VIII. NINETEENTH-CENTURY MEDICINE

The possibility of such a method was suggested by the familiar observation, made by Pasteur and numerous other workers, that animals of different species differ widely in their susceptibility to various maladies, and that the virus of a given disease may become more and more virulent when passed through the systems of successive individuals of one species, and, contrariwise, less and less virulent when passed through the systems of successive individuals of another species. These facts suggested the theory that the blood of resistant animals might contain something directly antagonistic to the virus, and the hope that this something might be transferred with curative effect to the blood of an infected susceptible animal. Numerous experimenters all over the world made investigations along the line of this alluring possibility, the leaders perhaps being Drs. Behring and Kitasato, closely followed by Dr. Roux and his associates of the Pasteur Institute of Paris. Definite results were announced by Behring in 1892 regarding two important diseases—tetanus and diphtheria—but the method did not come into general notice until 1894, when Dr. Roux read an epoch-making paper on the subject at the Congress of Hygiene at Buda-Pesth.

In this paper Dr. Roux, after adverting to the labors of Behring, Ehrlich, Boer, Kossel, and Wasserman, described in detail the methods that had been developed at the Pasteur Institute for the development of the curative serum, to which Behring had given the since-familiar name antitoxine. The method consists, first, of the cultivation, for some months, of the diphtheria bacillus (called the Klebs-Loeffler bacillus, in honor of its discoverers) in an artificial bouillon, for the development of a powerful toxine capable of giving the disease in a virulent form.

This toxine, after certain details of mechanical treatment, is injected in small but increasing doses into the system of an animal, care being taken to graduate the amount so that the animal does not succumb to the disease. After a certain course of this treatment it is found that a portion of blood serum of the animal so treated will act in a curative way if injected into the blood of another animal, or a human patient, suffering with diphtheria. In other words, according to theory, an antitoxine has been developed in the system of the animal subjected to the progressive inoculations of the diphtheria toxine. In Dr. Roux's experience the animal best suited for the purpose is the horse, though almost any of the domesticated animals will serve the purpose.

But Dr. Roux's paper did not stop with the description of laboratory methods. It told also of the practical application of the serum to the treatment of numerous cases of diphtheria in the hospitals of Paris—applications that had met with a gratifying measure of success. He made it clear that a means had been found of coping successfully with what had been one of the most virulent and intractable of the diseases of childhood. Hence it was not strange that his paper made a sensation in all circles, medical and lay alike.

Physicians from all over the world flocked to Paris to learn the details of the open secret, and within a few months the new serum-therapy had an acknowledged standing with the medical profession everywhere. What it had accomplished was regarded as but an earnest of what the new method might accomplish presently when applied to the other infectious diseases.

Efforts at such applications were immediately begun in numberless directions—had, indeed, been under way in many a laboratory for some years before. It is too early yet to speak of the results in detail. But enough has been done to show that this method also is susceptible of the widest generalization. It is not easy at the present stage to sift that which is tentative from that which will be permanent; but so great an authority as Behring does not hesitate to affirm that today we possess, in addition to the diphtheria antitoxine, equally specific antitoxines of tetanus, cholera, typhus fever, pneumonia, and tuberculosis—a set of diseases which in the aggregate account for a startling proportion of the general death-rate. Then it is known that Dr. Yersin, with the collaboration of his former colleagues of the Pasteur Institute, has developed, and has used with success, an antitoxine from the microbe of the plague which recently ravaged China.

Dr. Calmette, another graduate of the Pasteur Institute, has extended the range of the serum-therapy to include the prevention and treatment of poisoning by venoms, and has developed an antitoxine that has already given immunity from the lethal effects of snake bites to thousands of persons in India and Australia.

Just how much of present promise is tentative, just what are the limits of the methods—these are questions for the future to decide. But, in any event, there seems little question that the serum treatment will stand as the culminating achievement in therapeutics of our century. It is the logical outgrowth of those experimental studies with the microscope begun by our predecessors of the thirties, and it represents the present culmination of the rigidly experimental method which has brought medicine from a level of fanciful empiricism to the plane of a rational experimental science.