470 



NA rURE 



[September 17, 1896 



antitoxin so powerful that a quantity of it only a 200,000th part 

 of the weight of an animal will protect it perfectly against a dose 

 of the secretion of the poison glands of the most venomous ser- 

 pents known to exist, which without such protection would 

 have proved fatal in four hours. For curative purposes larger 

 quantities of the remedy are required, but cases have been 

 already published by Calmette in which death appears to have 

 been averted in the human subject by this treatment. 



Behring's darling object was to discover means of curing 

 tetanus and diphtheria in man. In tetanus the conditions are 

 not favourable ; because the specific bacilli lurk in the depths of 

 the wound, and only declare their presence by symptoms caused 

 by their toxin having been already in a greater or less amount 

 diffused through the system ; and in every case of this disease 

 there must be a fear that the antidote may be applied too late 

 to be useful. But in diphtheria the bacilli very early manifest 

 their presence by the false membrane which they cause upon the 

 throat, so that the antitoxin has a fair chance ; and here we are 

 justified in saying that Behring's object has been attained. 



The problem, however, was by no means so simple as in the 

 case of some mere chemical poison. However effectual the 

 antitoxin might be against the toxin, if it left the bacilli intact, 

 not only would repeated injections be required to maintain the 

 transient immunity to the poison perpetually secreted by the 

 microbes, but the bacilli might by their growth and extension 

 cause obstruction of the respiratory passages. 



Roux, however, whose name must always be mentioned with 

 honour in relation to this subject, effectually disposed of this 

 difficulty. He showed by experiments on animals that a 

 diphtheritic false membrane, rapidly extending and accompanied 

 by surrounding inflammation, was brought to a stand by the use 

 of the antitoxin, and soon dropped off, leaving a healthy sur- 

 face. Whatever be the explanation, the fact was thus established 

 that the antitoxic serum, while it renders the toxin harmless, 

 causes the microbe to languish and disappear. 



No theoretical objection could now be urged against the treat- 

 ment ; and it has during the last two years been extensively 

 tested in practice in various parts of the world, and it has 

 gradually made its way more and more into the confidence of 

 the profession. One important piece of evidence in its favour 

 in this country is derived from the report of the six large hospitals 

 under the management of the London Asylums Board. The 

 medical officers of these hospitals at first naturally regarded the 

 practice with scepticism ; but as it appeared to be at least harm- 

 less, they gave it a trial ; and during the year 1895 '' "'^s very 

 generally employed upon the2i82 cases admitted ; and they have 

 all become convinced of its great value. In the nature of things, 

 if the theory of the treatment is correct, the best results ^must 

 be obtained when the patients are admitted at an early stage of 

 the attack, before there has been time for much poisoning of the 

 system ; and accordingly we learn from the report that, com- 

 paring 1895 "'''h 1894, during which latter year the ordinary 

 treatment had been used, the percentage of mortality, in all the 

 six hospitals combined, among the patients admitted on the 

 first day of the disease, which in 1894 was 22'5, was only 4'6 

 in 1895 ; while for those admitted on the second day the num- 

 bers are 27 for 1894 and I4'8 for 1S95. Thus for cases admitted 

 on the first day the mortality was only one-fifth of what it was 

 in the previous year, and for those entering on the second it was 

 halved. Unfortunately, in the low parts of London, which fur- 

 nish most of these patients, the parents too often delay sending in 

 the children till much later : so that on the average no less than 

 67 5 per cent, were admitted on the fourth day of the disease or 

 later. Hence the aggregate statistics of all cases are not nearly so 

 striking. Nevertheless, taking it altogether, the mortality in 

 1895 was less than had ever before been experienced in those 

 hospitals. I should add that there was no reason to think that 

 the disease was of a milder type than usual in 1895 ; and no 

 change whatever was made in the treatment except as regards 

 the antitoxic injections. 



There is one piece of evidence recorded in the report which, 

 though it is not concerned with high numbers, is well worthy of 

 notice. It relates to a special institution to which convalescents 

 from scarlet fever are sent from all the six hospitals. Such 

 patients occasionally contract diphtheria, and when they do so 

 the added disease has generally proved extremely fatal. In the 

 five years preceding the introduction of the treatment with anti- 

 toxin the mortality from this cause had never been less than 

 50 per cent., and averaged on the whole 61 '9 percent. During 



NO. 1403, VOL. 54] 



1895, under antito-xin, the deaths among the 119 patients of this 

 class were only 7 '5 per cent., or one-eighth of what had been 

 previously experienced. This very striking result seems to be 

 naturally explained by the fact that these patients being already 

 in hospital when the diphtheria appeared, an unusually early 

 opportunity was afforded for dealing with it. 



There are certain cases of so malignant a character from the 

 first that no treatment will probably ever be able to cope with 

 them. But taking all cases together it seems probable that 

 Behring's hope that the mortality may be reduced to 5 per cent, 

 will lie fully realised when the public become alive to the para- 

 mount importance of having the treatment commenced at the 

 outset of the disease 



There are many able workers in the field of Bacteriology 

 whose names time does not permit me to mention, and to whose 

 important labours I cannot refer ; and even those researches of 

 which I have spoken have been, of course, most inadequately 

 dealt with. I feel this especially with regard to Pasteur, whose 

 work shines out more brightly the more his writings are perused. 



I have lastly to bring before you a subject which, though not 

 bacteriological, has intimate relations with bacteria. If a drop 

 of blood is drawn from the finger by a prick with a needle and 

 examined microscopically between two plates of glass, there are 

 seen in it minute solid elements of two kinds, the one pale 

 orange bi-concave discs, which, seen in mass, give the red 

 colour to the vital fluid, the other more or less granular spherical 

 masses of the soft material called protoplasm, destitute of 

 colour, and therefore called the colourless or white corpuscles. 

 It has been long known that if the microscope was placed at 

 such a distance from a fire as to have the temperature of the 

 human body, the white corpuscles might be seen to put out and 

 retract little processes or pseudopodia, and by their 

 means crawl over the .surface of the glass, just like 

 the extremely low forms of animal life termed, from 

 this faculty of changing their form, amcebLie. It was 

 a somewhat weird spectacle, that of seeing what had 

 just before been constituents of our own blood moving 

 about like independent creatures. Vet there was nothing in 

 this inconsistent with what we knew of the fixed components of 

 the animal frame. For example, the surface of a frog's tongue 

 is covered with a layer of cells, each of which is provided with 

 two or more lashing filaments or cilia, and those of all the cells 

 acting in concert cause a constant flow of fluid in a definite 

 direction over the organ. If we gently scrape the surface of 

 the animal's tongue, we can detach some of these ciliated cells ; 

 and on examining them with the microscope in a drop of 

 water, we find that they will continue for an indefinite time 

 their lashing movements, which are just as much living or vital 

 in their character as the writhings of a worm. And as I 

 observed many years ago, these detached cells behave under the 

 influence of a stimulus just like parts connected with the body, 

 the movements of the cilia being excited to greater activity by 

 gentle stimulation, and thrown into a state of temporary 

 inactivity when the irritation was more severe. Thus each con- 

 stituent element of our bodies may be regarded as in one sense 

 an independent living being, though all work together in 

 marvellous harmony for the good of the body politic. The 

 independent movements of the white corpuscles outside the 

 body were therefore not astonishing ; but they long remained 

 matters of mere curiosity. Much interest was called to them by 

 the observation of the German pathologist Cohnheim that in some 

 inflammatory conditions they passed through the pores in the 

 walls of the finest blood-vessels, and thus escaped into the inter- 

 stices of the surrounding tissues. Cohnheim attributed their 

 transit to the pressure of the blood. But why it was that, 

 though larger than the red corpuscles, and containing a nucleus 

 which the red ones have not, they alone passed through the 

 pores of the vessels, or why it was that this emigration of the 

 white corpuscles occurred abundantly in some inflammations and 

 was absent in others, was quite unexplained. 



These white corpuscles, however, have been invested with ex- 

 traordinary new interest by the researches of the Russian 

 naturalist and pathologist, Metchnikoft'. He observed that, 

 after passing through the walls of the vessels, they not only 

 crawl .about like amceba:, but, like them, receive nutritious 

 materials into their soft bodies and digest them. It is thus tliat 

 the efl'ete materials of a tadpole's tail are got rid of; so th.it 

 they play a most important part in the function of absorption. 



But still more interesting observations followed. He found 



