711PROTEIN SHOCK THERAPY FOR FIBROSITIS.

baths in an artisan’s cottage, yet there is no reasonwhy a special department should not be installedin the municipal baths. Turkish baths are, in fact,provided by certain local authorities. Sir GeorgeNewman, in his report for the year 1924, has givenan admirable summary of the case for the immediateprovision of treatment centres. He points out thatat the present time these cases, which are not admittedinto general hospitals because of their chronic nature,arrive eventually in the Poor-law infirmaries, wherefacilities for investigation and treatment are notadequately provided. The work of research andinvestigation should be undertaken at a much earlierstage in the disease, and this is only possible if casesare admitted to specially equipped institutions as

soon as they are incapacitated. " Essential forresearch," writes Sir George Newman, " is an institu-tion where enough cases can be concentrated inconditions to make it possible to employ a team ofmedical officers, where treatment and observationare systematised and represent continuous investiga-tion." This is a great ideal, both for the medicalprofession and the country, an ideal which, in viewof the issue at stake, should become a practicalcreed.

PROTEIN SHOCK THERAPY FOR FIBROSITIS.

A FEW years ago Dr. W. Ponndorf, of the InoculationInstitute of Weimar, set forth the claims of cutaneousinoculation of vaccines by scarification in the treat-ment of the " mixed infections " of tuberculosis, underwhich term he included almost every infectious diseaseto which man is prone. He prepared two vaccines :"A," which was used for pure tuberculosis, con-

sisted of concentrated Koch’s Old Tuberculin withthe addition of an empirically determined amount ofhuman and bovine autolysed tubercle bacilli; " B,"for the mixed infections, was similar to " A," plus theendotoxins of streptococci, staphylococci, pneumo-cocci, and influenza bacilli. Inspired by the effectwhich Ponndorf’s vaccines seemed to have on rheu-matic conditions, Dr. Gustav Paul, director of theState Inoculation Institute of Vienna, began somefour years ago to test the clinical value of that methodof treatment, and in a recent issue of the WienerKlinische W ochenschrift (Sept. 3rd, p. 984) he recordshis results in nearly 600 cases of rheumatism wherehe administered vaccine by scarification.The aetiology and history of Dr. Paul’s enthusiasm

for the treatment is not without interest. The story,as he himself tells it, is as follows. Although he hadbeen familiar with Ponndorf’s theories for many years,he had never tested them in practice owing to lack ofsuitable material. As a result of a visit to Weimar in192], however, he was so impressed with the possibilitiesof Ponndorf’s claims that he obtained facilities to carryout this method of inoculation in the sanatorium forchildren suffering from surgical tuberculosis in Grimm-stein, Lower Austria. In addition to over 300 casesof tuberculosis of the bones and glands in children,in which the treatment proved satisfactory, Dr. Paulwas able to observe what he terms the " amazing "(verblilffend) curative powers of the vaccine in some50 adults, nurses, and officials of the sanatorium,who suffered from rheumatism. In 1923 the Grimm-stein sanatorium was closed down, and as Dr. Paulhad no private practice of his own wherewith tocontinue his observations, he feared that furtherinvestigation on his part might lapse. Fortunefavoured him, however, and the successful treatmentof a " lady of quality " in Austria formed the nucleusof a private clinic for ambulatory cases of rheumatism,which up to therpresent has furnished him with some600 cases. Dr. Paul does not describe his techniquein detail, but indicates that a ..small area of skin isscarified, without drawing blood: and then the vaccineis applied in a carefully regulated dosage, which dependson thesize of the field of inoculation, the number of scarifications, and the amount of the vaccine. Thesuperiority of his method over the more usual methodsof protein shock he ascribes to : (1) the happy

combination of toxin and bacterial protein ; (2) themanner in which they are assimilated ; and (3) thecorrect choice of absorption routes-which shouldbe by the lymphatics. The first application of thevaccine serves to sensitise the patient, and thesubsequent allergy and local reaction furnishes avaluable indication in estimating the amount ofindividual tolerance. The results Dr. Paul hasobtained in his completed cases are reproduced inthe following table :-

He has thus 65 per cent. of cures and 95 per cent.of improvements to record, and in a further seriesof 257 uncompleted cases improvement alreadyreached 75 per cent. Dr. Paul points out that thesehigh percentages are all the more noteworthy as themajority of cases classified as chronic rheumatoidarthritis represented transition stages towards arthritisdeformans, and further, most of these patients hadcome to him as a last resort, having been previouslytreated unsuccessfully by every other known thera-peutic agent. He attributes the failure of othermethods, such as balneo-therapy, drug treatment,and radiation, to the over-energetic and heroicmanner in which they are exhibited, quoting Prof.Bier’s views on the over-sensitive state of thechronically inflamed tissues which require thesmallest possible stimulus to promote the activityof the cell.

Dr. Paul’s method, therefore, falls into the categoryof non-specific protein shock therapy, in which thetouchstone is not " quale " but " quantum " ; andhe regards the effective substitution of some otherantigen for- Ponndorf’s tuberculin as within thebounds of possibility, " for," as he says,

" the medicalworld is somewhat tuberculin-weary." His claimsare very large and in view of the official position heholds are hardly likely to pass unnoticed. Theyshould certainly be tested by those who are dis-satisfied with their own results in the big group offibrositic maladies.

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PROF. RICHET’S RETIREMENT.

THE retirement of Charles Richet from the chair ofphysiology in the Paris Faculty of Medicine, after47 years of devoted teaching and brilliant research,recalls to mind the enormous strides made in hissubject during the span of his professional life. Fiftyyears ago the renaissance of physiology was butjust beginning and the young Richet was the pupilof such masters as Berthelot, Marey, Vulpian, andClaude Bernard. The field was ripe to the harvest,and Richet and his contemporaries piled discoveryon discovery, and what to them were new factswrung from Nature by hours of patient research areto us almost banal. The diuretic properties of sugar,for instance, the refractory period of the nervoussystem, the salt-free diet for epilepsy, the virtues ofchloralose, the influence of anaesthesia on respiration-with all these points the name of Prof. Richet isassociated, as well as first and foremost with thediscovery of anaphylaxis. In his recent farewell