These vaccines were recommended in the various catalogues for use either alone or together with other vaccines in the prophylaxis and treatment of common colds, and in acute and chronic diseases of the respiratory tract. As a matter of fact, they had been used very little in prophylaxis, and had failed to show very much value in treatment. In discussing these vaccines from the standpoint of treatment, R. M. Pearce (13) had the following to say: “A mixed vaccine for common ‘colds’ containing several organisms (staphylococcus, streptococcus, pneumococcus, micrococcus catarrhalis group, bacillus of Friedlander group, diphtheroid group, bacillus influenza) is one of the most recent bacterial ‘shotgun’ mixtures, which takes the chance of one lucky bull’s-eye in seven shots.” “No one can claim a scientific or even a common-sense basis for the treatment of a cold by such a mixture.” Catarrhal mixed vaccines of a similar kind were refused acceptance by the committee on “New and Non-efficial Remedies” of the American Medical Association, in June, 1918 (14), on the grounds that insufficient evidence of their therapeutic value had been furnished by their manufacturers.
While the above illustrates the status of “mixed vaccine” for therapeutic purposes, it is a well-recognized fact that it is possible to produce an immunity for most of the bacteria composing such vaccines, if killed cultures of the various strains are injected in sufficiently large doses. Again referring to Pearce’s article, we find the statement: “Prophylactic vaccination rests on a sound, scientific basis of experimental studies and clinical observation.”
The attempt to protect against epidemic influenza by the use of mixed vaccines was based largely on the following points. The medical profession was confronted by a rapidly approaching deadly epidemic, against which ordinary measures of control had failed. The epidemic was supposed to be due to a primary infection with Pfeiffer’s bacillus, but all of the fatal cases were found to have profound secondary or symbiotic infections, with one or more of the strains contained in the “mixed vaccines.” It was known that mixed bacterial proteins, even though they were not actually specific, possessed certain qualities of producing reactions unfavorable to infections in general, which were characterized by a temporary rise in temperature, by an increase in the number of leucocytes, and by a more or less demonstrable amount of active immunity against each one of the contained bacterial toxins. The artificial production of a leucocytosis was especially desirable, because a characteristic of epidemic influenza was the failure of leucocytosis on the part of the infected individual. In other words, mixed vaccines were used because they were the only available substances which offered the hope of creating a reaction against the secondary invaders which were so commonly the cause of death in influenza.
Since Pittsburgh’s experience with prophylactic vaccination had chiefly to do with the use of commercially prepared mixed vaccines, a brief history of the local experience with them may be of interest.
About the time that the first cases of influenza were being reported from the Pittsburgh district, articles on preventive vaccines as used in Boston and at some of the camps began to appear in the daily papers, shortly after which came the announcement that the Carnegie Steel Company was offering free vaccination to their employees and to the families of their employees. Dr. W. O. Sherman, chief surgeon for the company, advocated the use of the vaccine because he hoped to increase the immunity to secondary infection and to produce an active leucocytosis in the vaccinated individuals, and at the same time to allay panic among the employees at a time when an interruption of manufacturing and mining pursuits might be disastrous to the entire country; and he did it with the assurance that if the vaccine did no good, it would at least do no harm. He took steps to arrange for the collection of data by which he hoped to determine whether or not the vaccine as used by their company did any good. His report has not yet appeared. Other large corporations at once instituted prophylactic vaccinations with commercial “mixed vaccines.”
In contrast to the altogether laudable efforts of these companies to protect their employees, a complete history of the vaccine episode in this community necessitates the recounting of a very different phase in the matter. When it became known that corporations were vaccinating their employees, people in general naturally began to investigate. Physicians’ offices were besieged by persons who either demanded vaccination at once or wanted to know whether or not there was “anything in it.” Conscientious physicians in their turn called up the offices of the medical societies, the various laboratories, and telegraphed everywhere trying to get some definite data before recommending the vaccine to their patients. It was impossible to answer the question definitely, because it was a new procedure and purely in the experimental stage. On the whole, the medical profession handled the situation in a competent and dignified manner, for the great majority gave vaccines only after a full explanation to the effect that its value was in doubt, or else refused to give it altogether. There were some, however, who were not conscientious, and the unscrupulous practitioner seldom had a better chance to impose upon the public. The demand for vaccine soon exceeded the supply, and it is claimed that there were doctors who gave any type of vaccine they could obtain without regard to its bacterial make-up or intended purpose. Anti-diphtheritic serum was given in many instances, and it is said that even normal salt was used. Statements to the effect that exorbitant sums were being charged and that guarantees of prevention were being made resulted in the Red Cross Society undertaking the distribution of the vaccine. To protect itself, the Medical Society issued the following notice in the weekly bulletin for October 26, 1918:
The Society wishes it understood that at present there is no vaccine, serum or inoculation which will secure anyone against influenza. It is desirable that everyone should avoid hysteria and consider only the reports which are officially given out by the Health Department, since of late various methods of prophylaxis and treatment have found their way into the daily newspapers, and these may prove harmful rather than do good.
Almost simultaneously the daily papers published the report of Surgeon-General Blue, of the United States Bureau of Public Health, which expressed practically the same opinion. It was not the intention of either of these articles to criticise the practice of vaccination, but merely to warn the public against profiteering and fraudulent guarantees. They had the unexpected effect, however, of causing people to completely lose faith in prophylactic vaccines, and in many instances to become actually antagonistic to them. It was during this period that the preparation of vaccines from pure influenza strains was undertaken, under supervision of the County Society and for distribution through the Department of Public Health. Two days after the first supply of this vaccine was ready the Red Cross authorities telephoned that there was no further call for vaccine. The man in charge of the distribution stated concretely that “the bottom had dropped out of the vaccine business.” A few days later the Department of Health issued an order to stop the preparation of the vaccine.
Many pharmacies, having small supplies of vaccines, realized the great call for it and the difficulty of obtaining a new supply, and were also guilty of commercialism. Certain of the large biological product companies were no exception. One house issued a hand-bill, printed in red on a yellow background, which stated: “Epidemic influenza is due to the influenza bacillus. The present epidemic of influenza has a tendency to develop pneumonia. The use of our influenza bacillus vaccine No. —— will abort the influenza and avoid pneumonia and other sequelæ. When pneumonia has developed, it can be reduced to less than one-third the mortality and duration usual with other methods of treatment,” etc. Practically all of the above statements are still unproven, and probably will never be shown to be true. Such a bulletin undoubtedly lays this firm of vaccine manufacturers open to prosecution under the law protecting against false and fraudulent advertising. Several fairly well-authenticated incidents occurred in which the representatives of vaccine houses offered factory managers and others share and share alike in the profits, if the brand of vaccine made by them was used. It is on such happenings as the above that the writer advocates legal measures, allowing Boards of Health to control the advertising of remedies and distribution of biological products during epidemics.
How much Pittsburgh will learn from the experience with vaccines will depend on the numerous analyses of data which were acquired during the epidemic.