Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS. 75
toxins. These give rise to the well known means which have been successsully emknown
symptoms of loss of appetite, head- ployed for their arrest or prevention.
ache, pains, fever, delirium, etc. In addi- Diphtheria.—Since the discovery of the.
tion to the active warfare of the leucocytes cause of this disease and our knowledge of
(Metchnikoff's theory of phagocytosis), the conditions of its transmission, together
groups of cells throughout the body, after with the use of antitoxin, there has been a
recovering from the first onslaught, as it marked reduction in its prevalence, and an
were, of the toxins, begin to tolerate their equally marked decrease in the mortality,
presence, then effect a change in their It is caused specifically, as is now known,
chemical constitution, and finally elaborate hy bacillus diphihe/ia-, described by Klebs
substances ( Bucliner's theory of Alexins^, and LoefQer in lSS,i-4. Its modes of infecwhich
antagonize the toxins and counter- tion are by inhaling infected air, by drinkact
their action altogether, thus lending aid ing infected milk, and also through clothlo
the warrior cells. Other substances are ing, etc., used by diphtheria patients. Virualso
present in the blood which help the lent bacilli have frequently been found in the
leucocytes by preparing the bacteria for healthy throats of persons who have been
absorption and destruction:' these are the (i/i- brought in direct contact with patients, ini^wzwi)
while, on the other hand, substances fected clothing, etc., without contracting
are given off by the virulent bacteria, — the disease. It is evident, therefore, that
lystm—by means of which they strive to infection requires more than the mere presneutralize
the protective substances of the ence of the specific germs in the throat, and
tissue cells, the anti-lysins. Ultimately, that individual susceptibility in this, as in
however, possibly after a desperate struggle, all infections, plays an important part,
during which the life of the patient may This susceptibility may be natural or achang
in the balance, the invading micro- quired.
organisms are overthrown and recovery is Rehring's discovery of antitoxin (1S92)
brought about, a more or less permanent in the treatment of diphtheria may be comdegree
of immunity being produced against ])ared in practical importance with Jenner's
the specific disease. discovery of vaccine in the prevention of
Besides the substances referred to, we smallpox, but there is this remarkable difknow
that aniiloxins also are developed in ference between them; while vaccination
the blood. As to the nature of the action was discovered by accident and empericof
the toxin and antitoxin upon each other ally proved to be of value by use in the
there has been mucli curious speculation. Imman subject, antitoxin was discovered
Among others, Ivhrlich's "side-chain" l)y an organized plan worked out in the
theories are interesting, whether they have laboratory and demonstrated to be true by
a foundation in fact or not, but their chief experiments on animals, before it was tried
value has been in establishing that the pro- on man. This method of investigation,
tection afforded by antoxic and bactericidal instituted by Pasteur as the pioneer, and
serums, used practically in the preventive adopted by Koch and his followers, which
treatment of certain infections, is due, for Hehring employed, was radically new, and
the most part, to purely chemical action, marks a great epoch in the history of medithe
antitoxins neutralizing the toxins after cine. Tliat anything so entirely different
the manner of chemical reagents and the from the old emperical methods should have
bacterial anti-bodies and complimentary met with opposition at first, from the older
bodies combining with the bacterial cells, members of the medical profession, who
Many points, however, are still far from had been taught to abide by clinical expeclear
as to the manner in which both anti- rience and time-honored traditions, is not
toxins and toxins act. Until recently noth- at all surprising. But positive conviction
ing was known about the chemical com- has now replaced misconception and prejuposition
of these substances, only their phy- dice in the minds of the majority of its for
siological properties having been studied, mer opponents.
But it has been shown, at least with regard The preparation of antitoxic serum is
to diphtheria and tetanus, that they are based upon the artificial immunization of
either closely bound to the serum globulins animals (horses), by subcutaneous injecor
are themselves substances of proteid na- tions, in gradually increasing doses, of tlie
tnre allied to the globulins. specific toxin. The antitoxin treatment of
Having thus briefly outlined the theories diphtheria, however, has been so frequently
advanced to explained the principles of in- and so fully described in numerous publifection
and immunity, I would now direct cations. l!i:it only iis practical results, beyour
attention to a review, as concisely cause of their great importance, need be
expressed as possiljle, of the known causes mentioned here.
and modes of infection of some of tlie more The great mass of physicians are now
prevalent infectious diseases, and of the convinced,—First, that diphtheria antitox-