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SERUM TREATMENT OF ACUTE STAPHYLOCOCCAL INFECTIONS
261 and the
psychological cause of discontent and While efforts on these lines are being made in this country, the progress of industrial medicine in civilised nations is watched by the International Labour Office at Geneva. Its report1 for 1933 shows that world-wide action is being taken to prevent industrial poisoning from lead, mercury, phosphorus and other toxic substances, and that much is being done to meet the spread of anthrax and the ravages of silicosis, ankylostomiasis and occupational cancer. Legislation to protect women and children employed in industry is now in force in most countries, including Japan, India and China. It is fairly clear that unemployment and depression have led to malnutrition and morbidity in direct proportion to the non-existence in any country of social legislation on the lines of unemployment insurance, and throughout the report recognition is given to the part played by Great Britain in initiating and furthering industrial work,
ill-health.
hygiene. SERUM TREATMENT OF ACUTE STAPHYLOCOCCAL INFECTIONS
quantities. Dolman rightly insists that should be given at the earliest justifiable moment, and this presumably would tend to obviate the necessity for very large doses. In his first paper he describes the preparation of the serum, and in setting forth the various properties of staphylococcal toxin makes out a strong theoretical case for using the remedy ; but in this section the criticism can be made that although he recognises the importance of staphylococcal leucocidin in the pathology of the infection, he does not seem to have tested his antiserum for its ability to neutralise this factor-the production of which by different strains does not run parallel with the production of hæmolysin. Although, however, the papers may be in some respects open to criticism, they deserve serious attention, especially from clinicians, who are apt to regard all perhaps " antisera," with one or two exceptions, as of little value, if not actually dangerous. Although the use of staphylococcal antitoxin can never take the place of skilful surgical intervention, it may often be of great assistance in combating infection and limiting its spread.
to moderate
the
serum
Dr. C. E. Dolman’s work on the treatment of THE AMBULANCE WORK OF THE ORDER acute staphylococcal infections has been attracting OF ST. JOHN a good deal of notice in Canada, and it is interesting THERE is confusion, it seems, in the minds of many to see the first two instalments of his report on it.3 as of the Order, and particularly to the constitution The results obtained in his 104 cases are summarised as to between the St. John Ambulance the distinction in the first paper, while the second provides a more John Association the Ambulance Brigade. and St. detailed description of 40 in which blood culture was of the Association a pity. This is The The difference morprimary object between the negative. striking in is first aid and kindred the instruction of in culture " cases deaths persons (4 tality these " negative that its purpose is and it has achieved among 40), and in the "positive" (35 among 64), shows subjects ; shown fact the that since its that staphylococcal antitoxin cannot be expected to by inception it has issued million over to successful at certificates students 2t work miracles in face of an established septicaemia with multiple metastatic abscesses. The same is of its examinations, and this figure increases annually course true of every other anti-serum-they are all of by some 40,000 or 50,000. Thus there will be found in the ranks of the police, on the railways and other service when the disease has before employed greatest forms of passenger transport, in mines, in industry, progressed too far-but it applies with special force to in fishing vessels, in lighthouses and among coaststaphylococcal infections, because in these every means tissue destruction and the guards lesion persons trained to give first aid properly. So secondary formation of a new abscess. In Dolman’s series, as valuable has this expert knowledge proved that in others, it is exceedingly difficult to form a definite qualification in its principles is often insisted upon by estimate of the effect of the antitoxin, because no employers of labour and the subject has been introtwo cases of severe staphylococcal infection can be duced into the curriculum of schools and education reasonably compared. Since no satisfactory controls establishments. The dividing line between the Association and the can be provided, one has to rely mainly on clinical evidence of improvement. Such evidence is by no Brigade is that the former issues the text-books of the Order, arranges for lectures and examinations, means always reliable, but in the present cases it is of real value ; and grants certificates to those who pass, and teaches the seems to indicate that antitoxin the significant fact appears that clinical improvement practice and principles of first aid to the different classes of the community just enumerated. But the was commonly accompanied by an increase in the antitoxin content of the patient’s serum. Amongst certificated persons all use their first aid knowledge the more severe cases are 32 of acute osteomyelitis in on the premises where they are employed, in other children, in which blood culture was positive before words the lost time is the employer’s time. The operation, and Dolman makes the extraordinary Brigade give their services away from the place of statement that the usual mortality in such cases is employment, in their own time and at their own approximately 50 per cent. ; whereas in this country expense. This is a body of voluntary unpaid workers it is held by many that in osteomyelitis a positive of whom there are in this country some 60,000 men blood culture before operation is so common as to and women, and overseas some 15,000. They practise have little prognostic significance. The serum was in their spare time so that they may retain and usually given intramuscularly, since it was found improve their knowledge of first aid, and they give that intravenous injection gave rise to serious up their leisure in the evenings and at week-ends and reactions, and the dosage was very variable. Super- holidays to the service of the public. The call on the services of the Brigade to-day has ficial infections, such as carbuncle, seemed to respond been made acute by the development of motoring, as a rule to less than 100 c.cm. ; in other cases, with a more general type of infection, the amount bringing a sad roll of accidents in its train. The was sometimes very large, reaching a total of motor abuses are being treated homoeopathically by given 600 c.cm., but there were some examples in which the motor ambulance service of the Brigade. This pyaemia and to xæmia appeared to respond excellently can now set over 250 ambulances in action and so relieve the local police in the case of street and road 2 Industrial Medicine in 1933. International Labour Office accidents, in addition to transporting ordinary medical Year-Book, Geneva. 1934. cases to centres of treatment. Assoc. 3 Canad. Med. Jour., June and July, 1934
psychological cause of discontent and While efforts on these lines are being made in this country, the progress of industrial medicine in civilised nations is watched by the International Labour Office at Geneva. Its report1 for 1933 shows that world-wide action is being taken to prevent industrial poisoning from lead, mercury, phosphorus and other toxic substances, and that much is being done to meet the spread of anthrax and the ravages of silicosis, ankylostomiasis and occupational cancer. Legislation to protect women and children employed in industry is now in force in most countries, including Japan, India and China. It is fairly clear that unemployment and depression have led to malnutrition and morbidity in direct proportion to the non-existence in any country of social legislation on the lines of unemployment insurance, and throughout the report recognition is given to the part played by Great Britain in initiating and furthering industrial work,
ill-health.
hygiene. SERUM TREATMENT OF ACUTE STAPHYLOCOCCAL INFECTIONS
quantities. Dolman rightly insists that should be given at the earliest justifiable moment, and this presumably would tend to obviate the necessity for very large doses. In his first paper he describes the preparation of the serum, and in setting forth the various properties of staphylococcal toxin makes out a strong theoretical case for using the remedy ; but in this section the criticism can be made that although he recognises the importance of staphylococcal leucocidin in the pathology of the infection, he does not seem to have tested his antiserum for its ability to neutralise this factor-the production of which by different strains does not run parallel with the production of hæmolysin. Although, however, the papers may be in some respects open to criticism, they deserve serious attention, especially from clinicians, who are apt to regard all perhaps " antisera," with one or two exceptions, as of little value, if not actually dangerous. Although the use of staphylococcal antitoxin can never take the place of skilful surgical intervention, it may often be of great assistance in combating infection and limiting its spread.
to moderate
the
serum
Dr. C. E. Dolman’s work on the treatment of THE AMBULANCE WORK OF THE ORDER acute staphylococcal infections has been attracting OF ST. JOHN a good deal of notice in Canada, and it is interesting THERE is confusion, it seems, in the minds of many to see the first two instalments of his report on it.3 as of the Order, and particularly to the constitution The results obtained in his 104 cases are summarised as to between the St. John Ambulance the distinction in the first paper, while the second provides a more John Association the Ambulance Brigade. and St. detailed description of 40 in which blood culture was of the Association a pity. This is The The difference morprimary object between the negative. striking in is first aid and kindred the instruction of in culture " cases deaths persons (4 tality these " negative that its purpose is and it has achieved among 40), and in the "positive" (35 among 64), shows subjects ; shown fact the that since its that staphylococcal antitoxin cannot be expected to by inception it has issued million over to successful at certificates students 2t work miracles in face of an established septicaemia with multiple metastatic abscesses. The same is of its examinations, and this figure increases annually course true of every other anti-serum-they are all of by some 40,000 or 50,000. Thus there will be found in the ranks of the police, on the railways and other service when the disease has before employed greatest forms of passenger transport, in mines, in industry, progressed too far-but it applies with special force to in fishing vessels, in lighthouses and among coaststaphylococcal infections, because in these every means tissue destruction and the guards lesion persons trained to give first aid properly. So secondary formation of a new abscess. In Dolman’s series, as valuable has this expert knowledge proved that in others, it is exceedingly difficult to form a definite qualification in its principles is often insisted upon by estimate of the effect of the antitoxin, because no employers of labour and the subject has been introtwo cases of severe staphylococcal infection can be duced into the curriculum of schools and education reasonably compared. Since no satisfactory controls establishments. The dividing line between the Association and the can be provided, one has to rely mainly on clinical evidence of improvement. Such evidence is by no Brigade is that the former issues the text-books of the Order, arranges for lectures and examinations, means always reliable, but in the present cases it is of real value ; and grants certificates to those who pass, and teaches the seems to indicate that antitoxin the significant fact appears that clinical improvement practice and principles of first aid to the different classes of the community just enumerated. But the was commonly accompanied by an increase in the antitoxin content of the patient’s serum. Amongst certificated persons all use their first aid knowledge the more severe cases are 32 of acute osteomyelitis in on the premises where they are employed, in other children, in which blood culture was positive before words the lost time is the employer’s time. The operation, and Dolman makes the extraordinary Brigade give their services away from the place of statement that the usual mortality in such cases is employment, in their own time and at their own approximately 50 per cent. ; whereas in this country expense. This is a body of voluntary unpaid workers it is held by many that in osteomyelitis a positive of whom there are in this country some 60,000 men blood culture before operation is so common as to and women, and overseas some 15,000. They practise have little prognostic significance. The serum was in their spare time so that they may retain and usually given intramuscularly, since it was found improve their knowledge of first aid, and they give that intravenous injection gave rise to serious up their leisure in the evenings and at week-ends and reactions, and the dosage was very variable. Super- holidays to the service of the public. The call on the services of the Brigade to-day has ficial infections, such as carbuncle, seemed to respond been made acute by the development of motoring, as a rule to less than 100 c.cm. ; in other cases, with a more general type of infection, the amount bringing a sad roll of accidents in its train. The was sometimes very large, reaching a total of motor abuses are being treated homoeopathically by given 600 c.cm., but there were some examples in which the motor ambulance service of the Brigade. This pyaemia and to xæmia appeared to respond excellently can now set over 250 ambulances in action and so relieve the local police in the case of street and road 2 Industrial Medicine in 1933. International Labour Office accidents, in addition to transporting ordinary medical Year-Book, Geneva. 1934. cases to centres of treatment. Assoc. 3 Canad. Med. Jour., June and July, 1934