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The variola-vaccinia flocculation reaction
19.~1.
PUBLIC HEALTH.
service. The events of the period of the meeting at Eastbourne have well borne out anticipations in this direction, and it is not at all out of place to offer congratulations to Dr. Willoughby on the success achieved, to which it may be claimed he contributed in no small degree.
The Census o f 1 9 3 1 . great part of the introduction A ofVERY the Registrar-General to his preliminary report on the census* has reference to the work done as enumerators by the unemployed, and suggests that a great deal of worry and anxiety must have been caused, not only to the Registrar-General himself but to local officers by a number of these men. To persons in the municipal service who hear sad tales from time to time of colleagues concerned in the business of elections the fact that there was trouble comes as no surprise. Apart from unburdening himself on the unemployed question, the Registrar-General gives some interesting information in his introduction with regard to the census itself and the results thereof. Most of these, no doubt, medical officers of health have already studied and digested, particularly such as refer to their own areas. The total population of Great Britain (44,790,485) is the largest yet recorded. To it England and Wales contribute 39,947,931, having increased their population since 1921 by 5.4 per cent. Amongst interesting points revealed is that though, of course, there is a preponderance of females over males, the female majority being 1,670,243, the ratio of females to males (1,087 to 1,000) is less than at the census of 1921. The majority in this latter year was 1,736,221. The number of births between 1921 and 1931 was more than a million and a quarter fewer than in the preceding ten years, and it is entirely due to this that the increase in the population is so comparatively low. That there has been so much of a fall in the number of births is not unexpected by persons engaged in public health work who have had to report year by year that the birth-rate is " the lowest yet recorded." The rate of 16-3 for the country has been reached by a steady fall each year during the last ten years; 16.3, as a fact, being half or less than half of that recorded in pre-war years. There are throughout the country a number *H.M. Statior/ery Office.
4s. net.
339
of areas in which more or less unexpectedly the population has been found to have decreased, but so far as can be made out there is no part in which the decreases are more startling or greater than in the metropolitan area. In the administrative county the decrease amounts to 87,702, and in the metropolitan boroughs to 84,989. Only some eight of these show an increase, greatest in the two most important dormitory boroughs, Lewisham and Wandsworth, the former giving 45,748, and the latter 24,794. The largest decreases are in Camberwell (15,825) and Stepney (24,454). Most of those who constitute the decrease appear to have gone to Essex, S u r r e y , Middlesex, Hertfordshire and Buckinghamshire, all of which show a very marked increase over 1921. When the time comes for the preparation of the annual report for 1931, the new census figures will really come into use in health departments and by medical officers of health, and there will offer the opportunity of comparing, considering and discussing the differences between the results obtained by actually counting the population and those reached as a result of making estimates. *
*
*
#
The Variola- Vaccinia Flocculation Reaction. Y none more than medical officers of health B has the absence of a test that would help in the diagnosis of cases of smallpox been felt, and this because they are usually called upon to make the. final decision and the responsibility they have to bear in relation to the disease in their district is so very great. None, therefore, viewed with greater interest the work done upon the " flocculation " test in 1925 by Dr. M. H. Gordon or have watched more closely or more expectantly the further investigations conducted by Professor TuUoch and Drs. Burgess and Craigie of Dundee. The hopes originally aroused by Dr. Gordon that in the flocculation test there was something that might readily prove of great assistance have been greatly added to by these other workers, and in a report by Professor Tulloch and Dr. Craigie just issued by the Medical Research Council s . information is forthcoming that cannot but encourage belief that he test is one upon which absolute reliance may be placed and that in time will become available for use in cases of difficulty. Not only so, *Special Report Series, No. 156. H.M. Stationery Office, 1931. pp. 129, illustrated. Price 3s. net.
3~o
PUBLIC HEALTH.
but out of the work done there may develop results capable of conferring benefits very far reaching in the realm of preventive medicine. So far as the test is concerned, the findings of Professor Tulloch and Dr. Craigie leave no doubt as to the accuracy of the results obtainable, for the test has now been applied to over two hundred specimens of material with an experimental error of less than 1.5 per cent. It has also been definitely shown that the flocculation which occurs when antivaccinia serum is brought into contact with extracts of vaccinia or variola material is not due to adventitious antibodies reacting with secondarily infecting bacteria that may be present on the skin. Further, the serological identity of variola major and variola minor with both dermal vaccinia and generalized neurovaccinia has been established. The mechanism of the test is discussed by the authors, and the influence of different factors upon the delicacy and specificity of the flocculation is described. The reaction resembles a precipitation rather than an agglutination, and on this observation is based the section of the report giving a detailed description of the methods both of preparing the reagents required and of making the test itself. Special interest attaches to the last three sub-divisions of the report. Although admittedly incomplete, they break new ground in the study of immunity against smallpox. The questions dealt with are the action of antivaccinia serum upon vaccinia virus in vitro, the use of antivaccinia serum in giving passive protection against infection, and the production of immunity by the administration of vaccinia virus exposed to antivaccinia serum. Flocculating serum seems to form a moderately stable union with virus in vitro, and mixtures of the serum with infective material do not exhibit the so-called ' dilution phenomenon ' on dermal inoculation. This suggests t h a t the quality of the antibodies in active flocculating antivaccinia serum is different from that of the serum of animals which have acquired active immunity by dermal inoculation alone and which have not been hyperimmunized by the administration of large doses of virus material over a prolonged period. The dilution phenomenon is briefly discussed in the report, and a suggestion as to its mechanism is offered which, if it prove correct, may remove much of the misunderstanding that has hitherto retarded progress in the serological investigation of vaccinia.
Au~u~'t",
The experiments on passive protection suggest that the flocculating serum has valuable anti-infective properties. This raises a hope that smallpox contacts might be passively immunized with a reasonable expectation that the disease would be aborted even in circumstances when vaccination might fail to prevent infection. Finally it is shown that vaccinia virus sensitized by exposure to flocculating serum retains its vitality although unable on inoculation to produce dermal lesions. Nevertheless, this sensitized material has immunizing properties, even when quite small doses are given. It seems possible, therefore, that vaccinia virus might be successflflly introduced under cover of its antiserum. By this means, the small margin of risk of abnormal sequet~e after vaccination would be still further reduced. In general it may be claimed that this " variola-vaccinia flocculation reaction " is not only a valuable diagnostic test for small pox, but that the careful scientific study, by Tulloch and Craigie particularly, of its mechanism has opened up the possibility of a new method of immunization that may ultimately prove to have great importance as a safe protection against the disease.
The Maternity and Child Welfare Conference. HE change of venue of the National Conference on Maternity and Child Welfare from London to the provinces raised grave doubts in the minds of many as to the wisdom of the move. All doubts were, however, dispelled on the opening day at Cardiff on July 1st, when it was unanimously agreed by delegates that the confidence of the Committee had been amply justified. The Public Health Department of the City of Cardiff, under the enthusiastic direction and example of Dr. Ralph M. F. Picken, the Medical Officer of Health, had thrown itself ardently into the task of offering and providing facilities for the edification and convenience of those attending the Conference. The palatial municipal offices in which the various sessions took place, afforded a setting which has never been equalled in London, except at the Guildhall meeting a few years ago. Almost six hundred delegates attended, and the papers and discussions in general reached a higher level of practical common-sense than usual. The first day was occupied with a discussion
T
PUBLIC HEALTH.
service. The events of the period of the meeting at Eastbourne have well borne out anticipations in this direction, and it is not at all out of place to offer congratulations to Dr. Willoughby on the success achieved, to which it may be claimed he contributed in no small degree.
The Census o f 1 9 3 1 . great part of the introduction A ofVERY the Registrar-General to his preliminary report on the census* has reference to the work done as enumerators by the unemployed, and suggests that a great deal of worry and anxiety must have been caused, not only to the Registrar-General himself but to local officers by a number of these men. To persons in the municipal service who hear sad tales from time to time of colleagues concerned in the business of elections the fact that there was trouble comes as no surprise. Apart from unburdening himself on the unemployed question, the Registrar-General gives some interesting information in his introduction with regard to the census itself and the results thereof. Most of these, no doubt, medical officers of health have already studied and digested, particularly such as refer to their own areas. The total population of Great Britain (44,790,485) is the largest yet recorded. To it England and Wales contribute 39,947,931, having increased their population since 1921 by 5.4 per cent. Amongst interesting points revealed is that though, of course, there is a preponderance of females over males, the female majority being 1,670,243, the ratio of females to males (1,087 to 1,000) is less than at the census of 1921. The majority in this latter year was 1,736,221. The number of births between 1921 and 1931 was more than a million and a quarter fewer than in the preceding ten years, and it is entirely due to this that the increase in the population is so comparatively low. That there has been so much of a fall in the number of births is not unexpected by persons engaged in public health work who have had to report year by year that the birth-rate is " the lowest yet recorded." The rate of 16-3 for the country has been reached by a steady fall each year during the last ten years; 16.3, as a fact, being half or less than half of that recorded in pre-war years. There are throughout the country a number *H.M. Statior/ery Office.
4s. net.
339
of areas in which more or less unexpectedly the population has been found to have decreased, but so far as can be made out there is no part in which the decreases are more startling or greater than in the metropolitan area. In the administrative county the decrease amounts to 87,702, and in the metropolitan boroughs to 84,989. Only some eight of these show an increase, greatest in the two most important dormitory boroughs, Lewisham and Wandsworth, the former giving 45,748, and the latter 24,794. The largest decreases are in Camberwell (15,825) and Stepney (24,454). Most of those who constitute the decrease appear to have gone to Essex, S u r r e y , Middlesex, Hertfordshire and Buckinghamshire, all of which show a very marked increase over 1921. When the time comes for the preparation of the annual report for 1931, the new census figures will really come into use in health departments and by medical officers of health, and there will offer the opportunity of comparing, considering and discussing the differences between the results obtained by actually counting the population and those reached as a result of making estimates. *
*
*
#
The Variola- Vaccinia Flocculation Reaction. Y none more than medical officers of health B has the absence of a test that would help in the diagnosis of cases of smallpox been felt, and this because they are usually called upon to make the. final decision and the responsibility they have to bear in relation to the disease in their district is so very great. None, therefore, viewed with greater interest the work done upon the " flocculation " test in 1925 by Dr. M. H. Gordon or have watched more closely or more expectantly the further investigations conducted by Professor TuUoch and Drs. Burgess and Craigie of Dundee. The hopes originally aroused by Dr. Gordon that in the flocculation test there was something that might readily prove of great assistance have been greatly added to by these other workers, and in a report by Professor Tulloch and Dr. Craigie just issued by the Medical Research Council s . information is forthcoming that cannot but encourage belief that he test is one upon which absolute reliance may be placed and that in time will become available for use in cases of difficulty. Not only so, *Special Report Series, No. 156. H.M. Stationery Office, 1931. pp. 129, illustrated. Price 3s. net.
3~o
PUBLIC HEALTH.
but out of the work done there may develop results capable of conferring benefits very far reaching in the realm of preventive medicine. So far as the test is concerned, the findings of Professor Tulloch and Dr. Craigie leave no doubt as to the accuracy of the results obtainable, for the test has now been applied to over two hundred specimens of material with an experimental error of less than 1.5 per cent. It has also been definitely shown that the flocculation which occurs when antivaccinia serum is brought into contact with extracts of vaccinia or variola material is not due to adventitious antibodies reacting with secondarily infecting bacteria that may be present on the skin. Further, the serological identity of variola major and variola minor with both dermal vaccinia and generalized neurovaccinia has been established. The mechanism of the test is discussed by the authors, and the influence of different factors upon the delicacy and specificity of the flocculation is described. The reaction resembles a precipitation rather than an agglutination, and on this observation is based the section of the report giving a detailed description of the methods both of preparing the reagents required and of making the test itself. Special interest attaches to the last three sub-divisions of the report. Although admittedly incomplete, they break new ground in the study of immunity against smallpox. The questions dealt with are the action of antivaccinia serum upon vaccinia virus in vitro, the use of antivaccinia serum in giving passive protection against infection, and the production of immunity by the administration of vaccinia virus exposed to antivaccinia serum. Flocculating serum seems to form a moderately stable union with virus in vitro, and mixtures of the serum with infective material do not exhibit the so-called ' dilution phenomenon ' on dermal inoculation. This suggests t h a t the quality of the antibodies in active flocculating antivaccinia serum is different from that of the serum of animals which have acquired active immunity by dermal inoculation alone and which have not been hyperimmunized by the administration of large doses of virus material over a prolonged period. The dilution phenomenon is briefly discussed in the report, and a suggestion as to its mechanism is offered which, if it prove correct, may remove much of the misunderstanding that has hitherto retarded progress in the serological investigation of vaccinia.
Au~u~'t",
The experiments on passive protection suggest that the flocculating serum has valuable anti-infective properties. This raises a hope that smallpox contacts might be passively immunized with a reasonable expectation that the disease would be aborted even in circumstances when vaccination might fail to prevent infection. Finally it is shown that vaccinia virus sensitized by exposure to flocculating serum retains its vitality although unable on inoculation to produce dermal lesions. Nevertheless, this sensitized material has immunizing properties, even when quite small doses are given. It seems possible, therefore, that vaccinia virus might be successflflly introduced under cover of its antiserum. By this means, the small margin of risk of abnormal sequet~e after vaccination would be still further reduced. In general it may be claimed that this " variola-vaccinia flocculation reaction " is not only a valuable diagnostic test for small pox, but that the careful scientific study, by Tulloch and Craigie particularly, of its mechanism has opened up the possibility of a new method of immunization that may ultimately prove to have great importance as a safe protection against the disease.
The Maternity and Child Welfare Conference. HE change of venue of the National Conference on Maternity and Child Welfare from London to the provinces raised grave doubts in the minds of many as to the wisdom of the move. All doubts were, however, dispelled on the opening day at Cardiff on July 1st, when it was unanimously agreed by delegates that the confidence of the Committee had been amply justified. The Public Health Department of the City of Cardiff, under the enthusiastic direction and example of Dr. Ralph M. F. Picken, the Medical Officer of Health, had thrown itself ardently into the task of offering and providing facilities for the edification and convenience of those attending the Conference. The palatial municipal offices in which the various sessions took place, afforded a setting which has never been equalled in London, except at the Guildhall meeting a few years ago. Almost six hundred delegates attended, and the papers and discussions in general reached a higher level of practical common-sense than usual. The first day was occupied with a discussion
T