive_. As cow-pox vaccine is the greatest preventive we know, the word _vaccine_ might be justified when applied to the bacterial cultures or to the pollens or to any preventative of disease. But when you leave pure prevention and apply these remedies to the _cure_ of disease, the word _vaccine_ loses even this shadow of justification and the present confusion results. One American house makes a laudable attempt at a more exact terminology by calling the killed cultures of bacteria _bacterins_. Still, the word _vaccine_ for killed bacterial cultures has been advertised so deeply into the medical mind that it is firmly rooted there and not likely to be disturbed by mere considerations of etymology. As for the pollen extracts, they are yet young and impressionable. It would be better to leave off the word _vaccine_ as applied to them and call them what they are, _pollen extracts_.