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DIPHTHERIA IMMUNISATION.
252
ANNOTATIONS dantly proved to be sound and useful ; that there is still room for improvement is shown in two papers A FORTNIGHT ago, by a majority of 42 out of 470 published in the last number of the Journal of votes, the subscribers to the scheme for a great Pathology and Bacteriology (1932, xxxv., 91 and 142) Hospitals Centre for Birmingham authorised the execu- by Mr. A. T. Glenny, D.Sc., and Miss Mollie Barr of tive to proceed with the first part of the plan. This the Wellcome Foundation at Beckenham. All decision was reached at a meeting of the contributories of antitoxin do not combine equally preparations over which the Lord Mayor of Birmingham presided, firmly with toxin, and with some of them a mixture and at which full statements of all sides of the case which is neutral to a test animal in a volume of 1 c.cm. were made. The proposed centre is the joint extension may become poisonous if it is made up with saline. scheme of the General and the Queen’s Hospitals and to 100 c.cm. That is, the toxin-antitoxin compound will be under the joint management of their boards,[dissociates when it is diluted. now show in a They and is the result of a unanimous recommendation by series of exceptionally interesting experiments that a joint committee appointed by the Hospitals Council the same kind of thing may happen in the body. Thus, composed solely of members of the two hospitals. in one experiment a series of rabbits were injected When the project for the establishment of a hospital intravenously with varying quantities of the same centre with a medical school in proximity to, and toxin-antitoxin mixture. The animal which received working in connexion with, the University was first 0-0005 c.cm. survived, seven rabbits which had doses mooted it met with general acceptance, and in 14 from 0-001 to 0-1 c.cm. died between the fourth and months 620,000 (including the value of the site) was eighth days, while five which received doses ranging promised towards its realisation. Some interesting from 1 to 10 c.cm. all survived the tenth day. The designs were obtained on open competition and the first animal lived because the amount of toxin it winning design was remarkable for its broad minded received was not enough to kill it, the last because the recognition of all the needs of a hospital community.1 dose was so large that when it was diluted in the body Of late, however, the general economic situation has fluids the of dissociation was not sufficient to aroused misgivings, and when it was decided to obtain set free a degree fatal amount of toxin ; the intermediate tenders for erecting the first portion of the buildings an animals died because they had more than enough agitation arose which had for its object the abandon- toxin and the dilution in the body was enough to set ment of the scheme or, at least, its postponement to it free. Was ever the I treachery of a simple experiment a more propitious season. It was urged that it would so well illustrated ?z? And Dr. Glenny substantiates be impossible in present circumstances to erect and his a brilliant corollary. Give a explanation by maintain a hospital with 500 beds and a medical rabbit 10 c.cm. of the it will come to no mixture; school without seriously risking the whole voluntary harm. Two hours later draw off some of its blood hospital system of the city. In addition to the and inject 1 c.cm. of its serum into other rabbits which :E702,000 which the work was estimated to cost, the will die unless they are protected with an adequate matter of maintenance loomed up formidably. On the dose of antitoxin. It seems evident from these other hand the hospital, when completed, will have that a toxin-antitoxin mixture which 100 pay beds, the need of which is generally admitted. experiments harmless when tested on guinea-pigs might proved In the 12 months ending with August last, the General be poisonous in a child, and it is not easy to devise Hospital turned away more than 2000 cases officially any simple method of testing which would expose stated to be in need of " urgent in-patient treatment." mixtures with certainty. For practical Even so the hospital is so short of bed accommodation dangerousit is fortunately unnecessary to solve these that day-rooms have had to be turned into wards, purposes since all possible source of difficulties, particular while, as the result of the persistent congestion, danger can be avoided by using, instead of toxin, the patients have had to be discharged before their time. modification of toxin prepared by treating it with Special departments are overcrowded, and there is formalin. This toxoid is not and cannot become no room for their expansion. One of the advantages and it is as efficacious as toxin as an claimed in favour of immediately starting upon the poisonous, agent for human use. It is clear that work is that economy will be consulted by the inclusion immunising toxin-antitoxin mixtures should be given up. of certain of the service departments required for the complete scheme. Since the meeting referred to, BIRMINGHAM HOSPITALS CENTRE.
the executive board have decided to action until the beginning of next year. Meanwhile a joint appeal is being made by theGeneral, the Queen’s, and the Ear and Throat Hospital for :E90,000. Of this sum 50,000 is asked for by the General Hospital, which last year treated more than 8000 in-patients and over 54,000 out-patients and casualties.
however,
postpone
---
DIPHTHERIA IMMUNISATION. THE deliberate immunisation of children against diphtheria is one of the most substantial advances made in recent years in sanitary bacteriology. There have been troubles and a few accidents, and our knowledge of the details of exactly what happens when toxin rather than toxoid is used is still not wholly complete. The procedure has, however, been abun1 See THE LANCET, 1930, i., 317.
I
THE MINIMAL LETHAL HOOKWORM LOAD.
Two winters ago the faeces of 73 inmates of the National Training School for Boys, Washington, were microscopically examined at the National Institute of Health and the results are now reported by C. E. Baker. Sixty-seven of them came from the hookworm area of the United States, and they showed a detected hookworm infection rate of 34 per cent. C. W. Stiles2 has already reported that none of these boys was seriously ill; some were clinical suspects, while regarding several he would have been prepared to make a diagnosis of hookworm disease on their
histories, and on physical examination quite independently of the microscope. The school being urban in site and sanitation, it is unreasonable to suggest that this infection was acquired in it ; it becomes then a 1 U.S. Pub. Health Reps. 1931, xlvi., 2980. 2 Ibid., 1930, xlv., 1763.
ANNOTATIONS dantly proved to be sound and useful ; that there is still room for improvement is shown in two papers A FORTNIGHT ago, by a majority of 42 out of 470 published in the last number of the Journal of votes, the subscribers to the scheme for a great Pathology and Bacteriology (1932, xxxv., 91 and 142) Hospitals Centre for Birmingham authorised the execu- by Mr. A. T. Glenny, D.Sc., and Miss Mollie Barr of tive to proceed with the first part of the plan. This the Wellcome Foundation at Beckenham. All decision was reached at a meeting of the contributories of antitoxin do not combine equally preparations over which the Lord Mayor of Birmingham presided, firmly with toxin, and with some of them a mixture and at which full statements of all sides of the case which is neutral to a test animal in a volume of 1 c.cm. were made. The proposed centre is the joint extension may become poisonous if it is made up with saline. scheme of the General and the Queen’s Hospitals and to 100 c.cm. That is, the toxin-antitoxin compound will be under the joint management of their boards,[dissociates when it is diluted. now show in a They and is the result of a unanimous recommendation by series of exceptionally interesting experiments that a joint committee appointed by the Hospitals Council the same kind of thing may happen in the body. Thus, composed solely of members of the two hospitals. in one experiment a series of rabbits were injected When the project for the establishment of a hospital intravenously with varying quantities of the same centre with a medical school in proximity to, and toxin-antitoxin mixture. The animal which received working in connexion with, the University was first 0-0005 c.cm. survived, seven rabbits which had doses mooted it met with general acceptance, and in 14 from 0-001 to 0-1 c.cm. died between the fourth and months 620,000 (including the value of the site) was eighth days, while five which received doses ranging promised towards its realisation. Some interesting from 1 to 10 c.cm. all survived the tenth day. The designs were obtained on open competition and the first animal lived because the amount of toxin it winning design was remarkable for its broad minded received was not enough to kill it, the last because the recognition of all the needs of a hospital community.1 dose was so large that when it was diluted in the body Of late, however, the general economic situation has fluids the of dissociation was not sufficient to aroused misgivings, and when it was decided to obtain set free a degree fatal amount of toxin ; the intermediate tenders for erecting the first portion of the buildings an animals died because they had more than enough agitation arose which had for its object the abandon- toxin and the dilution in the body was enough to set ment of the scheme or, at least, its postponement to it free. Was ever the I treachery of a simple experiment a more propitious season. It was urged that it would so well illustrated ?z? And Dr. Glenny substantiates be impossible in present circumstances to erect and his a brilliant corollary. Give a explanation by maintain a hospital with 500 beds and a medical rabbit 10 c.cm. of the it will come to no mixture; school without seriously risking the whole voluntary harm. Two hours later draw off some of its blood hospital system of the city. In addition to the and inject 1 c.cm. of its serum into other rabbits which :E702,000 which the work was estimated to cost, the will die unless they are protected with an adequate matter of maintenance loomed up formidably. On the dose of antitoxin. It seems evident from these other hand the hospital, when completed, will have that a toxin-antitoxin mixture which 100 pay beds, the need of which is generally admitted. experiments harmless when tested on guinea-pigs might proved In the 12 months ending with August last, the General be poisonous in a child, and it is not easy to devise Hospital turned away more than 2000 cases officially any simple method of testing which would expose stated to be in need of " urgent in-patient treatment." mixtures with certainty. For practical Even so the hospital is so short of bed accommodation dangerousit is fortunately unnecessary to solve these that day-rooms have had to be turned into wards, purposes since all possible source of difficulties, particular while, as the result of the persistent congestion, danger can be avoided by using, instead of toxin, the patients have had to be discharged before their time. modification of toxin prepared by treating it with Special departments are overcrowded, and there is formalin. This toxoid is not and cannot become no room for their expansion. One of the advantages and it is as efficacious as toxin as an claimed in favour of immediately starting upon the poisonous, agent for human use. It is clear that work is that economy will be consulted by the inclusion immunising toxin-antitoxin mixtures should be given up. of certain of the service departments required for the complete scheme. Since the meeting referred to, BIRMINGHAM HOSPITALS CENTRE.
the executive board have decided to action until the beginning of next year. Meanwhile a joint appeal is being made by theGeneral, the Queen’s, and the Ear and Throat Hospital for :E90,000. Of this sum 50,000 is asked for by the General Hospital, which last year treated more than 8000 in-patients and over 54,000 out-patients and casualties.
however,
postpone
---
DIPHTHERIA IMMUNISATION. THE deliberate immunisation of children against diphtheria is one of the most substantial advances made in recent years in sanitary bacteriology. There have been troubles and a few accidents, and our knowledge of the details of exactly what happens when toxin rather than toxoid is used is still not wholly complete. The procedure has, however, been abun1 See THE LANCET, 1930, i., 317.
I
THE MINIMAL LETHAL HOOKWORM LOAD.
Two winters ago the faeces of 73 inmates of the National Training School for Boys, Washington, were microscopically examined at the National Institute of Health and the results are now reported by C. E. Baker. Sixty-seven of them came from the hookworm area of the United States, and they showed a detected hookworm infection rate of 34 per cent. C. W. Stiles2 has already reported that none of these boys was seriously ill; some were clinical suspects, while regarding several he would have been prepared to make a diagnosis of hookworm disease on their
histories, and on physical examination quite independently of the microscope. The school being urban in site and sanitation, it is unreasonable to suggest that this infection was acquired in it ; it becomes then a 1 U.S. Pub. Health Reps. 1931, xlvi., 2980. 2 Ibid., 1930, xlv., 1763.