TOXINS AND ANTITOXINS 67 



sible to determine quickly the type of toxin in a particular outbreak, 

 it is of the greatest importance to use polyvalent sera. 



Gas Bacillus Toxin. The frequent occurrence of gas gangrene 

 in the Great War has given especial interest to the preparation of 

 antitoxins for the organisms causing the disease. Klose, in 1916, 

 and Bull and Pritchett, in 1917, were able to prepare a soluble toxin 

 of the bacillus Welchii or as it is often named bacillus perfringens. 

 Bull and Pritchett drew especial attention to the necessity for select- 

 ing a strain which is capable of producing toxin in fairly large 

 amounts. The British Medical Research Committee reports that 

 the toxin of vibrion septique has very little effect following 

 subcutaneous injection. Upon intravenous injection, however, it 

 produces convulsions and usually death in a few minutes. An 

 antitoxin may be produced, but it is not effective after the toxin has 

 been injected. The toxin of bacillus edematiens produces massive 

 edema about the site of inoculation. The toxin of bacillus aerogenes 

 capsulatus was found to have a necrotic action upon the tissues ; it is 

 generally toxic in large doses and animals may be protected by 

 antitoxic serum. 



The Use of Immune Sera in Gas Gangrene Treatment of the 

 Disease. Leclainche and Vallee, Sacquepee, Weinberg and Seguin, 

 Bull and Pritchett were the first to apply serum therapy in wounds 

 infected with the gas bacilli. Leclainche and Vallee's and Weinberg 

 and Seguin's serums were polyvalent and also antibacterial, while 

 Bull and Pritchett's serum was antitoxic. In 1917 Bull and 

 Pritchett produced an exotoxin from twenty-four-hour cultures of 

 bacillus aerogenes capsulatus, which when injected into pigeons 

 or guinea-pigs caused local edema, necrosis, and hemolysis of red 

 cells, and was capable of stimulating the formation of an antitoxin. 

 Bull's claim for the potency of his antitoxic serum was based on ex- 

 periments in which he used pure cultures of bacillus aerogenes cap- 

 sulatus and made no attempt to discriminate between the different 

 types of the organism, such as have been found to exist by Henry, 

 or to consider the fact that in war wounds the bacillus aerogenes 

 capsulatus is not the only causal factor of gas gangrene. From 

 Nevin's work it would appear that neither anti-perfringens serum 

 (bacillus aerogenes capsulatus anti-microbial serum) nor Bull's anti- 

 toxin afford any protection when other pathogenic anaerobes inci- 

 dent to war wounds are present, together with bacillus aerogenes 

 capsulatus, whereas when the vibrion septique and bacillus 

 edematiens are present in mixed infections without bacillus aero- 

 genes capsulatus, the prophylactic use of the specific sera, even 

 when diluted by another serum, is effective. Weinberg and Seguin, 

 who have contributed extensively to the serum therapy of gas 

 gangrene, found treatment by serum alone limited because of rapid 

 absorption of toxin in this disease. The association of rational 

 surgery and of serum therapy gives the best results. In a series of 

 sixty-six cases reported by these authors in which sixty did not 



