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SULPHANILAMIDE IN SCARLET FEVER
840
ANNOTATIONS PLASMA TRANSFUSION
gether justifiable, however, since individually severe complications were rather conspicuous by their THE Star of Oct. 2 gave a short account of a absence. While admitting that the results of her form of blood-transfusion in which preliminary typing is superfluous. This consists in giving plasma only. investigation do not support routine administration of Reference was made to an announcement before the sulphanilamide in scarlet fever, few would at present American Congress of Obstetricians and Gynecologists feel justified in withholding the drug in cases where virulence is evidently high-e.g. on the by Dr. J. Elliot and Dr. N. Nessett, who are quoted streptococcalof a severe appearance complication. Statistical proof as saying that plasma may be stored for a year or of the of the value remedy in treating severe complilonger and can easily be given by partly trained staff, cations as arise they may take some time to obtain, but such as stretcher-bearers, if necessary in a front-line the of individual clinicians suggests that experience trench. As a matter of fact, however, plasma-transbe of a high order. for example, has it Banks,’ may the fusion is no new idea, and its advantages in treata case of primary streptococcal peritonitis described ment of shock and burns have been clearly stated by Walther.1 Hence it would be interesting to know if in scarlet fever in which rapid sterilisation of the pus was achieved by oral and parenteral administration of any steps are being taken to conserve the plasma from M. & B. 693, the patient ultimately making a good in blood already obtained from volunteer donors the present emergency. This blood is unlikely to keep recovery. longer than 4-6 weeks, after which it will have PASTEUR become unsuitable through haemolysis of the red cells. THE letters and addresses of Pasteur, which form Thousands of volunteers have already given their the last volume of his collected works,5 reveal the inner think that and it is sad to the of blood, greater part this supply may be destined to be poured down the workings of his mind more than his actual experiments. He did not possess the quality popularly described as sink. An excellent opportunity now presents itself brilliance. He mistrusted mental facility and subtlety, to conserve the supernatant plasma of the older samples of stored blood and to test the claims of and despised irony and scepticism. In teaching and those who advocate the use of plasma rather than administration, as well as in his scientific investigawhole blood in the treatment of shock.2 SULPHANILAMIDE
IN SCARLET FEVER
THE aggression of scarlatinal streptococci against the human body is achieved by means of two distinct properties-toxin-production and invasiveness. Streptococcal toxin can be fairly readily neutralised by the use of antiscarlatinal serum, but streptococcal invasion cannot be influenced by serum, except perhaps indirectly. Hence the specific serum treatment of scarlet fever must be regarded as incomplete, and attempts have accordingly been made to supplement it by giving sulphanilamide. These attempts have not yet resulted in unanimity of opinion as to the value of the new remedy in this disease. It is clear that sulphanilamide cannot replace serum in treatment, being distinctly less effective in controlling those manifestations, due to a specific soluble exotoxin, such as rash and initial fever. But whether sulphanilamide should be employed as a routine measure remains a moot point. French,3 thinks not. In her investigation, sulphanilamide or benzyl-sulphanilamide was given to alternate cases of scarlet fever in large doses and over a continuous period of about a month. Thus the average total dose for a child of five years of age or more was no less than 112 g. Antiscarlatinal serum was given, in addition, to cases thought to require it, irrespective of whether thev were in the treated or control series. Although toxic manifestations due to the drug were common, no effect on the initial toxaemia of scarlet fever was noted. nor was there a statistically significant difference in the complication-rates between the two groups of cases. Only 1 death occurred in the combined series of 340 cases, so that no conclusion could be drawn from the fatalitv-rate. French does not believe that low virulence of streptococcal strains could explain the failure of sulphanilamide in her experiment, for complication-rates generally were high. This conclusion may not be alto1. Walther, W. W., Lancet, 1937, 1, 6. 2. See Lancet, Sept. 16, 1939, p. 657. 3. French, J. O., J. Hyg., Camb. September,
1939, p. 581.
tions, he admits that he owed his
success to that infinite capacity for taking pains which has sometimes been described as the chief attribute of genius. His lectures and addresses are a constant psean in praise of will, effort and enthusiasm, the driving forces of his life. He warned his students against considering only the practical value of scientific observations, aptly quoting Franklin-" what is the use" of a newTheoretical knowledge he said, born babe ? " " can foster the spirit of invention, but you must submit every new idea to strict experimental control. The critical faculty alone cannot produce ideas but without it no scientific work can be elaborated." Teaching he considered essential to the scientific worker, "as it, constantly obliged him to review the relationship of his own particular branch to other sciences." He attributed to Lavoisier a greater influence on modern chemistry than either of his contemporaries Scheele or since Lavoisier methodically planned his experiments. " In the field of observation," Pasteur was wont to say, " luck will only favour those minds which are duly prepared and ready." Side by side with the shy investigator humbly deprecating his work and modestly admitting, le when acknowledging international honours, sentiment de mon insuffisance," stalked a vastly different personality, an aggressive fighter impatient of opposition. His friends warned him against the implacable rigour of his dialectic, trying at the same time to restrain his ardour and to allay his fears that the cause of science might be imperilled through the virulent attacks of obscure tract-writers. Not content with the already large number of his adversaries, he created new ones. When his work on fermentation led him to investigate the nature of infectious diseases (incidentally proving the correctness of Robert Boyle’s assertion of two centuries earlier that the study of fermentation might throw more light on "
...
Priestley,
"
4. Banks, H. S. Lancet, 1939, 1, 983. 5. Oeuvres de Pasteur. Collected by Prof. Pasteur Radot. Paris: Masson et Cie. Vol. 7. 1939. Frs.200.
ValléryPp. 666.
ANNOTATIONS PLASMA TRANSFUSION
gether justifiable, however, since individually severe complications were rather conspicuous by their THE Star of Oct. 2 gave a short account of a absence. While admitting that the results of her form of blood-transfusion in which preliminary typing is superfluous. This consists in giving plasma only. investigation do not support routine administration of Reference was made to an announcement before the sulphanilamide in scarlet fever, few would at present American Congress of Obstetricians and Gynecologists feel justified in withholding the drug in cases where virulence is evidently high-e.g. on the by Dr. J. Elliot and Dr. N. Nessett, who are quoted streptococcalof a severe appearance complication. Statistical proof as saying that plasma may be stored for a year or of the of the value remedy in treating severe complilonger and can easily be given by partly trained staff, cations as arise they may take some time to obtain, but such as stretcher-bearers, if necessary in a front-line the of individual clinicians suggests that experience trench. As a matter of fact, however, plasma-transbe of a high order. for example, has it Banks,’ may the fusion is no new idea, and its advantages in treata case of primary streptococcal peritonitis described ment of shock and burns have been clearly stated by Walther.1 Hence it would be interesting to know if in scarlet fever in which rapid sterilisation of the pus was achieved by oral and parenteral administration of any steps are being taken to conserve the plasma from M. & B. 693, the patient ultimately making a good in blood already obtained from volunteer donors the present emergency. This blood is unlikely to keep recovery. longer than 4-6 weeks, after which it will have PASTEUR become unsuitable through haemolysis of the red cells. THE letters and addresses of Pasteur, which form Thousands of volunteers have already given their the last volume of his collected works,5 reveal the inner think that and it is sad to the of blood, greater part this supply may be destined to be poured down the workings of his mind more than his actual experiments. He did not possess the quality popularly described as sink. An excellent opportunity now presents itself brilliance. He mistrusted mental facility and subtlety, to conserve the supernatant plasma of the older samples of stored blood and to test the claims of and despised irony and scepticism. In teaching and those who advocate the use of plasma rather than administration, as well as in his scientific investigawhole blood in the treatment of shock.2 SULPHANILAMIDE
IN SCARLET FEVER
THE aggression of scarlatinal streptococci against the human body is achieved by means of two distinct properties-toxin-production and invasiveness. Streptococcal toxin can be fairly readily neutralised by the use of antiscarlatinal serum, but streptococcal invasion cannot be influenced by serum, except perhaps indirectly. Hence the specific serum treatment of scarlet fever must be regarded as incomplete, and attempts have accordingly been made to supplement it by giving sulphanilamide. These attempts have not yet resulted in unanimity of opinion as to the value of the new remedy in this disease. It is clear that sulphanilamide cannot replace serum in treatment, being distinctly less effective in controlling those manifestations, due to a specific soluble exotoxin, such as rash and initial fever. But whether sulphanilamide should be employed as a routine measure remains a moot point. French,3 thinks not. In her investigation, sulphanilamide or benzyl-sulphanilamide was given to alternate cases of scarlet fever in large doses and over a continuous period of about a month. Thus the average total dose for a child of five years of age or more was no less than 112 g. Antiscarlatinal serum was given, in addition, to cases thought to require it, irrespective of whether thev were in the treated or control series. Although toxic manifestations due to the drug were common, no effect on the initial toxaemia of scarlet fever was noted. nor was there a statistically significant difference in the complication-rates between the two groups of cases. Only 1 death occurred in the combined series of 340 cases, so that no conclusion could be drawn from the fatalitv-rate. French does not believe that low virulence of streptococcal strains could explain the failure of sulphanilamide in her experiment, for complication-rates generally were high. This conclusion may not be alto1. Walther, W. W., Lancet, 1937, 1, 6. 2. See Lancet, Sept. 16, 1939, p. 657. 3. French, J. O., J. Hyg., Camb. September,
1939, p. 581.
tions, he admits that he owed his
success to that infinite capacity for taking pains which has sometimes been described as the chief attribute of genius. His lectures and addresses are a constant psean in praise of will, effort and enthusiasm, the driving forces of his life. He warned his students against considering only the practical value of scientific observations, aptly quoting Franklin-" what is the use" of a newTheoretical knowledge he said, born babe ? " " can foster the spirit of invention, but you must submit every new idea to strict experimental control. The critical faculty alone cannot produce ideas but without it no scientific work can be elaborated." Teaching he considered essential to the scientific worker, "as it, constantly obliged him to review the relationship of his own particular branch to other sciences." He attributed to Lavoisier a greater influence on modern chemistry than either of his contemporaries Scheele or since Lavoisier methodically planned his experiments. " In the field of observation," Pasteur was wont to say, " luck will only favour those minds which are duly prepared and ready." Side by side with the shy investigator humbly deprecating his work and modestly admitting, le when acknowledging international honours, sentiment de mon insuffisance," stalked a vastly different personality, an aggressive fighter impatient of opposition. His friends warned him against the implacable rigour of his dialectic, trying at the same time to restrain his ardour and to allay his fears that the cause of science might be imperilled through the virulent attacks of obscure tract-writers. Not content with the already large number of his adversaries, he created new ones. When his work on fermentation led him to investigate the nature of infectious diseases (incidentally proving the correctness of Robert Boyle’s assertion of two centuries earlier that the study of fermentation might throw more light on "
...
Priestley,
"
4. Banks, H. S. Lancet, 1939, 1, 983. 5. Oeuvres de Pasteur. Collected by Prof. Pasteur Radot. Paris: Masson et Cie. Vol. 7. 1939. Frs.200.
ValléryPp. 666.