It is proper to say that the presentation of this subject is by request. Iowa, it seems, has become somewhat conspicuous in this connection. The extensive employment in my state of internal vaccination by means of Variolinum, the large mass of experience resulting from that use, and the vigorous defense made in the courts when the authorities questioned our right to use it, have combined to produce in many quarters an impression that it is in some sort an "Iowa Idea," although Iowa obtained it precisely as it did belladonna-- by homeopathic inheritance.
But Iowa is proud of this splendid piece of homeopathic practice; is proud of the three independent and distinct decisions of its District Courts in widely separated localities, amply protecting the right to use this method and compelling school and municipal authorities to accept it; proud of the thousands who have thus been rendered immune, and at the same time spared the scarification danger of acute and chronic septicemias; and when the request comes that Iowa take this matter up before the Institute, she is ready to respond.
I count myself happy that the request was for "a paper that would discuss the subject in a scientific manner." For no matter what our views may have been when we entered this room, if we take the matter up in a really scientific manner, we are sure to reach practical agreement in conclusions.
I care not how many of you have previously been favorable and how many unfavorable. The privilege of this occasion lies in the fact that all present are life-long workers in applied science, and are, therefore, always ready to take up anything or abandon anything, irrespective of preconceived opinion, provided the demonstration be sufficient.
The entire matter of internal vaccination by means of Variolinum is comprised in the answer to three simple questions:
First. What is Variolinum?
Second. Is its use, as a greatly improved form of vaccination, reasonable ?
Third. Has the test of actual experience demonstrated its effectiveness ?
First. What is Variolinum? A pertinent and necessary inquiry it would seem; for the leading editorial in a recent issue of one of our ablest Journals refers to it as "a drug." As a matter of fact, Variolinum is the contents of the ripened pustule of smallpox. It is not the contents of a vaccine pustule. It is the virus of variola; not the virus of vaccinia. It is the virus of smallpox; not the virus of cowpox. There has been some confusion on this point. Our pharmacies afford both Variolinum and vaccininum, with the result that the two preparations have been mistaken for each other.
The importance of this distinction is evident when it is remembered that any immunity conferred by cowpox virus is indirect; conferred by smallpox virus, it is direct.
Second. Is the use of Variolinum reasonable?
It is reasonable--
(a) If an individual may be rendered immune to a given disease by inoculation with the virus of that disease, in the proper preparation and amount; and
(b) If the virus of disease is effective when administered by the mouth, as distinguished from administration hypodermatically or by scarification.
These two propositions demand close attention and exact thinking. For just here is the very core of the whole matter. No loose and hazy "general impressions," and no half-and-half conclusions will do here. We must advance cautiously; weigh our words; reach definite and clear-cut conclusions; and then stand by them. In this spirit of unbiased precision let us take up each in its turn.
(a) May then an individual be rendered immune to a given disease by the administration of the virus of that disease in the proper preparation and amount?
Behind this question lies an enormous amount of experimental research which bears upon it as directly as if instituted for the sole purpose of determining the answer. For you will not fail to observe that all the work done in the entire field of serum therapy, rests absolutely upon the proposition that immunity is obtained by the administration of the virus of the disease. I am especially anxious not to be misunderstood just here. We have nothing so do just now with the question of the merits or demerits of serum therapy as a mode of treatment. We are not concerned with the question what these serums accomplish, but solely with the question how these serums are obtained. Stop and think closely for a moment. These serums are all obtained from animals rendered immune to a disease by the administration of the virus of that disease. Every animal that ever furnished a serum is an affirmative answer to this question. Every animal is evidence that immunity is obtained by the administration of the virus of the disease.
It is wonderful to think of the countless thousands of animal experiments, of clinical experiences, and of the steadily proceeding manufacture in biological laboratories, the combined volume of which testifies to this one fact of immunity conferred by the proper use of the virus.
Perhaps I owe you an apology for taking time to call your attention to a matter so familiar. But it is for the purpose of asking that it have at this time, your special and pointed attention, because I want now and here your definite and specific assent or dissent. Let us come squarely to the scratch. Has scientific research demonstrated that immunity is obtained by the proper administration of the virus of disease? If the answer is "yes," let us say "yes," clearly and decisively.
(b) Now for the second question; and again I invite that pointed attention which has in it the decisive quality. Is the virus of disease effective when administered by the mouth as distinguished from administration hypodermatically or by scarification? Must it be by the hypodermic syringe, or may it be by the mouth ' Is disease virus absorbed, actually taken into the system when swallowed? Are its characteristic reaction and its immunizing impress upon the system, obtained only when it is injected? Or are they also so obtained when it is ingested?
Never mind the theory, what we want is the fact. And again I avoid trespass on your time by citing at once an established and conspicuous fact, namely, the danger from ingestion of tuberculous milk and meat. Why dangerous? Because disease products do make their impress on the system when ingested. The protest of the medical world when Koch maintained that bovine tuberculosis was not transmissible to man, and the quick and earnest demonstration that he was in error, are still fresh in your minds. In Great Britain this assertion of Koch caused the appointment of a Royal a Commission to investigate. I have before me their "Second Intermediary Report," an extended and elaborate document published this year. They say, "Of the total sixty cases (of human tuberculosis) investigated by us, twenty-eight possessed clinical histories indicating that in them the bacillus was introduced through the alimentary canal. * * * These facts indicate that a very large proportion of tuberculosis contracted by ingestion [italics mine] IS due to tubercle bacilli of bovine source."
The whole importance of their investigation, and of our systems of milk and meat inspection, lies in the fact that disease products do inoculate the system when taken into the alimentary canal. It is, of course, not held that the Mount necessary to produce toxic effects is the same when given by the mouth as it is when given hypodermatically. In the case of our familiar drugs, the hypodermatic dose is always the smaller. This, however, is not an invariable rule. While writing these lines, it was my good fortune to listen to an address by Dr. Fenton B. Turck, whose experimental researches concerning food, digestion and nutrition have made him an authority. In the course of this address he had occasion to refer to the fact that his experiments showed that alcohol, and the extractives of meat, do not produce their characteristic pathological changes at all when injected hypodermatically, but only produce them when ingested. But the comparative amount required by the two methods of inoculation in order to produce toxic effects, does not now concern us. The question is not one of size of dose, but simply whether actual inoculation results from swallowing disease products in any dose. And the answer furnished by the investigations of the British Royal Commission, and by the establishment of our own systems of meat and milk inspection, is so undeniable and so pointed, that it would seem to be a waste of your time to indulge its further consideration. So again I ask you to come squarely to the scratch. If your answer is "yes," let it be clear and decisive.
It may be proper in passing, to note that for the Homeopathist ample evidence is at hand from the therapeutic side. The effective action of such a remedy as Psorinum, long established and undoubted, is of itself conclusive that disease products profoundly impress the organism when given by the mouth. But, however interesting and convincing this may be to us as Homeopathists, I prefer to rest the case solely upon the common ground of that general biological and pathological knowledge which is familiar to all alike, irrespective of any knowledge of Homeopathic therapeutics.
Reverting now to the original query, is the use of Variolinum reasonable? there seems to be no escape from an affirmative answer. We have seen that it is the virus of small pox; we have seen how complete is the demonstration that an individual may be rendered immune to a given disease by the proper administration of its virus; we have seen how experience has so amply demonstrated inoculation by swallowing, that that fact has compelled the enactment of food inspection laws. How then can we escape the verdict that the use of Variolinum is reasonable? In a words we have first the virus, second the law of immunization, and third the fact of inoculation by ingestion. Is internal vaccination reasonable? The answer is inevitable.
So much for the scientific basis. It remains to inquire whether the test of actual experience has demonstrated its effectiveness.
The smallpox epidemic of five years ago (which, indeed, has not yet wholly disappeared) afforded a rare opportunity for just such a test. Up to the time of this epidemic, most physicians had never even see a case of smallpox, much less had any chance to test its prophylaxis. Rut with its onset, all this was changed, and experience with both methods of vaccination accumulated rapidly. What was the verdict of this experience regarding the internal method? How did Variolinum stand the test in actual practice?
This is a simple question of fact and should be answered by the actual figures. So I asked some of my Iowa colleagues who I knew were users of the new vaccination, to contribute their experience in the following particulars:
I. Number whom you protected by Variolinum
II. Number that you know to have been exposed to smallpox after taking Variolinum
III. Number who had smallpox after taking Variolinum.....
In making this request, I was careful to write, "I trust that reference to your case book, ledger and other records will enable you to make your figures on these three points definite and exact. May I ask that in any uncertain cases such ones be omitted from your report, to the end that the figures may be conservative, and an understatement rather than an overstatement."
This suggestion was cordially received, all those reporting their experience being careful to have their figures well inside the facts. So much so that the total number they vaccinated by the internal method was much larger than the figures given, because their records were not complete enough to enable them to report the full number. One of the most careful observers wrote that he presumed he had used Variolinum in twice as many cases as he reported, but had not the records to verify the figures. Because of this care on their part to make the report of their experience conservative, I take pleasure in presenting the following combined experience:
Number Protected by Variolinum: 2806 *
Number known to have been exposed to smallpox after taking Variolinum: 547
Number who had smallpox after taking Variolinum: 14
*I am indebted for these reports to Drs. C. B. Adams, Sac City, E. C. Brown, Madrid; E. N. Bywater, Iowa Falls; A. P. Hanchett, Council Bluffs; A. H. Hatch, Des Moines; T. L. Hazard, Iowa City; H. M. Humphrey, Lake City; J. W. Laird, Mt. Pleasant, A. M. Linn, Des Moines, H. E. Messenger, Des Moines, P. J. Montgomery, Council Bluffs; L W. Struble; George Royal, Des Moines, L. W. Struble, West Liberty. It is but just to say that these are all well known Iowa practitioners of character and standing. Two are members of the State Board of Health, and a third was also a member of that body when the smallpox epidemic was at its height.
As already noted, the total number of Variolinum vaccinations was in fact materially greater than the figures indicate, because of rigid conservatism in reporting. But to a still greater degree are the reported number of exposures less than those which actually occurred, for the terms of the report were severe, namely, "Number that you know to have been exposed to smallpox." Necessarily the number known to have been exposed must have been far less than the number actually exposed. And here again the scientific caution of the reporting physicians is conspicuous and commendable. For example, one of them who reports only eight known exposures expresses the opinion that 100 were "doubtless exposed."
Many of these reported "Exposures" were of severe character as for instance the following:
"Mrs. A. R. aged 64. Had never been vaccinated. Found her nursing her son who was in the pustular stage of smallpox. Gave Variolinum 12X five disks every four hours. On the fifth day had a severe general headache with a temperature of 102.5. The next day one vesicle appeared on the face. The temperature subsided on the fifth day. She had sole care of her convalescing son and herself all the time." (Dr. Royal)
"I had three different houses where one of the inmates had smallpox. In one house there were six inmates. One of their number had smallpox. The other five had never been vaccinated. I used the Variolinum on three, the other two I scarified. None of them took smallpox. In the other two houses there were four and five inmates besides the one stricken. I gave Variolinum to all of them and none of them took the disease." (Dr. Laird)
"One case began atypically, was taken to the hospital where he was visited by a number of relatives, was worked over by interns and nurses by the hour to relieve a severe pain in an old appendicular scar, thus fully exposing at least twenty people. To every one of them Variolinum was given and not one of them took the disease. This was a marked case and was in the pesthouse for about four weeks." (Dr. Hazard)
"I know positively of eleven that were exposed to smallpox and were continuously in the room with the sick. Of that number, two had what I thought to be the initial fever of smallpox but no eruption appeared, and in three days all the trouble had subsided." (Dr. Humphrey)
"Family of J. S. Three cases of smallpox developed in family before I was called in. Four other members of family, two young men who had never been vaccinated, and the parents who had been vaccinated. Administered Variolinum to all four and none of them developed smallpox, though in constant and direct contact with the sick members of the family." ( Dr. Adams )
"February, I901. V. H. Developed smallpox. His wife who had been vaccinated, and three children who had not been vaccinated, were given Variolinum. They lived in the same house, and slept in the same room with him during all of his sickness, yet none of them contracted the disease." (Dr. Adams )
"March, 1902. D. L. Four of family developed smallpox. His wife and five children, none of whom had been vaccinated, were given Variolinum. Within 48 hours the oldest son developed symptoms of smallpox, but his attack was very light. All other members of the family, though living in the same house and directly exposed through attendance on the sick, escaped all symptoms of the disease." (Dr. Adams)
March 1902. F. R. Young man aged thirty, developed smallpox. His mother and an adult sister who lived with him, neither of whom had been vaccinated, were given Variolinum. They attended him and nursed him through a virulent attack and neither contracted the disease." ( Dr. Adams)
March 1902. C. S. A young man aged 24 developed smallpox. His father and mother were given Variolinum and both escaped the disease though in constant attendance upon him. (Dr. Adams)
"Gave Variolinum 30x for one week. That day her brother came home with a well developed case of smallpox The girl nor her mother had neither ever been vaccinated before. I at once gave the mother Variolinum. They were quarantined 35 days with the case of smallpox and neither of them contracted the disease." (Dr. Bywater)
"Girl. Given Variolinum in October, I904. Was quarantined 35 days this spring with three cases of smallpox and did not contract the disease. Was of that type that takes everything that comes along, but escaped this time." (Dr. Bywater).
"Ethel Stevens. Then aged 6 was given Variolinum 30x in January 1902. Have had smallpox in the family three times since the Variolinum was given, was never vaccinated or protected in any other way, has been exposed at least each o these three times, and has never showed a symptom of the disease. Her grandfather died of it, her brother was very sick with it (the worst case of smallpox I ever attended) in March 1903, and some cousins had it a year later, and she has been with them all and never contracted the disease." (Dr. Brown)
"Two children who had never been vaccinated I protected by Variolinum. An uncle had smallpox some two or three months after, and they were exposed but did not take the disease. (Dr. Brown)
Of the 14 who had smallpox after the use of Variolinum, one was a mild case of smallpox occurring two years after, three were not strictly within the limitations of the test, as they "had also been vaccinated by scarification a short time previous to the attacks of smallpox. In addition to the fourteen cases reported, there were three others, but "in each of these cases the symptoms appeared within 72 hours after the first dose, thereby proving that infection had occurred before the administration of the remedy."
The evident deduction to be drawn from these few cases is that the protection afforded is not absolute and without a single break; but that in exceptional instances, smallpox will occur in spite of the fact that Variolinum had been used. But the same is true of the scarification method; and experience shows that smallpox occurs after scarification with much greater frequency than it occurs after the use of Variolinum. That the old vaccination often fails to protect, has been the personal observation of all those who have had to do with smallpox epidemics; while the numerous deaths in the army of the Phillippines, in spite of the Government's painstaking vaccination and re-vaccination of the troops, is fresh in the minds of all. The same fact is indicated in the reports of the Registrar-General for England and Wales, which show for the years 1879 to 1884, a total number of deaths from smallpox among those who had been vaccinated, of 1648 persons.
With these few words of comment I have the honor to place before the Institute the above figures of actual experience with the internal method of vaccination by the administration of Variolinum. The 2806 cases, the 547 known exposures, and the 14 instances of smallpox, should constitute a sufficiently extended test to satisfy all scientific requirements. Further than this, it must be remembered that the figures submitted represent the experience of only a few of the Iowa physicians using Variolinum, and constitute but a fraction of the total Iowa experience. And with striking unanimity the physicians using it have come to be strong adherents of the Variolinum method, though many began its use with decided skepticism.
My own personal experience is not included in the above reports. It seems to me so important that this inquiry be scrupulously judicial in its spirit, that I omit my personal figures, so that this presentation of the matter sham have in it nothing of the bias of the advocate.
FOOTNOTE (Two letters at end of article)
There are a few related matters which should not be omitted. The first of these is the fact that this vaccination by Variolinum is not new. Dr. Jonathan Pettet of Cleveland, Ohio, read a paper on the subject before this body in 1873; and Variolinum has its regular place in Hering's Guiding Symptoms, in Clarke's Dictionary of Materia Medica, and (more generally accessible) in Boericke's Pocket Manual of Materia Medica.
The systemic effects produced by its administration are definite and decided in those who are at all sensitive; so that we have a multitude of provings occurring in the practice of all those who use it. As these provings have not, so far at least, been utilized in general practice, the use of Variolinum being confined to the prevention and treatment of smallpox, the present point is not so much the accurate and extended observations necessary for the creation of its materia medica, as it is the mere establishing of the fact that it does produce an active and marked effect upon the organism. This is so thoroughly established by many observations in the practice of a large number of physicians, that it seems unnecessary to go into detail. Yet for the sake of scientific thoroughness, the following illustrative provings are put on record:
"On January 5, I903, Mr. J. C. aged 52, who had been exposed, applied for some Variolinum for internal vaccination. He was given the 12X to be taken five disks before each meal and at bedtime. After taking seven doses he complained that the medicine caused nausea after each dose and that he had vomited his supper of the night before. The medicine was discontinued for two days and then resumed with same result except that he vomited his meal after the fourth dose. The medicine was then discontinued for six days, during the last four days there being no nausea or vomiting. He was then induced to take the medicine again with a repetition of the two former experiences." (Dr. Royal)
"Grace L. Aged I5. Was always sickly, light complexion, scrofulous build, glandular temperament. Gave Variolinum 30x for one week. Was called to see her and found her with high fever which had been preceded by chill, rapid pulse, backache, headache, malaise, loss of appetite, loose stools and restlessness. Called again next day and found an eruption very similar to chickenpox which had already begun to disappear. Called in one Allopathist and one Eclectic to confirm the action of Variolinum. Girl had had chicken pox when a child so it was not that. Since that time the girl has been stronger and particularly free from sickness. (Dr. Bywater)
"Girl six years old. Good health to all appearances. Gave Variolinum 30x. At the end of five days was called to see the child. They threatened to sue me for making their child sick. Chill, temperature I03.2, general aching, backache, headache very pronounced, loss of appetite, looseness of bowels, restlessness and vomiting. Stopped remedy and in few days all right. (Dr. Bywater)
"Boy and girl. Gave Variolinum 30x. Chill, fever, headache, backache, general aching, loss of appetite, diarrhea and restlessness. Eruption on boy's hand very much resembling smallpox. After a few days disappeared. Eruption was on the palm of the hand. Girl had similar eruption except not so marked, on sole of one foot. Very sore." (Dr. Bywater)
"Dentist,--who had no use for Homeopathy. Aged 47. Came to me because he thought he had been exposed by a patient of his own, and had heard that I gave an internal vaccination, saying that he could not possibly be off work with a sore arm, so chanced it on Homeopathy. In April, 1907, I gave a three dram vial full of sugar disks moistened with the 12X. After taking it for about four days he complained of chills, headache, aching all over, and especially in the back. He discontinued it for two days. Then began again. After three days he came to my office saying that he was so sick that if it was not for press of work he would be home in bed. All of the above mentioned symptoms were much intensified and an indescribable sickness all over him in addition." (Dr. A. H. Barker, Brooklyn, IA.)
At the 1904 meeting of the Institute, one of our Professors of Materia Medica very properly expressed the wish that some one who was in charge of an asylum "would demonstrate this Variolinum say on 25, 30 or 40 of the children who have not been vaccinated and report whether there were manifested the direct results of febrile disturbances."- While not aware of this suggestion, Dr. Messenger of my own city, in the ordinary course of service at the Home for Friendless Children, administered it to forty-- not for experimental but for vaccination purposes. The 200th was used; with the result that ten of the forty developed the usual symptoms, including fever and a rash.
One test of the effectiveness of internal vaccination has been suggested which is erroneous, and the error involved should be pointed out. This suggestion is that if one has used Variolinum a subsequent scarification should fail to "take." This is a mistake because in the majority of scarification cases the resulting infection is of a mixed type. It is the exception when the characteristic small, pearly vaccine pustule results. Of course a preceding use of Variolinum would have no possible relation to a mixed infection and therefore any such test would necessarily be fallacious.
As to the advantages of this internal vaccination, they will readily suggest themselves to all. Chief among them is the fact that by this method the septicemias, acute and chronic, following the scarification method, are avoided altogether. How deplorable these septicemias are, is witnessed by the great efforts made by manufacturers of vaccine to contrive some way by which these mixed infections may be eliminated. One standard and reputable house advertised "antiseptic vaccine" (!); while one concern during the height of the epidemic, far out-stripped its competitors by advertising "sterilized vaccine!!"
Without entering a long discussion, suffice it to say that we all recognize that the substances, whatever they may be, which set up what we know as septicemia when taken directly into the circulation, are inoperative -when introduced into the stomach. This is well illustrated in the case of the septic products from an ulcerating tooth, or a discharging quinsy. They would be highly dangerous introduced into the circulation, but are harmless when finding their way, as they do, into the stomach.
In the use of Variolinum, extensive experience has shown that we reap the advantage of this provision. The essential smallpox virus makes its full impress upon the system, while any accompanying substances which might light up a septicemia if introduced direct into the circulation, are inert in the alimentary canal.
Again, the internal method eliminates all uncertainty as to whether the vaccination will "take." For with a preparation once proved to be active, there can be no question that it will "take" whenever administered, just as there is no question that a dose of strychnine will "take" whenever it may be swallowed.
As to the number of years during which the immunity conferred by Variolinum will remain in force, nothing can be said, because there have been no experimental researches which have settled this question regarding either form of vaccination. There has, however, been a great reduction in the assumed length of time during which protection-continues after scarification. Originally it was said to continue as long as there was "a good scar," a manifestly ridiculous and puerile standard. This assumed length of immunity has gradually been decreased, until the United States Government re-vaccinates its soldiers every three years. It would seem that there would be no special difference in this respect between the scarification and the internal methods; but the whole matter is one of assumption and not of demonstrated fact.
Mention of the value of Variolinum in the treatment of smallpox itself should not be omitted, although aside from the direct purpose of this report. In the lower potencies it has proved itself a strikingly effective and satisfactory remedy.
At the risk of wearying you, I have tried to present for your consideration a report of the facts about Variolinum which should be thorough and exact. A review of the facts established by experimental research has shown that an individual may be rendered immune by inoculation with the virus of disease, and that such virus IS effective when administered by the mouth; it follows, therefore that the use of Variolinum is in exact line with modern physiological and pathological research, and is scientifically correct.
Proceeding then to the test of actual experience, we have passed in review a series of 2806 vaccinations with Variolinum including 547 exposures and 14 cases of smallpox. Shown thus by clinical test to be remarkably effective in actual practice, as well as scientifically correct in principle, the demonstration stands complete. The use of Variolinum is sound in theory and conspicuously successful in practice. It therefore does not ask our acceptance It demands it. As scientific men, we are not at liberty to indulge our whim about the matter. It is not something that asks our support. The demonstration is placed squarely before us, and a demonstration never requests, it demands. We must not do Homeopathy the injustice of giving this, one of its most successful and useful outgrowths, a partial and equivocal recognition, just because it happens to be strange to us. This splendid piece of practice is not new, it has its roots in the past, though we may not have known it. And we must not injure the cause by refusing to recognize its value, Just because we happen not to have been conversant with it We cannot afford to play with the question, and temporize with it and half way repudiate it, until in the course of time some one of our opponents shall make a wonderful discovery, and cultivating the smallpox virus through old horses or prolific guinea pigs, produce an uncertain and inferior product combined with some secret antiseptic to preserve it, which yet shall retain sufficient activity to make possible the announcement of another great advance, to be used for the good of humanity,-- and the discomfiture of Homeopathy .
Variolinum is distinctively our own, as distinctively as is Aconite or Lachesis or Lycopodium, and its immense value should be gladly recognized and vigorously claimed. It is a high honor to Homeopathy, and we cannot, we must not, let our individual lack of familiarity with it bar it out from its proper place. An unfamiliarity that costs Homeopathy so much, is a heavy responsibility. When so much is at stake, it is not optional with us whether we will know or remain uninformed. In such circumstances, we are under the highest obligations to know; and failure to inform ourselves is, in the words of the Organon, "a crime."
Let us take to ourselves the earnest admonition which a shrewd old Sioux Indian woman impressed upon her grandson,-- "When you see a new trail, or a footprint that you do not know, follow it to the point of knowing."
DISCUSSION
Dr. Joseph Hensley:
I must say that I cannot see very much difference in giving Variolinum from giving vaccine by means of vaccination with the present aseptic and antiseptic methods used when done by scarification. Of course in times past when I first practiced vaccination I used to give 50 cents or $1.00 for a scab from a patient who had been vaccinated, but now things are very different, and with modern methods of asepsis now in vogue, I must say that I would rather have vaccination by scarification than by Variolinum. One is prepared from the smallpox pustule, and one from the cowpox. It all practically comes from the same source.
Dr. H. H. Baker of Chicago:
I most thoroughly disagree with what the last speaker has said. One of our most prominent surgeons lost a son from methods due to vaccination. I do not see why Dr. Hensley should object to the internal administration of Variolinum any more than to that of lachesis, mephitis, etc.
One more point. Much stress has been laid on the fact that out of the 2600 cases there were 14 who had smallpox, but that is no sign that Variolinum is not preventative. Probably if the Variolinum had been given a little further, immunization would have been complete in those 14 cases. Probably there was not enough given.
I recently had a case of scarlet fever where I gave a few doses of scarlatina to other children in the family, and ordered them taken away. The baby, however, was kept at home, and was further exposed. About a week later she came down with a very mild attack of scarlet fever. A few more doses of the prophylactic, I believe would have entirely prevented.
Dr. Joseph Hensley:
There were about 5000 vaccinated in our schools in Oklahoma City. There were really no bad results at all. The only case we heard of, which was not due to the vaccination at all, was a little girl who got a pin scratch on her toe, and died of septicemia, but this was not due to vaccination.
Dr. Z. T. Miller of Pittsburg:
I have been warned by the chairman not to say anything except about Variolinum, and I have been admonished to say nothing about compulsory vaccination. Now that is just what I want to fight. I am a born uncompromising enemy to that thing and expect to be until I die. I have had very few experiences with Variolinum, but have had with Malandrinum. I have never been vaccinated. I have never given anything but Malandrinum as a prophylaxis, my little girl has taken it. I use Malandrinum and am not afraid of smallpox. My wife had varioloid when she was young. That word "varioloid" should never be used. It is smallpox not like smallpox. I attended a family where one of the children had been vaccinated by the Board of Health and allowed to go to school. She contracted smallpox had a good development of pustules all over the body. There were several children in the house and they were given Malandrinum about the 32nd dilution, and they were exposed as much as people are who take smallpox, but they never took it. I have given this remedy to hundreds of people, and have never yet known of a case to occur where it had been given.
In regard to this paper on Variolinum to which we have had the pleasure of listening. I should call it a classic, and the Institute cannot give Dr. Eaton enough credit for preparing a paper of such vast importance. We owe him a debt of gratitude. The only suggestion I have to make is that possibly the 14 cases would have escaped the disease had the Variolinum been given in a little higher potency. If we vaccinate a person and he breaks out with an eruption, we can reasonably expect that if the internal remedy has any effect at all it is capable of causing these symptoms. There are plenty of people exposed to smallpox who do not take it. Some years ago at Cleveland I presented three letters from all the three vaccine firms of the country, and the principal firm confessed to me that there was never such a thing as cowpox, that it was variolus virus from the beginning that had run through five heifers. Now that shows if there never was such a thing as vaccine, then we had mixed infection that did not prevent smallpox. We have no right whatever to give statistics of vaccination prior to 1903. The combined committee in the Legislature three weeks ago said that they proposed to throw out all statistics previous to three years ago since the aseptic methods had been introduced. Now aseptic vaccination is an impossibility. If it is not septic material which you put into the arm you get no effect. If you put anything into the arm which produces a vesicle, and later produces pus, it certainly is septic, and if the product of vaccination is not pus, I do not know what it is.
Dr. C. E. Lane:
In our state the School Board interferes at times and vaccination is required, and from my experience with it as a preventative, I must say I have never seen a case of smallpox after vaccination, but if we can get as good results from Variolinum, we shall be glad. I remember about 25 years ago as good an authority as Dr. Deschere said he had treated about 50 cases of smallpox and everybody he saw in the family who did not have it he gave Variolinum which prevented any spread of the disease. I just want to call attention to the fact that septic vaccine does not take.
Dr. Augustus Korndoerfer, Philadelphia:
Having had considerable experience in the treatment of smallpox, notably in the serious epidemic of 1871 and 1872, and later in the epidemics of 1881 and 1885, I feel a deep interest in the subject under discussion.
Prior to 1871, I was strongly opposed to vaccination. During that epidemic, however, my views changed. The facts gleaned from practice led me to become an earnest advocate of this means of protection; for I had learned to know it as a great and beneficial modifier of this dread disease.
I have not had a single fatal issue in smallpox among patients who, even in infancy, had a successful vaccination: but, among the unvaccinated, I regret to say, the disease invariably ran a more violent course, and the fatalities numbered about twenty-five per cent. During the early days of the epidemic of 1871 and 1872, Dr. Hering called my attention to an accidental observation which he made while chemically testing the saliva of a patient suffering from a chronic gastric disorder. He noted a marked diminution in the reaction for the sulphocyanogen elements of the saliva: the following day the patient developed an eruption which proved to be smallpox. A question naturally arose as to the relation between these two conditions.
At Dr. Hering's suggestion I made an examination of the saliva lymph and pus of every smallpox patient coming under my care. Briefly, the results of these examinations were as follows: There was a marked diminution in the reaction for the sulphocyanogen element of the saliva, especially of the unvaccinated patients; the more severe the case the more positive the loss of reaction.
In cases that had-been vaccinated, even though years before the decrease of the sulphocyanides was much less marked and of much shorter duration than in the unvaccinated.
Again, while the lymph gave nothing positive, the pus promptly showed the reaction for cyanogen.
The normal reaction was restored to the saliva, from a single day in very mild cases, to from eight to twelve days in strongly marked confluent unvaccinated cases. If the saliva failed to give the normal reaction on the twelfth day death occurred within forty-eight hours.
These facts led to the query: What effects would the cyanides have upon the
susceptibility of patients to this disease: Knowing that silver platers and
some other workers in metals were exposed to the vapors arising from the potassium
cyanide solutions employed in their work, I made inquiry and found an apparent
immunity among such workmen; the foreman of one of our largest plating establishments
remarking that he "had never known of a silver plater taking smallpox."
Without entering into my line of reasoning, which probably was influenced by
Grauvogl's views of the nutritive remedies, I was led to employ a solution of
this salt as a disinfectant,-- sprinkling small quantities about the rooms and
hallways of each infected house, with the result that no second case occurred
in any house after its use.
The extremely poisonous character of the potassium cyanide led me to personally disinfect each house on my visits, employing for this purpose a solution containing five grains of the salt to two ounces of distilled water. Of this I sprinkled about three or four drams in the patient's room, preferably in the corners and under the bed. I used also a few drams along the halls, from the entrance on the stairs, and when allowed in other rooms of the house, using from one to two ounces in each house once or twice daily.
As to the prophylactic use of Variolinum, I must counsel against dependence upon this or other internal means, for, until the utility of such method is proved beyond a reasonable doubt, we surely would be doing a serious injustice to our patients by depriving them of the great benefit to be derived from true vaccination.
Dr. A. E. Austin:
I would like to ask Dr. Korndoerfer if when he tried these experiments, he vaccinated any of the other children?
Dr. Korndoerfer:
I was making experiments, and did not vaccinate the exposed cases.
Dr. Z. T. Miller of Pittsburg:
We have reports from the health officer of the city of New York who says that the results following, and the deaths that have occurred from vaccination have made it necessary to reconsider the question of vaccination as a preventive of smallpox.
Dr. Joseph Hensley:
I think that the homeopathic fraternity cannot discourage any development in therapeutics. I appreciate Dr. Eaton's paper very much. I have been vaccinated something like a dozen times, and it has never taken. I want to make a motion that the Doctor be requested to turn the paper over to the North American Journal of Homeopathy for publication, and that we extend a vote of thanks to Dr. Eaton for his careful work on this paper.
Dr. Hills Cole of New York City:
One reason why I asked Dr. Eaton to write this paper was because a request came to the NY State Dept. of Health to state whether it would accept internal vaccination. The matter was referred to me and I had to say that the homeopathic school could not be considered as having decided that prophylaxis by Variolinum was sufficiently substantiated to take the place of the ordinary means of vaccination, and until the homeopathic school had settled for itself the question as to whether this was a sufficient prophylactic method, we could not accept that method as efficient. I feel that I am perfectly safe in saying that fully 70% of homeopathic physicians stand by vaccination. I took the trouble to look up statistics as to the reported cases of smallpox and I found that during 1906 there were special reports filed at the New York State Department of Health concerning 353 cases of smallpox, and the data concerning vaccination could be classified as follows:
Cases vaccinated but no statement made as to date of vaccination: 6
Vaccinated within 15 years: 26
Vaccinated but not within 15 years 40
Vaccinated within six months: 5
Vaccinated within 15 days: 13
Vaccinated unsuccessfully: 14
Unvaccinated: 233
No statement made as to vaccination: 16
Thus at least 66 per cent of the smallpox cases occurred in unvaccinated persons.
Dr. Charles W. Eaton:
The figures given us by Dr. Cole are specially pertinent and specially valuable because both recent and authoritative; and they are of service in that they set clearly before us the fact that there is no such thing as absolute protection by any method whatever. Smallpox will occur in exceptional cases after vaccination by either method. Dr. Cole's statistics show that ten per cent of the scarified were not protected thereby; and the experience with Variolinum just cited shows but fourteen cases where this internal vaccination failed to protect, which is a record of success far in advance of the old method. It is not a question of absolute protection; no method affords that. There will always be exceptional cases of smallpox occurring after any method; but the percentage of cases occurring after the use of Variolinum is strikingly less than the number occurring after the use of scarification.
We must not be misled into the notion that advocacy of Variolinum is an attack upon vaccination. It is just the reverse. It helps to promote vaccination by improving its method; just as the appearance of the steamship was not antagonistic to navigation, it promoted it.
But though the percentage of success is so largely in favor of the Variolinum method, the one conspicuous and over-shadowing fact before which all lesser considerations are dwarfed into insignificance is that by this method we escape both the acute and the chronic sepsis which so frequently follow the infection inflicted by scarification. These two forms of post-scarification sepsis differ widely, but both are lamentable. They are so familiar to all present that I should not be justified in taking your time for their consideration. It is beyond my comprehension how any partisan of scarification, no matter how prejudiced he may be, can assert that no bad symptoms occur after scarification under modern antiseptic precautions Such an one simply refuses to recognize what is right before his eyes.
During the height of the smallpox epidemic in Des Moines, an able young physician who was the junior partner in perhaps the largest Allopathic practice in my city, took occasion to call me aside privately, and after detailing the thorough and painstaking antiseptic precautions he used in making his vaccinations, said, "And yet I see arms that make me shudder, and I want to know what you can tell me about this internal method."
As to the suggestion that the Institute endorse Variolinum, I confess that I am not in favor of such endorsement. It would seem that it is the Institute's province to endorse Homeopathy in its entirety rather than its individual details. But I am emphatically in favor of its taking action demanding that physicians shall have the right to use such method of prophylaxis in smallpox as seems to them best. In other words, make prophylaxis compulsory, if you please, but leave the method of prophylaxis to the physician. Mandatory vaccination may possible find excuse under the plea of protection of the public, but when the law is invoked to say to the physician ' You shall do it by this method" and "You shall not do it by that," it is simply a return to stark, absolute despotism.
Iowa Homeopathy has been reasonable and broadminded in this matter. The Iowa Homeopathic State Society adopted a definition of vaccination which recognized both the scarification method and the Variolinum method, so that every practitioner is at liberty to follow his own judgment and conscience.*
Though it is long past the hour of adjournment, I should fail of my duty if I did not again call your attention to one other use of Variolinum, namely, as a remedy in the treatment of smallpox itself. Its curative power in the lower potencies (I use the 6th) is remarkable. Under its use the disease will go to the vesicular stage and then abort. This use of Variolinum is so valuable that it is a duty to call attention to it.
Dr. Hills Cole: The point which you make, Dr. Eaton, is that there should be some general method of prophylaxis, two or three ways, one man had had a small experience with one method, another with another, but there would be a great many people exposed to danger that way. We want to establish prophylaxis which shall be of merit. I do not believe that it is safe to leave it to the individual judgment of the physician. I do not think that is safe. There should be some established, authoritative system which has been proven to be the most widely effective.
Dr. Charles W. Eaton:
Dr. Cole says that it is not safe to leave the method of vaccination to any one man's judgment. He is undoubtedly right in that statement. But such a proposition was never advanced by any one. The Variolinum method is not a one man method, it is a minority method. And that minority is thoroughly respectable in numbers, while in quality it includes not a few of the best names in our ranks.
The notion that minorities have no rights which the majority are bound to respect, is a piece of stupid bigotry that progress long ago left far behind; and it is mortifying to see Boards of Health still clinging to this obsolete and oppressive relic of an outgrown past. It seems strangely difficult for these bodies to remember that they were created by the profession, of the profession, and for the profession. And they seem constantly to gravitate toward the conception that they are ordained superiors, and that the medical profession are wayward and ignorant underlings who must be disciplined by their strong and omniscient hand.
* Vaccination is the introduction of a virus into the system for the prevention of smallpox, and is accomplished either by the administration of a proper preparation of the virus of smallpox through the mouth, or by introducing into the circulation the virus of cowpox by applying it to a freshly made scarification of the skin."
FOOTNOTE:
While this is properly an Iowa Report, yet it should not for a moment be forgotten that there are a multitude of physicians all over the country who are using this method, most of whom are keen and competent observers.
In illustration of this fact, the following interesting letters from Dr. Fahrestock in the East, and Dr. Bishop in the far West, are here subjoined.
Piqua, Ohio, May 25, 1907.
Your letter received and in reply will say that as to the exact number of cases I have given Variolinum, I cannot tell. but to more than 100 cases.
Have not seen or heard of a case contracting smallpox in any form since giving the prophylactic.
I went to see a case of smallpox with our Health Officer (a genuine case) gave Variolinum to mother and son who did not have the disease All lived together, exposed all the time, mother and son never contracted the disease.
Three years ago had an epidemic. The first man having it came from Cincinnati, Ohio. The case was diagnosed "hives," then chicken pox. When the eruption was coming out he went to the barber shop and was there fully an hour waiting his turn. He had fever, back-ache, eruption, etc. On each side of him was two of my patients. They in turn looked at him, felt the shotty eruption, etc., and both made the remark, "You have the smallpox." Sure enough the next day another MD pronounced it a genuine case of smallpox. I gave these men Variolinum 30x. Neither one contracted the disease. One of them was exposed the second time. More than 15 cases were exposed after using Variolinum and none were taken sick. Just a month ago the family washing was just being ironed, --finished, when the washwoman was breaking out with smallpox, also the husband at the same time. Washing stood there several days. Parties called for washing, also exposed at same time. Took washing home. Next day house was carded smallpox.
In this family I gave Variolinum 30X, had washing put in boiling water, etc. No trouble as yet, and no indications of any. I only give you a few cases and only add a mite to your own experiences. ***
Yours truly,
J. C. FAHNESTOCK.
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Los Angeles, California, May 27, 1907.
My dear Dr. Eaton:
Yours of the 22nd is at hand and after carefully perusing it I am doubtful of satisfying your needs concerning my experience with Variolinum for I never have kept tally of the exact number of cases in which it has been used by me as a prophylactic. Speaking generally, however, will say that for over a quarter of a century I have used the Variolinum in lieu of other vaccinations, in hundreds of cases, and with a single exception not one of them had an attack of smallpox afterwards. The exception was in the case of the father of an infant of two and a half years. Said infant had confluent smallpox and had been sleeping with its mother until the fifth day of the disease when I was called and found the disease just verging from the vesicular to the pustular stage. Furthermore, the mother was in the seventh month of pregnancy, and none of the family had ever been vaccinated. The Variolinum saved the infant, who was tabulated by the health officials as a necessarily fatal case; the mother in due time was delivered of a healthy daughter; the father alone contacted the disease which assumed the confluent and congestive form, but was speedily cured with Variolinum. He admitted to me that he had neglected to take the powders which were left for the family (the Variolinum) and was careless in taking up the floor coverings where is son had been confined; that he breathed into his lungs clouds of dust mingled with dessicated scales that had fallen from the patient. This experience was in the epidemic of smallpox here in Los Angeles seven years ago.
Before coming to California, fourteen years ago, while practicing in Connecticut for twenty-four years, I also had ample opportunity to prove the efficacy of Variolinum both as a curative and preventative of variola without a single disappointment.
To sum up then, the number whom I have protected with Variolinum is all whom have come to me in a continuous and extensive general practice in the past thirty years, with one exception, the circumstances of which were doubtful. The number I have known to be exposed to smallpox after taking Variolinum, are the members of many households in which I have treated cases of smallpox of every degree of severity as well as others outside of the family who were exposed, including myself.
Very truly yours
HERBERT MARTIN BISHOP