THE STANDARDISATION OF TETANUS ANTITOXIN.

1
1641 THE STANDARDISATION OF TETANUS ANTITOXIN. (Rome, 1895) of the "Missionari Catholici Italian, must ever remain in our memories. But even those efforts-and particularly this last-lacked the systematic support and the " staying power" characteristic of Anglo-Saxon enterprise, and they remain rather as evidence of "the might have been " than of the fait accompli. With such examples of failure, past and contemporary, Great Britain will have herself to blame if she does not keep in the van of "Imperial expansion" so auspiciously begun, so fraught with future augury, if she does not vouchsafe all encouragement and support to the efforts, in which her various Churches compete in honourable rivalry, for the rehabilitation of her ever- increasing subject-races by the methods so conspicuously successful of the medico-missionary organisation. Annotations. THE STANDARDISATION OF TETANUS ANTITOXIN. I I Ne quid nimis." " IN a United States Treasury Bulletin 1 Dr. Milton J. I Rosenau and Dr. John F. Anderson describe the American method of standardising tetanus antitoxin and compare it with the German method described by Behring, the French method of Roux, and the Italian method after Tizzoni. They state that the European standards are admitted to be un- satisfactory and for the most part inaccurate, further that they are complicated and difficult to carry out. The American method is the result of several years’ work in the Hygienic Laboratory and it is believed that it will commend itself for its simplicity, directness, and accuracy. The standard toxins and antitoxins are preserved under special precautions to prevent deterioration and are tested against each other reciprocally so that the least alteration in either may be detected. The unit is based upon the neutralising value of an arbitrary quantity of antitoxic serum but the antitoxin is not issued to other laboratories for the purpose of control, as is the case with diphtheria antitoxin. All the tetanus antitoxic serums for use in man upon the American market are now measured against a stable, precipitated tetanus toxin, the test dose of which has been carefully determined. Before the establish- ment of the American standard the tetanus antitoxins upon the market varied widely in the unit strength claimed for them and were for the most part comparatively weak in antitoxin potency. The American official immunity unit for measuring the strength of tetanus antitoxin is ten times the least quantity of antitetanic serum necessary to save the life of a guinea-pig weighing 350 grammes for 96 hours against the official test dose of a standard toxin furnished by the Hygienic Laboratory. In other words, one-tenth of a unit of the antitetanic serum mixed with 100 minimal lethal doses of the standard toxin contains just enough free poison in the mixture to kill the guinea-pig in four days after subcutaneous injection. The antitoxic serum for the purposes of this standard was obtained from a single horse. The serum was dried, powdered, and pre- served in vacuum tubes under the influence of penta- phosphoric acid, in darkness, at a temperature of 50C. While the antitoxin so prepared is stable, duplicates are made from time to time so as to guard against loss or change and to insure the permanence of the standard. In order to obtain trustworthy and comparable results it is necessary to take into account all the factors concerned, including the Bulletin No. 43, Hygienic Laboratory, United States Public Health and Marine Hospital Service, Washington, D.C., March, 1908, pp. 59. composition of the poisons, their concentration, the diluting nuid, the length of time during which the mixtures are allowed to stand, the site of inoculation, and other factors. All the known factors have been considered in devising this method of standardising tetanus antitoxin which is described in detail in the Bulletin. The necessity for an accurate standard is shown by a table representing the differences in potency and in the methods of testing tetanus antitoxin before the adoption of the American unit. It is now well known that when the symptoms of tetanus have developed the toxin has combined with the motor nerve cells and that the union between the cell and the poison is too strong for the anti- toxin to break up. But if the antitoxin is given in time the toxin is neutralised and rendered harmless. Tetanus anti- toxin is therefore an exceedingly valuable prophylactic and for this purpose it is coming into more general use in human and in veterinary practice. THE MIDDLESEX HOSPITAL AND CANCER RESEARCH. THE weekly board of the Middlesex Hospital reported to a recent meeting of the court of governors that a special com- mittee had been established which will have for its sole object the promotion of the interests of the Cancer Charity and the collection of such sums as shall place the advance of the research work beyond the impediment of pecuniary anxiety. An urgent public appeal is being made for funds to meet the expenses of the current year, R1000 of the requisite <&2500 having been already subscribed. At the same court, which was presided over by Field-Marshal Lord Grenfell, Major-General Lord Cheylesmore, C.V.O., moved the adoption of the hospital’s report, which was seconded in a very able speech by Mr. A. Pearce Gould. This was largely directed to warning those who were in- terested in the Cancer Research Fund against becoming disheartened by the comparative slowness and the apparent insignificance of the steps which it was making in its advance against the hidden strongholds of malignant disease. He pointed out the necessity of the patient and laborious collection of facts bearing upon every side of the question as being the sure foundation upon which successful treatment of the disease must ultimately rest. In this connexion he adduced the recent reopening of a lying-in ward at the Middlesex Hospital, saying that it was a demonstration of the advance in the knowledge of another dread disease-puerperal fever-the prevalence of which in hospitals not so many years ago had made such wards simply disastrous for their inmates. The benefits which poor par- turient women now infallibly derived from them were due entirely to the anxious, persistent, and devoted investigation in the laboratory which had revolutionised the whole prac- tice with regard to midwifery. He confidently looked forward to an equally signal victory over cancer which would be attained by similar means. We agree with Mr. Gould that patient research will ultimately solve the problem, but we are not without hope that some investigator may arise who will be possessed of the true scientific imagina- tion to reduce a thousand isolated facts into the compass of apparent law, the enunciation of which will suggest further investigations for its verification until the inner heart of the mystery is laid bare. It is only once in several generations that a genius arises who could, for instance, be led directly from a crystallographic study of tartaric acid to the elucidation of the causes of puerperal septicasmia by sheer scientific insight, but the conquest of cancer awaits such a one as Pasteur and we would fain believe that he will appear in this country. Meanwhile the continued minute study of the natural history of cancer by every means at our disposal is worthy of the fullest measure of support, and, indeed, the money already expended has been justified by

Transcript of THE STANDARDISATION OF TETANUS ANTITOXIN.

Page 1: THE STANDARDISATION OF TETANUS ANTITOXIN.

1641THE STANDARDISATION OF TETANUS ANTITOXIN.

(Rome, 1895) of the "Missionari Catholici Italian, mustever remain in our memories. But even those efforts-and

particularly this last-lacked the systematic support and the" staying power" characteristic of Anglo-Saxon enterprise,and they remain rather as evidence of "the might havebeen " than of the fait accompli. With such examples offailure, past and contemporary, Great Britain will have

herself to blame if she does not keep in the van of "Imperialexpansion" so auspiciously begun, so fraught with future

augury, if she does not vouchsafe all encouragement and

support to the efforts, in which her various Churches competein honourable rivalry, for the rehabilitation of her ever-

increasing subject-races by the methods so conspicuouslysuccessful of the medico-missionary organisation.

Annotations.

THE STANDARDISATION OF TETANUS ANTITOXIN.

I I Ne quid nimis." "

IN a United States Treasury Bulletin 1 Dr. Milton J. IRosenau and Dr. John F. Anderson describe the Americanmethod of standardising tetanus antitoxin and compare itwith the German method described by Behring, the Frenchmethod of Roux, and the Italian method after Tizzoni. Theystate that the European standards are admitted to be un-satisfactory and for the most part inaccurate, further thatthey are complicated and difficult to carry out. The

American method is the result of several years’ work inthe Hygienic Laboratory and it is believed that it willcommend itself for its simplicity, directness, and accuracy.The standard toxins and antitoxins are preserved underspecial precautions to prevent deterioration and are

tested against each other reciprocally so that the least

alteration in either may be detected. The unit is based

upon the neutralising value of an arbitrary quantity ofantitoxic serum but the antitoxin is not issued to other

laboratories for the purpose of control, as is the case with

diphtheria antitoxin. All the tetanus antitoxic serums foruse in man upon the American market are now measured

against a stable, precipitated tetanus toxin, the test dose ofwhich has been carefully determined. Before the establish-

ment of the American standard the tetanus antitoxins uponthe market varied widely in the unit strength claimed forthem and were for the most part comparatively weak inantitoxin potency. The American official immunity unit formeasuring the strength of tetanus antitoxin is ten times theleast quantity of antitetanic serum necessary to save the lifeof a guinea-pig weighing 350 grammes for 96 hours againstthe official test dose of a standard toxin furnished by theHygienic Laboratory. In other words, one-tenth of a unitof the antitetanic serum mixed with 100 minimal lethaldoses of the standard toxin contains just enough free

poison in the mixture to kill the guinea-pig in four daysafter subcutaneous injection. The antitoxic serum forthe purposes of this standard was obtained from a

single horse. The serum was dried, powdered, and pre-served in vacuum tubes under the influence of penta-phosphoric acid, in darkness, at a temperature of 50C.While the antitoxin so prepared is stable, duplicates aremade from time to time so as to guard against loss or changeand to insure the permanence of the standard. In order toobtain trustworthy and comparable results it is necessary totake into account all the factors concerned, including the

Bulletin No. 43, Hygienic Laboratory, United States Public Healthand Marine Hospital Service, Washington, D.C., March, 1908, pp. 59.

composition of the poisons, their concentration, the dilutingnuid, the length of time during which the mixtures are allowedto stand, the site of inoculation, and other factors. All the

known factors have been considered in devising this methodof standardising tetanus antitoxin which is described in detailin the Bulletin. The necessity for an accurate standard isshown by a table representing the differences in potencyand in the methods of testing tetanus antitoxin before theadoption of the American unit. It is now well known thatwhen the symptoms of tetanus have developed the toxin hascombined with the motor nerve cells and that the unionbetween the cell and the poison is too strong for the anti-toxin to break up. But if the antitoxin is given in time thetoxin is neutralised and rendered harmless. Tetanus anti-toxin is therefore an exceedingly valuable prophylactic andfor this purpose it is coming into more general use in humanand in veterinary practice.

THE MIDDLESEX HOSPITAL AND CANCERRESEARCH.

THE weekly board of the Middlesex Hospital reported to arecent meeting of the court of governors that a special com-mittee had been established which will have for its sole

object the promotion of the interests of the Cancer

Charity and the collection of such sums as shall place theadvance of the research work beyond the impediment ofpecuniary anxiety. An urgent public appeal is being madefor funds to meet the expenses of the current year, R1000 ofthe requisite <&2500 having been already subscribed. At the

same court, which was presided over by Field-Marshal LordGrenfell, Major-General Lord Cheylesmore, C.V.O., movedthe adoption of the hospital’s report, which was secondedin a very able speech by Mr. A. Pearce Gould. Thiswas largely directed to warning those who were in-

terested in the Cancer Research Fund against becomingdisheartened by the comparative slowness and the

apparent insignificance of the steps which it was

making in its advance against the hidden strongholdsof malignant disease. He pointed out the necessity of thepatient and laborious collection of facts bearing upon everyside of the question as being the sure foundation uponwhich successful treatment of the disease must ultimatelyrest. In this connexion he adduced the recent reopening ofa lying-in ward at the Middlesex Hospital, saying that it wasa demonstration of the advance in the knowledge of anotherdread disease-puerperal fever-the prevalence of which inhospitals not so many years ago had made such wards simplydisastrous for their inmates. The benefits which poor par-turient women now infallibly derived from them were dueentirely to the anxious, persistent, and devoted investigationin the laboratory which had revolutionised the whole prac-tice with regard to midwifery. He confidently lookedforward to an equally signal victory over cancer whichwould be attained by similar means. We agree with Mr.Gould that patient research will ultimately solve the problem,but we are not without hope that some investigator mayarise who will be possessed of the true scientific imagina-tion to reduce a thousand isolated facts into the compassof apparent law, the enunciation of which will suggestfurther investigations for its verification until the inner

heart of the mystery is laid bare. It is only once in severalgenerations that a genius arises who could, for instance, beled directly from a crystallographic study of tartaric acid tothe elucidation of the causes of puerperal septicasmia bysheer scientific insight, but the conquest of cancer awaitssuch a one as Pasteur and we would fain believe that he will

appear in this country. Meanwhile the continued minute

study of the natural history of cancer by every means at ourdisposal is worthy of the fullest measure of support, and,indeed, the money already expended has been justified by