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LIVE AND DEAD VACCINES.
1020
physician or surgeon and registrar, followed long period of more or less continual presence the hospital as clinical assistant until a vacancy
little academic to condemn a method which holds out at least some slight chance of success on theoretical considerations of our ignorance of what might happen. The success, too, with dead vaccines in plague and pneumonia is scarcely as great as one would like ; the pneumococcus, indeed, has resisted bacteriology and hygiene with most disappointing A return to live vaccines would certainly success. be a return to an earlier practice ; it does not necessarily follow that it would be ineffective or dangerous.
house
by in
seems a
a
should arise on the honorary staff. It is this intermediate period of "hanging round hospital "prohibitive to those without private means-that can now usefully be filled by tenure of a research fellowship. The varied record of achievement of the Beit fellows is a sign that whatever the aspirations of a newly-qualified man or woman, the tenure of such a fellowship is likely to advance them.
THE LIVE AND
DEAD
VACCINES.
THE stricter sect of the pharmacologists are apt to say that there are about half a dozen drugs which really have some action which is worth considering, and that a good deal of the rest of the pharmacopoeia might well go the way of sarsaparilla. What they mean is that only a few drugs have a definite curative action which is so obvious that it cannot be missed by the superficial observation of a few cases. It is one of the great problems of therapeutics to decide for certain whether the effects of " tonics " and " alteratives " and such like really justify the vast quantities of them which are prescribed and drunk. In their favour is the mass experience of practising medical men ; against them is the fact that their use is empirical, and their actions, if any, inexplicable. The pharmacological use of bacterial bodies and of substances derived from them came in under the influence of one of the greatest of modern biological discoveries-the immunological species-specificity of proteids-and it was natural that in the earlier trials this specificity should have controlled the choice of the remedial agent ; to try to protect against typhoid fever by injecting dead anthrax bacilli would have been an attempt of almost inconceivable originality. But as Prof. J. McIntosh points out in his presidential address to the Pathological Section of the Royal Society of Medicine, which we printed on Oct. 30th, there has slowly grown up a body of varied observations which show that the injection of any foreign proteid may rouse the body to a response which may be favourable against any infection, and, indeed, against some morbid conditions which are not clearly known to have an infective origin. It is not known why ulcers of the leg should be improved and cured by the injection of the bacteria which find their way into distilled water or by an intravenous dose of boiled milk or by an extra large quantity of any bacterial vaccine. The practice is at present empirical. Prof. McIntosh suggests that these non-specific injections throw the body into a state analogous to the fever due to infection and help the general resistance as a poultice helps local resistance. It may well be so, though much more demonstrative evidence is needed before this explanation can be regarded as wholly satisfactory. Whatever its rationale, however, the method is clearly of some therapeutic value, in some It cases, notably general paralysis, of a high order. is, indeed, an alterative," as anyone who has experienced protein shock therapy will readily agree. If it were better understood it would be easier to use it more efficiently, and it is of good augury that it should be favourably considered from a point of view where specificity generally reigns supreme. Prof. Mclntosh puts forward other conclusions which are also open to some differences of opinion. He regards the use of living vaccines as a retrograde step, which should be rigorously opposed, having in mind the recent discovery of vaccinial encephalitis, and looking with suspicion on Calmette’s advocacy of a live vaccine of attenuated tubercle bacilli. It is possible that a dead vaccine virus may be as efficacious against small-pox as killed rabies virus seems to be, and it is most desirable that every effort should be made to find out whether this is so. But it can hardly be denied that all attempts to protect against tuberculosis with dead tubercle bacilli have failed, and in the face of the importance of the problem it
frankly
"
z,
’, ’ I
INCIDENCE OF CANCER
IN AMERICA.
recent issue of the Bulletin of the Office International d’Hygiene Publique Dr. W. W. King, of the U.S. Public Health Service, discusses the incidence of malignant disease in the United States It is only since 1900 that complete of America. statistics have been available, but even within the comparatively short period of a quarter of a century cancer has passed from the ninth to the fourth place among the principal causes of death. In 1900 deaths from malignant new growths formed 3’6 per cent. of the total mortality, whereas in 1924 the percentage had nearly doubled, reaching 7-75. An exhaustive inquiry was set on foot some years ago by the U.S. Public Health Department in order to ascertain how far the apparently increased incidence of cancer was real. An analysis of the tables brings out a number of interesting points. Thus, in investigating the cancer mortality-rate in various age-groups, it was found that the increased percentage-rate occurred from the age of 20 to 29 years and upwards, but was most marked from 70 years of age. It is pointed out, however, that, as in other countries, there has been a marked decline in the number of certificates in which the cause of death is " unknown " or ascribed to senility, the greater accuracy of modern diagnosis also being reflected in the drop in the number of deaths ascribed to benign tumours. These and other factors probably account for about 30 per cent. of the increased cancer mortality-rate, the remaining 70 per cent. representing the true increase. With regard to the site of malignant tumours, there is a markedly greater increase in the incidence of cancer affecting certain of the more accessible organs, such as the tongue, breast, or uterus, than in that of less accessible sites, such as stomach or liver, the increase ranging from 65 per cent. in cases of cancer of the female genital organs and 103 per cent. in cancer of the oral cavity, to 51 per cent. in cancer of stomach or liver. The greatest increase of all, however, was found in cancer of the peritoneum, intestine, and rectum, which amounted to 148 per cent. in the 20 years under review. As far as cancer of the breast is concerned, it is the age-group 30-39 years which shows the greatest increase in the deathrate. On the other hand, in cancer of the stomach and liver, which accounts for 36 per cent. of all cancer deaths in the United States, the greatest increase appeared in the age-groups above 40 years. Analysis of the statistics furnished by 34 of the United States and by a large number of towns with more than 100,000 inhabitants shows that, generally speaking, the Northern States have a higher percentage of deaths from cancer than the Southern States. Negro and white races appear to be equally susceptible. IN
a
ANGINA
PECTORIS.
Angina pectoris was known to Hippocrates and Erasistratus, but Heberden was the first of later physicians to describe it, using in 1768 the name it still bears. Parry first suggested calcification of the coronary artery as a cause, but did not follow up his hypothesis with anatomical proof. Jurine, in 1815, suggested as the cause a neuralgia of the pneumogastric and phrenic nerves, and Latham, in 1846, put forward a theory that it was due to cramp of the heart-muscle. Bernard was the first to produce an attack artificially by nicotine, and later work
physician or surgeon and registrar, followed long period of more or less continual presence the hospital as clinical assistant until a vacancy
little academic to condemn a method which holds out at least some slight chance of success on theoretical considerations of our ignorance of what might happen. The success, too, with dead vaccines in plague and pneumonia is scarcely as great as one would like ; the pneumococcus, indeed, has resisted bacteriology and hygiene with most disappointing A return to live vaccines would certainly success. be a return to an earlier practice ; it does not necessarily follow that it would be ineffective or dangerous.
house
by in
seems a
a
should arise on the honorary staff. It is this intermediate period of "hanging round hospital "prohibitive to those without private means-that can now usefully be filled by tenure of a research fellowship. The varied record of achievement of the Beit fellows is a sign that whatever the aspirations of a newly-qualified man or woman, the tenure of such a fellowship is likely to advance them.
THE LIVE AND
DEAD
VACCINES.
THE stricter sect of the pharmacologists are apt to say that there are about half a dozen drugs which really have some action which is worth considering, and that a good deal of the rest of the pharmacopoeia might well go the way of sarsaparilla. What they mean is that only a few drugs have a definite curative action which is so obvious that it cannot be missed by the superficial observation of a few cases. It is one of the great problems of therapeutics to decide for certain whether the effects of " tonics " and " alteratives " and such like really justify the vast quantities of them which are prescribed and drunk. In their favour is the mass experience of practising medical men ; against them is the fact that their use is empirical, and their actions, if any, inexplicable. The pharmacological use of bacterial bodies and of substances derived from them came in under the influence of one of the greatest of modern biological discoveries-the immunological species-specificity of proteids-and it was natural that in the earlier trials this specificity should have controlled the choice of the remedial agent ; to try to protect against typhoid fever by injecting dead anthrax bacilli would have been an attempt of almost inconceivable originality. But as Prof. J. McIntosh points out in his presidential address to the Pathological Section of the Royal Society of Medicine, which we printed on Oct. 30th, there has slowly grown up a body of varied observations which show that the injection of any foreign proteid may rouse the body to a response which may be favourable against any infection, and, indeed, against some morbid conditions which are not clearly known to have an infective origin. It is not known why ulcers of the leg should be improved and cured by the injection of the bacteria which find their way into distilled water or by an intravenous dose of boiled milk or by an extra large quantity of any bacterial vaccine. The practice is at present empirical. Prof. McIntosh suggests that these non-specific injections throw the body into a state analogous to the fever due to infection and help the general resistance as a poultice helps local resistance. It may well be so, though much more demonstrative evidence is needed before this explanation can be regarded as wholly satisfactory. Whatever its rationale, however, the method is clearly of some therapeutic value, in some It cases, notably general paralysis, of a high order. is, indeed, an alterative," as anyone who has experienced protein shock therapy will readily agree. If it were better understood it would be easier to use it more efficiently, and it is of good augury that it should be favourably considered from a point of view where specificity generally reigns supreme. Prof. Mclntosh puts forward other conclusions which are also open to some differences of opinion. He regards the use of living vaccines as a retrograde step, which should be rigorously opposed, having in mind the recent discovery of vaccinial encephalitis, and looking with suspicion on Calmette’s advocacy of a live vaccine of attenuated tubercle bacilli. It is possible that a dead vaccine virus may be as efficacious against small-pox as killed rabies virus seems to be, and it is most desirable that every effort should be made to find out whether this is so. But it can hardly be denied that all attempts to protect against tuberculosis with dead tubercle bacilli have failed, and in the face of the importance of the problem it
frankly
"
z,
’, ’ I
INCIDENCE OF CANCER
IN AMERICA.
recent issue of the Bulletin of the Office International d’Hygiene Publique Dr. W. W. King, of the U.S. Public Health Service, discusses the incidence of malignant disease in the United States It is only since 1900 that complete of America. statistics have been available, but even within the comparatively short period of a quarter of a century cancer has passed from the ninth to the fourth place among the principal causes of death. In 1900 deaths from malignant new growths formed 3’6 per cent. of the total mortality, whereas in 1924 the percentage had nearly doubled, reaching 7-75. An exhaustive inquiry was set on foot some years ago by the U.S. Public Health Department in order to ascertain how far the apparently increased incidence of cancer was real. An analysis of the tables brings out a number of interesting points. Thus, in investigating the cancer mortality-rate in various age-groups, it was found that the increased percentage-rate occurred from the age of 20 to 29 years and upwards, but was most marked from 70 years of age. It is pointed out, however, that, as in other countries, there has been a marked decline in the number of certificates in which the cause of death is " unknown " or ascribed to senility, the greater accuracy of modern diagnosis also being reflected in the drop in the number of deaths ascribed to benign tumours. These and other factors probably account for about 30 per cent. of the increased cancer mortality-rate, the remaining 70 per cent. representing the true increase. With regard to the site of malignant tumours, there is a markedly greater increase in the incidence of cancer affecting certain of the more accessible organs, such as the tongue, breast, or uterus, than in that of less accessible sites, such as stomach or liver, the increase ranging from 65 per cent. in cases of cancer of the female genital organs and 103 per cent. in cancer of the oral cavity, to 51 per cent. in cancer of stomach or liver. The greatest increase of all, however, was found in cancer of the peritoneum, intestine, and rectum, which amounted to 148 per cent. in the 20 years under review. As far as cancer of the breast is concerned, it is the age-group 30-39 years which shows the greatest increase in the deathrate. On the other hand, in cancer of the stomach and liver, which accounts for 36 per cent. of all cancer deaths in the United States, the greatest increase appeared in the age-groups above 40 years. Analysis of the statistics furnished by 34 of the United States and by a large number of towns with more than 100,000 inhabitants shows that, generally speaking, the Northern States have a higher percentage of deaths from cancer than the Southern States. Negro and white races appear to be equally susceptible. IN
a
ANGINA
PECTORIS.
Angina pectoris was known to Hippocrates and Erasistratus, but Heberden was the first of later physicians to describe it, using in 1768 the name it still bears. Parry first suggested calcification of the coronary artery as a cause, but did not follow up his hypothesis with anatomical proof. Jurine, in 1815, suggested as the cause a neuralgia of the pneumogastric and phrenic nerves, and Latham, in 1846, put forward a theory that it was due to cramp of the heart-muscle. Bernard was the first to produce an attack artificially by nicotine, and later work