June 3, 1922] 



NATURE 



717 



Non-Specific Therapy. 



By Dr. J. Stephenson. 



IN inoculation against typhoid fever; dead typhoid 

 bacilli are injected subcutaneously or into a 

 muscle. Inoculation against plague consists in the 

 injection of an emulsion of dead plague bacilli artifici- 

 ally grown in broth. These are prophylactic measures 

 for the protection of persons who are likely to be 

 exposed to infection. Hydrophobia vaccine, used in 

 order to prevent the development of the disease in 

 persons who have been bitten by a rabid animal, is 

 prepared according to a definite system from the spinal 

 cords of rabbits inoculated with the disease. Anti- 

 diphtheritic serum, used in the treatment of patients 

 actually suffering from diphtheria, is the blood-serum 

 of a horse which has had diphtheria toxin (the broth 

 in which diphtheria bacilli have been grown, and from 

 which the bacilli have been filtered off) repeatedly 

 injected into it. 



In using vaccines the object is to stimulate the 

 individual to produce protective substances in his 

 own body ; in using sera, the protective substances, 

 elaborated by some other animal, are themselves 

 supplied to the patient. But in all the above instances, 

 and in numerous other similar modes of treatment, — 

 whether the treatment takes place before infection 

 {i.e. is prophylactic), or is carried out during the 

 incubation period, or during the actual disease ; 

 whether bacilli are used, or a serum free from bacilli 

 but containing an antitoxin, — the implication is that 

 certain substances are protective against one disease, 

 certain other substances against another ; in other 

 words, the treatment is specific. The idea of specifi- 

 city may go even further, as where a patient is 

 treated by means of the particular strain of micro- 

 organism, or the particular mixture of them, that he 

 himself harbours (the use of autogenous vaccines in 

 asthma, acne, boils, etc.). As Sir Almroth Wright 

 has recently written : — 



pneumococcus inoculations as a preventive against 

 pneumonia in the Transvaal mines, I nourished 

 exactly the same prejudices. But here the statistical 

 results which were obtained in the Premier Mine 

 demonstrated that the pneumococcus inoculations 

 had, in addition to bringing down the mortality from 

 pneumonia by 85 per cent., reduced also the mortality 

 from " other diseases " by 50 per cent. From that 

 on we had to take up into our categories the fact 

 that inoculation produces in addition to " direct " 

 also " collateral " immunisation. This once recog- 

 nised, presumptive evidence of collateral immunisa- 

 tion began gradually to filter into our minds. . . . 

 From such cases hints are conveyed to us that there 

 may exist a useful sphere of application for collateral 

 immunisation ; ... we should discard the confident 

 dogmatic belief that immunisation should be strictly 

 specific, and that we should in every case of failure 

 endeavour to make our immunisation more and more 

 strictly specific. We should instead proceed upon 

 the principle that the best vaccine to employ will 

 always be the vaccine which gives on trial the best 

 immunising response against the microbe we propose 

 to combat." 



"That immunisation is always strictly specific 

 counts as an article of faith ; and it passes as axiom- 

 atic that microbic infections can be warded off only 

 by working with homologous vaccines, and that we 

 must in every case, before employing a vaccine 

 therapeutically, make sure that the patient is harbour- 

 ing the corresponding microbes." 



To attempt treatment on a non-specific basis would 

 seem therefore at first glance to be a step backward, 

 and investigation of such a subject illogical, if nothing 

 worse. But while reason, working on the accepted 

 lines, was all against the idea, facts have cropped up 

 repeatedly which seem to give a value to non-specific 

 treatment. At first these were ignored ; but a time 

 has come when this method of disposing of them is no 

 longer possible. Thus, to quote Wright again : — 



" I confess to having shared the conviction that im- 

 munisation is always strictly specific. Twenty years 

 ago, when it was alleged, before the Indian Plague 

 Commission, that anti-plague inoculation had cured 

 eczema, gonorrhoea, and other miscellaneous infec- 

 tions, I thought the matter undeserving of examina- 

 tion. I took the same view when it was reported 

 in connection with anti-typhoid inoculation that it 

 rendered the patients much less susceptible to 

 malaria. Again, some years ago, when applying 



' The present position of non-specific therapy is 

 explained in a recently published volume by Dr. 

 Petersen of Chicago,^ from which the above quotation 

 from Wright is taken. When we come to inquire 

 into the rationale of the procedure, we find that a 

 theoretical basis to account for the results has been 

 lacking, — the treatment has been empirical. With 

 Petersen, we may perhaps put the matter broadly 

 thus : the reaction of the body is fundamentally the 

 same in all cases of injury ; there is an effort to dilute 

 the noxious agent (increased flow of lymph), to remove 

 it (phagocytosis by leucocytes), to neutralise it (manu- 

 facture of antibodies) ; these failing, to wall it in. 

 We may, in trying to influence this process, adopt one 

 of two avenues of approach ; we may proceed against 

 the cause of the inflammatory reaction by fostering 

 the production of an antibacterial agent or an anti- 

 toxin ; treatment on these lines must necessarily be 

 specific, must be directed against the particular micro- 

 organism or toxin. Or we may endeavour to alter the 

 inflammatory reaction of the body itself, — to stimulate 

 the potential forces, latent or held in abeyance until 

 the non-specific stimulation brings them into activity. 

 This is somewhat vague ; Wright has, in a recent 

 lecture (see the Lancet, May 6), described one way, at 

 least, in which the activation works. He has dis- 

 covered that "the intravenous injection of a vaccine 

 is immediately followed by the appearance of bacteri- 

 cidal substances in the blood, which are not specific 

 but can act upon various types of organisms. ... 

 The late result of an inoculation with, say, a typhoid 

 vaccine, is the production of antibodies which are 

 specific for the typhoid bacillus, but the immediate 

 result of such an inoculation is the appearance of non- 

 specific antibodies. Inasmuch as leucocytes possess 

 the power of inhibiting the growth of organisms on 

 culture media, it seems likely that these non-specific 

 substances exist ready-formed in the leucocytes which 

 yield them in response to the immediate demand." 



' Protein Therapy and Nonspecific Resistance. By Dr. William F. 

 Petersen. Pp. xviii+314. (New York : The Macmillan Company ; 

 London: Macmillan and Co., Ltd., 1922.) 21s. net. 



NO. 2744, VOL. 109] 



