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A CONSIDERATION OF CERTAIN RECENT DEVELOPMENTS IN

PRACTICAL SERUM THERAPY*

A. P. OHLMACHER, M. D.

Detroit

Naturally the pre-eminent position in ters, and more particularly in the splenthe list of remedies comprehended by did results obtained in the Boston City the term, serum therapy, must be as- Hospital, the importance of using larger signed to antidiphtheric serum or diph- quantities of serum has been demonstrattheric antitoxin, which, of all the serums ed. It appears, indeed, that for the thus far evolved for application in the practical end in view, namely, the cure human being, has earned the distinction of diphtheria, a large dose of low poof being an absolute and certain specific. tency serum is actually more effective In truth, of the multitude of serums for than a small dose of one strongly imother microbic diseases which have been pregnated with antitoxic power, and produced and tested since the epoch in there are those who believe that these therapeutics inaugurated by Behring's favorable consequences are due to the and Roux's discovery, antidiphtheric presence in antidiphtheric serum of some serum has alone wholly fulfilled the ex- substance besides the specific antibody pectations of those who believed a new of diphtheria which, acting as a

a comera in the conquest of man's maladies plement or otherwise, assists the specific had been inaugurated. But all the prob- antitoxin in overcoming the disease. My lems relating to this important biologic personal observation which began with agent have not yet been solved. Take, an experience in producing antidiphfor instance, the weighty matter of dos- theric serum in the early days of its inage. Here after some fuctuations caused troduction and which has continued in by the occasional success in obtaining a private and institution practice, inclines very high potency serum in the uncom- me strongly to this view. mon horse, and the consequent stress

"Refined and Concentrated" Antitoxin. laid upon the small dose of serum very high in unitary value, we find the cur- Allied to this question of dosage comes rent tending towards larger doses, or, in a consideration of antidiphtheric globulin other words, more massive doses, irre- solution, or as it is called in commerce, spective of the potency. In several quar- "refined and concentrated” diphtheric

"

antitoxin, the chief merit of which is said *Read before the Wayne County Medical Society, November 5, 1906.

to be its small dose and a reduction in

ever

frequency of serum reactions. This product will globulin antitoxin endure the test which has been known in the experi- of time and usage in an enormous nummental laboratory for several years is ber of cases which antidiphtheric serum obtained by treating ordinary antidiph has so splendidly withstood? If so, and theric serum after the process devised if by its use, the frequency of serum by Pick, Seng, Atkinson and others, and sequels can be somewhat reduced, it modified by Gibson. Essentially the should ultimately replace the whole procedure is to precipitate with am- serum as now employed. monium sulphate, the proteids of anti

Antitetanic Serum. diphtheric serum. These proteids are collected, dissolved, reprecipitated, then

As for antitetanic serum, it must be dissolved in saturated common salt solu- reluctantly confessed that the beguiling tion. Here a separation of proteids en

promises of the laboratory have not been sues, certain globulins, including those upheld at the bedside of the patient afcarrying the antitoxin, being dissolved in

flicted with lockjaw. The specificity of the salt solution from which they are

this serum as tested on laboratory aniprecipitated once more by ammonium

mals is demonstrable by the same beausulphate or weak acetic acid. The final tiful accuracy as obtains with antidiphglobulin precipitate is then subjected to

theric serum, but when man is infected dialysis by which the salts are removed by the tetanus bacillus to a point at and its solution follows. This solution

which symptoms show, his organism is of the globulins which is reduced in bulk apparently overwhelmed by the deadly as compared with the original serum

tetanus toxin to an extent prohibiting volume, and which contains the anti

neutralization by antitetanic serum howtoxin minus a certain amount lost in the

administered, and by however manipulations, after bacterial filtration

heroic a dosage. Offsetting its theraand the addition of a preservative, is the peutic failure, however, is the certainty finished product, and in its smaller vol

of its success as a prophylactic, and the ume represents a concentration of the vast importance of using subcutaneous original antitoxic content of the serum.

immunizing doses of this serum in cases By this treatment one leaves behind

of suspicious wounds, and of dusting the serum albumin, the globulins insoluble dry powdered serum locally cannot be in saturated chloride solution, the salts

overstated. and extractives of the serum, and the

To American physicians who have felt finished product is a most attractive

the desirability of some uniform measure looking, clear fluid, which, in guinea-pig

of value of commercial antitetanic serum, essays, neutralizes the test toxin just as

it will not be unwelcome news to learn does the antidiphtheric horse's serum.

that the Hygienic Laboratory of the U. Waiving the matter of volume in dos

S. Public Health and Marine Hospital

Service is about to establish a standard, age which, after all, is of little signifi

which will be for tetanus serum the same cance to the physician skilled in serum injections, comes the vital question-

guarantee of uniformity that their official

or Standard Unit is for all antidiphtheric does this solution of antidiphtheric

serums admitted to interstate commerce. globulins represent all the curative subs'tances residing in the native horse's Utility of Antistreptococcic Serums. serum and essential for combating diph- Antistreptococcic

serums, of which theria in man in all its clinical manifes- several are found in commerce both in tations, including the various forms of the United States and in Europe, cannot mixed infection. Or, to put it otherwise, be said to have fulfilled the original ex

a

pectations of their therapeutic efficacy. least for acute streptococcic diseases any Furthermore, there is much variation in remedy except antistreptococcic serum, the different brands found on the mar- physicians should, I believe, allow themket, both in their behavior in laboratory selves to be swayed by the clinical testests and in their use at the bedside. I timony thus far adduced, and give their cannot here discuss the very inviting patients the benefit of such doubt as subject of animal tests of antistrepto- may exist, administering antistreptococcoccic serums, or point out what in my cic serum in sufficient doses to permit a estimation is the absurd futility of at- fair trial. tempting to gage the therapeutic value of these serums in human infections by

Serum Therapy of Pneumonia. mouse, rabbit or guinea-pig experiments.

Of antipneumococcic serum it may be But appraised by the supreme trial of said that the status is one of uncertainty any therapeutic agent's serviceableness

much more pronounced than regards the the results of its clinical application, antistreptococcic serums.

That

this one must admit that for certain at least

should be the case must cause profound of the products now found on the mar

regret on the part of every physician ket, evidence is strongly in favor of their who realizes that croupous pneumonia usefulness in various streptococcus in- heads the list of fatal acute infections fections whether primary or secondary. during the cold season in our north temFrom what I have individually seen dur

perate zone, and that it chooses indising the last year in the trial of a certain

criminately young and middle-aged roantistreptococcic serum, and from what

bust adults in all walks of life. Today has come to my personal notice of the one hears little or nothing about several written or verbal testimony of compe

serums for pneumonia proclaimed in tent medical men, I cannot escape a con- Europe on the basis of laboratory exviction as to its therapeutic value in such perimentations and a limited trial in hosaffections as scarlet fever, acute and pital and private practice. Perhaps the chronic rheumatism, various local or re

same fate may await a report which I gional streptococcic infections including possibly may make in due time of an acute otitis media and mastoiditis. In

antipneumococcic serum which has been the streptococcus mixed-infection of produced under my direction, and which phthisis, a curious contradiction exists

was given preliminary clinical trial last in the extreme enthusiasm of one group spring in Detroit through the kind coof reporters and the unqualified dissent operations of several local physicians, of another. A similar incompatibility is and in three of the leading hospitals of found in recent German literature con- Chicago. cerning the value of antistreptococcic

My own verdict on these tests of the serum as a prophylactic against infection in extensive surgical operations, tory but not conclusive. Satisfactory is

new serum for pneumonia is-satisfaceither in conditions in which pre-exist

a justifiable report in that no untoward ing infections are likely to be aroused

or harmful effects were noted, though to further activity or where the extent

considerable amounts of serum of operative mutilation predisposes to

used in several cases, intravenous injecinfection.

tion being practiced in the most urgent But with what we know of our help

ones, and, further, some astonishing and lessness in the fact of many infections rapid recoveries, quite out of accord with the streptococcus, and since bio- with what one might expect to see in logic therapy has not yet offered, at the ordinary course of cases of pneu

were

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