Therapeutics

THERAPEUTICS, the name given to that branch of medi cine which deals with the means employed to prevent or cure disease if possible, or to control and lessen its evil results when a cure is impossible.

Treatment may be symptomatic or radical, empirical or rational. Obviously the ideal is a radical treatment based on reasoned knowl edge of the disease and of the means employed to combat it. Such a form of therapeutics is represented by the antitoxin treatment of diphtheria. But in the case of many diseases and drugs knowledge is still so imperfect that symptomatic and empirical treatment is all that can be employed at the present time. Of this form of therapeutics the use of colchicum in gout is an example. In the case of drugs the purpose to which each is usually put is contained in the article under that special heading (e.g., DIGITALIS, OPIUM, QUININE, etc.) ; here other and more recent therapeutic methods are considered.

Prevention.—Prevention, the ideal aim of medicine, has great ly advanced in its practical application. In Great Britain this has been fostered by the establishment of a Ministry of Health in 1919 which has greatly expanded the scope of work carried on by the Local Government Board, and also by the activities of the Medical Research Council founded in 1913 as part of the Na tional Insurance Scheme. Preventive medicine includes, in addi tion to improvement of environmental conditions, prophylactic treatment in the very early stages of disease, such as can be pro vided in antenatal, school, dental and venereal clinics and so comes within the heading of therapeutics.

A notable example of prophylactic treatment is the prevention of goitre (see GOITRE) ; this is an endemic or local disease, prob ably depending, as Lieut.-Colonel R. McCarrison in India showed, on contamination of the water supply with micro-organisms; it is extremely prevalent in Switzerland and in North America both in men and lower 'animals in the neighbourhood of the Great Lakes, and has been found to be associated with a diminished content of iodine, which has a well-marked antiseptic action, in the thyroid gland. By the periodical administration of iodine to children in districts where the condition is prevalent it has been most suc cessfully prevented.

Deficiency Diseases.

Another aspect of the same question is presented by the group of "the deficiency diseases" or the avita minoses, which depend on the absence from the food of the vitamins or "accessory food factors." As constituents of food

these vitamins (q.v.), of which there are several, are remarkable for the contrast between the extremely minute amounts present and the striking changes resulting from their absence. (See BERI BERI, SCURVY, RICKETS, PELLAGRA.) Tropical Diseases.—The prevention of tropical disease, origi nated in Great Britain under Sir Ronald Ross's direction with the destruction of the mosquito, the carrier of the malarial parasite (see TROPICAL MEDICINE), has been much expanded by the Rock efeller Foundation, which has instituted many campaigns against diseases, such as malaria, yellow fever and especially a world-wide attack on ankylostomiasis (see HOOKWORM ; MALARIA ; YELLOW FEVER). Yellow fever, which formerly took such a terrible toll of life, has now been almost entirely eradicated from South America by destruction of mosquitoes, the carriers of the infection.

Inoculation.

The World War proved the enormous value of prophylactic or protective inoculations against certain diseases on the same lines as Edward Jenner's vaccination against small pox (q.v.). Just before the South African campaign Sir Almroth Wright started the method of protection against typhoid fever (see IMMUNITY) by injection with a vaccine composed, of killed cultures of the Bacillus typhosus; this inoculation sets in the body which render the individual immune for a time, prob ably about four years, to this form of infection, in the same way as an attack of the disease. After the South African campaign cases were observed resembling typhoid fever but due to different though allied bacilli, and two additional forms, paratyphoid A. and paratyphoid B., of fever became recognized, the three dis eases being collectively described as enteric fever (q.v.). In order to protect against infection of these three forms of fever, it is nec essary to inoculate the individual with the three vaccines, and soon after the outbreak of the World War paratyphoid fever attacked the troops in Flanders and did not spare those inoculated against typhoid fever only; the three vaccines, known collectively as T.A.B., were then given, and the wonderful freedom of the army from enteric fever, which in past wars has killed as many as bul lets, was a triumph for preventive medicine. In like manner men who were wounded and so likely to be infected with Bacillus tetani (see TETANUS), were at once injected with antitetanic serum and so protected from tetanus or lockjaw.