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40~~~~~J and Fred Firestone, M 336 CALIFORNIA AND WZESTERN MEDICINE Vol. XXXI, No. S VACCINE THERAPY IN INFECTIOUS 1-5 6-10 11-15 A-2021-2 26-30 31-35 3640 44-45 46+ BRONCHITIS AND ASTHMA* 5 + F I__ _ F H7H± T T I 4, ,f " ;g4r;l' By WILLIAM C. VOORSANGER, M. D. 40~~~~~J AND FRED FIRESTONE, M. D. San Francisco DIscussIoN by Albert H. Rowe, M. D., Oakland; George Piness, M. D., Los Angeles. TN two previous papers' the authors attempted 2U to classify nontuberculous cough according to its underlying pathology. Based upon a study of two hundred cases selected from routine clinic 15~~~~~~~~~~~~~~~~~1 and private practice, twenty different causes were found. The two prevailing groups, a 38 per cent "undiagnosed group," and a 37 per cent group which showed a "pulmonary infiltration and 'A~~~~I'I thickening with or without enlarged root glands." FIG. 1.-Chart showing influence of heredity on ae of onst. most often followed influenza, pneumonia, and and lactose. These serum waters were incubated occasionally pleurisy with effusion. for fourteen days unless coagulation took place PREPARATION OF VACCINE before that time. At the end of fourteen days In 1919 I. Chandler Walker22 pointed out the the tubes in which change had not taken place significance of vaccines in the treatment of bron- were carefully examined according to Holman's In his early work he recognized method of classification. Vaccines were prepared chial asthma. in the strength of one billion organisms per cubic two distinct types of asthmatic patients-those 0.05 in which some foreign protein, either of the in- centimeter, the initial dose in adults being variety, inaugurated the at- cubic centimeter, gradually increasing by 0.05 halant or ingestive cubic centimeter at a three to five to seven-day tack, and a second type in which the attack was resist- aggravated or precipitated by a superimposed interval, this time being governed by the bacterial infection. ance of the patient, as determined by local re- Since the inception of our work on infectious action and constitutional symptoms. bronchitis and asthma, we have modified some- HEREDITY AS A CAUSATIVE FACTOR what the Chandler Walker technique preparation IN ASTHMA of vaccines and of dosage, and give herewith a Cooke,4 in 1925, after a careful survey of the brief resume of our method of preparing cul- nature of the inheritance in asthma and pre- tures and vaccines including our more recent asthmatic conditions, made a graphic chart show- modifications. ing the influence of heredity Qn the age of onset. Throughout this work the following bacterio- (See Fig. 1.) logical technique was used: After thorough anti- Where both father and mother showed some sepsis of the mouth, sputum was collected daily hypersensitiveness 75 per cent of the offspring for three consecutive days in sterile sputum jars. showed clinical signs before the tenth year; where Thick masses of sputum, raised during an asth- there is a unilateral heredity, 35 per cent showed matic attack or during a severe paroxysm of symptoms before the tenth year. In the third coughing, which usually occurred in the morning, class, where there is a negative heredity his- wete washed in sterile sodium chlorid solution tory, 17 per cent showed symptoms before the and shaken in five cubic centimeters of plain tenth year. This group comprises the infectious bouillon or glucose veal broth of proper hydrogen type, and a study of the curve reveals a small ion concentration. Tubes of melted plain agar, peak rising from the first to the tenth year, a fall to which 0.5 cubic centimeters of sterile defibri- in nated human blood was added, were inoculated TABLE No. 1.-Results of Vaccines Infectious with varying amounts of the broth emulsion of Bronchitis and Asthma 2XJ3- Petri dishes and incu- i -laaIJLT sputum and poured into i;FlauM I1t"T= sm N70"9+ kI r?f ""es _Ios WJTPi bated for thirty-six hours. The various types of I--l 32 IF22 T .T-,CA.Mo..c L 2 E*Ow,m.ln3 in I1YEARSi s CHMMIC colonies were then picked off, subcultivated C2H222N 52W222ns2 PuL 2m F _ iTm1 votIDW P"OV 0 bouillon and incubated for about twenty- fALe ORONC-ITIS dextrose flfMl a3L PCOWAYC>419 :: "O WEftOL ftEPCFITED v4PROV I5 IIYEARS| W.c UTOGIENOtl5I COLOS hours. The organisms from this dextrose 222222 four - -H* M 222222m -" 2.222222|, RercATEO VN4t4P*WCD bouillon growth were stained by Gram's method 23 65 CIOLDS a bile solubility test was made. Those organ- muOCENOUS IMMUCNZA ViELL and Os If FE YEAR "M. which proved to be Gram-negative cocci in I5tH 1t ^K WVCLL *isms 2YSARS 50 lb| *E= in- RSTHg1A SC bile insoluble were &W eVlIID and m chains, noncapsulated GROW,--" .Ct mp2 GWP w4powco 12 2M22LE EraRS R oculated, according to the method of Hiss, into 3q 43 1ow".fmsyw 1-m 1 v lOce.ious P2 FIL2 Lr acpc.".. I wmp"ovco 222222a IJWOO litmus waters which contained salicin, mannite, 45 *1 ~ A P.22222222222pl - 04pnowco IE S YEARS H-: SS W -'2222222rW2 8 PUf¢C|STRP C.M OET * of Mount Zion Hospital, GRO OWUMNZFIL From the Chest Department Pfl-E 1A. V.- VIIOwo^. vS emcumoms WELL San Francisco. 62 28 |.VERPS , PUDA'kgM * Read before the General Medicine Section of the Cali- F"CL*W"I'l IMPMWO fornia Medical Association at the Fifty-eighth Annual 66 t errusom Session, May 6-9, 1929. 337 November,Novmbe,1929 129 VACCINE THERAPY-VOORSANGER AND FIRESTONE33 0 from the tenth to the fifteenth year, and a rapid trinsic asthma is the result of infectious processes. rise to the twenty-first year, where the incidence in other parts of the body, such as asthma rela'te-d of asthma stays at a maximal level until over to and relieved by removal of an' infected gall thirty years, to drop gradually to the age of forty bladder or kidney or associated with the menstrual when it climbs again, reaching its maximum at cycle. the sixty-fifth year. Asthma developing after the In our classification we demonstrated that in- thirteenth year, and especially after the fortieth, fected sinuses were responsible for 8 per cent of is usually the resuilt of chronic foci of infection all chronic coughs. We therefore emphatically in the bronchi, tonsils, teeth, and sinuses. Here, recommend in all bronchitis and asthma follow- too,-development is gradual. Cough and wheez- ing an acute upper respiratory infection that all ing and frequent attacks of bronchitis may go on sinuses be thoroughly examined, d'rained if neces- for years before the true dyspnea of asthma be- sary, and a vaccine from the sinus pus or secre- gins. Many of the cases of chronic bronchitis tion be administered. In our experience we have with emphysema are truly infectious asthma and often seen good results from the latter procedure, should early be recognized, because the results and have seldom seen permanent relief from a obtained with some of these long-standing cases purely operative correction. How often, after sub- warrant the belief that much better results could mitting the patient to trying sinus operations- be obtained had they been treated along the same either drainage or the more radical method-have lines that we now follow after they-.have become we seen a recurrence of all symptoms or a very definitely asthmatic. temporary relief. We believe frankly that many sinus infections are true secondary infections CLASSIFICATION OF CASES TREATED superimposed upon a sensitive membrane; an'd This present paper consists of a critical review we advocate the elimination of every condition of 481 cases reporting for routine chest -exami- of hypersensitiveness or allergic sensitiveness nation and includes a series of 110 cases of proved (proved such by protein skin-testing with dust, tuberculosis, as checked by physical examination, pollens, danders, and foods) by a period of rest 'c-ray films of chest, sputum, and guinea-pig in-- and vaccine therapy before surgery is employed. )culation for tubercle bacilli. These tuberculous A detailed analysis of the sixty-six cases of :ases have been eliminated from this study. Of infectious bronchitis and asthma reveals the the remaining 371 nontuberculous cases, we have following :* been able to isolate sixty-six cases of infectious Fifteen, or 22.7 per cent, we classify as "well," bronchitis and asthma which have received vac- by which we mean the patient has been clinically cine therapy, and it is this latter series that we' relieved of all evidence of the acute paroxysms report here in detail, giving our observations since of wheezing with signs of bronchospasm for a 1920. period of over two years. We avoid the term REVIEW OF SIXTY-SIX CASES OF INFECTIOUS "cured" as we feel that, in the future, repeated BRONCHITIS AND ASTHMA TREATED epidemics of influenza or other acute respiratory WITH VACCINE diseases may so alter the bacterial flora of the All patients treated had a history of some patient as to break down the resistance established acute pulmonary infection, principally influenza- and possibly precipitate an asthmatic attack. pneumonia, repeated colds, and in children whoop- Twenty-seven, or 40.9 per cent, are considered ing-cough was an underlying factor. All proved as "improved," by which we mean the patient has cases of tuberculosis have naturally been eliminated been relieved for over a period of six months of although we have in a few instances seen chronic the real asthmatic paroxysms, has lost the associ- tuberculosis, complicated with asthma, 'improve ated cough and dyspnea on exertion, and is able under an autogenous vaccine, which improvement * The table showing the results of vaccine treatment I-n we as from a tuberculin made infectious bronchitis and asthma will appear in the re- interpret resulting prints of this article, which may be had on application tco of the patients' own sputum.
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