November 22, 1912] 



SCIENCE 



701 



to be accorded to the question of specific 

 type in the infecting bacteria. 



In pursuing the devious courses of in- 

 fection, of which examples have just been 

 given, the fact has emerged that the effec- 

 tiveness of curative means will be deter- 

 mined not only by the intrinsic qualities of 

 the parasites but also in a high degree by 

 the manner of location and distribution of 

 the parasites themselves within the infected 

 host. Whether they have a general distri- 

 bution throughout the blood and tissues or 

 whether they are confined within an impor- 

 tant organ or part may be the factor de- 

 termining the ease with which they can be 

 reached not only by the natural curative 

 principles of the body but also by artificial 

 curative agents introduced into the body.^° 



The parasite, struggling to survive, with- 

 draws, at one time, into situations to which 

 the curative substances gain access imper- 

 fectly and with difficulty, causing thereby 

 local infections more or less cut off from 

 the general circulation and the curative 

 substances purveyed by the blood. This is 

 the condition met with in focalized inflam- 

 mation and in infections of specialized por- 

 tions of the body, such as the great serous 

 cavities that r.eceive a modified and dilute 

 lymph secretion carrying reduced quanti- 

 ties of the protective principles contained 

 within the blood. The quality of lymph 

 in the several serous cavities and in the 

 various tissues is not the same, and the 

 lowest limit of strength is reached by the 

 cerebrospinal fluid that functions as the 

 lymph of the brain and spinal cord. The 

 exclusion of dissolved substances from the 

 cerebrospinal liquid is a provision of great 

 importance, but is not an unmixed good. 

 For while it affords protection to the sensi- 

 tive nervous tissues from injurious chemi- 



^ Flexner, Simon, Boston Medical and Surgical 

 Journal, 1911, CLXV., 709; The Harben Lectures, 

 Journal of State Medicine, 1912, XX., 130, 193, 

 257. 



cals, it deprives them also of curative prin- 

 ciples. Happily this deficiency has now 

 been superseded by a method of direct local 

 treatment by injections that has given ex- 

 cellent results in meningitis, but is now 

 being employed in luetic affections of the 

 meninges and central nervous organs with 

 encouraging results.^^ 



Remote as some of them may seem, the 

 considerations to which I have called your 

 attention have a bearing more or less vital 

 upon the problem of a specific and effective 

 treatment of poliomyelitis. Poliomyelitis 

 is not a disease with a very high mortality ; 

 its chief terror lies in its appalling power 

 to produce deformities. When death does 

 occur it is not the result, as in many infec- 

 tions, of a process of poisoning that robs 

 the patient of strength and consciousness 

 before its imminence, but is caused solely 

 by paralysis of the respiratory function, 

 sometimes with merciful suddenness but 

 often with painful slowness, without in any 

 degree obscuring the consciousness of the 

 suffocating victim until just before the end 

 is reached. No more terrible tragedy can 

 be witnessed. 



I have already laid before you certain 

 facts regarding immunity in poliomyelitis 

 and it remains to be added that the em- 

 ployment for treatment of the immune 

 serum, taken from monkeys or from hu- 

 man beings, exercises a definite if not very 

 strong protective action upon inoculated 

 monkeys. Either the disease is prevented 

 altogether or its evolution is modified in 

 such a manner as to diminish its severity. 

 When the virus used for inoculation is 

 highly adapted to the monkey and thus 

 very virulent it is more difficult to control 

 the result than when it departs less from 

 the original human type and is less active. 



^' Swift and Ellis, New YorJc Medical Journal, 

 1912, XGVI., 53. Wechselmann, Deutsche medi- 

 zinische Wochenschrift, 1912, XXXVIII., 1446. 



