Therapeutics

The treatment of leprosy (see LEPROSY) by intravenous and intramuscular injections of soluble products of chaulmoogra, hydnocarpus, soya bean and cod-liver oils, as advocated by Sir Leonard Rogers, has been shown by reports from leper asylums in various parts of the world to have had beneficial effects and to have reduced the death-rate in a remarkable manner. Although there are very few lepers in Great Britain, there are 300,00o in the British Empire, and at a conservative estimate 1,700,000 in the world, so that any efficient remedy is obviously important.

Protein Therapy.

By a turn of the wheel the strictly scien tific employment of vaccines composed of the micro-organisms thought to be responsible for the morbid conditions has led by an empirical process to non-specific protein therapy. It was found, sometimes accidentally, not only that the administration of a vac cine specific for one form of infection benefits a morbid condition due to another infection, but that intravenous injection of foreign protein, such as peptone and milk, may when they set up a reac tion, namely fever, shivering and illness ("protein shock thera py"), produce a beneficial effect, just as one disease sometimes cures another. This protein shock therapy has been employed particularly in asthma and in chronic rheumatoid arthritis.

After an attack of many infective diseases there develops an immunity so that a second attack is rare ; the reverse of immunity is an exaggerated susceptibility or hypersensitiveness (see ANA PHYLAXIS) ; this is what is meant by idiosyncrasies and the proverb "What is one man's meat is another man's poison." This is seen in various diseases, such as recurrent colds and asthma. A method of cure is to desensitize the subject of one of these toxic idiopathies by the administration, usually by hypodermic injec tion, of the substance, a bacterial or other protein, to which the individual is hypersensitive. Thus a patient subject to hay fever is injected with the pollen of the plant which excites an attack; or a patient with bronchitis and asthmatic seizures is injected with an emulsion of dead bacilli (vaccine) obtained from the ex pectoration.

In many cases of disease and ill-health the cause is a "septic focus" or a local collection of micro-organisms, for example, in the teeth (see DENTISTRY), tonsils, appendix, gall bladder and intes tines, which poison the body and may produce chronic painful conditions, such as chronic arthritis, sciatica, lumbago, fibrositis. The removal of such foci is therefore the important and indeed the first step in treatment ; after that vaccines made from the predominant micro-organism present in the focus, and spa treat ment may complete the cure.

Anaemia.

The form of anaemia (q.v.) called pernicious or Addisonian after its describer Thomas Addison of Guy's Hospital (see ANAEMIA) is apparently the result of chronic infection of the stomach and alimentary canal, which in its turn may be due to a septic focus, but the observations of Arthur F. Hurst, also of Guy's Hospital, indicate that an important factor is absence of the hydrochloric acid in the gastric juice. It has, therefore, been treated by supplying the absent hydrochloric acid by its medicinal administration by the mouth, with a success which is due to inves tigation of the chemistry of the stomach. The manner in which liver feeding acts in pernicious anaemia (vide supra) is unknown.

In pernicious anaemia, as in anaemia due to haemorrhage, trans fusion of blood (see BLOOD TRANSFUSION) has been carried out, after the blood of the donor has been compared with that of the patient to see that they are compatible and after measures have been taken to avoid transmitting diseases, such as influenza, malaria and syphilis from the donor. Transfusion of blood is a

very old method of treatment and was performed as long ago as 1667, but it is only recently that the tests for the compatibility of the blood based on the existence of four blood groups in man have rendered the procedure less dangerous. Transfusion of blood with these precautions was employed on a large scale in the War for haemorrhages and severe shock, as from gunshot and shell wounds, and has also been used in conditions popularly called blood poison ing. A recent development of blood transfusion is to immunize by means of vaccines, made from the micro-organism infecting the patient, the blood of the donor, and then to transfuse his blood into the patient.

Radiotherapy.

X-rays, though mainly employed for diag nosis, have from their power of destroying the tissue cells, many therapeutic uses. Thus enlarged glands and the spleen in various diseases of the blood, and especially in lymphadenoma, are much reduced by X-ray exposure. The recent Erlangen treatment of in ternal cancer by intensive X-rays has the grave disadvantage of making some patients extremely ill (see RADIOTHERAPY). Radium bromide, the rays of which are much the same, has been much used in the treatment of inoperable carcinoma and in quite super ficial growths of the skin, especially rodent ulcer on the face, which, though classed as malignant, is much less virulent. In cancer of the neck of the womb radium has proved of unquestion able value ; from a combination of operation and radium good results have been obtained in cancer of the breast ; in malignant growths of the tongue, mouth and throat its successful use is probably dependent upon technique.

The important advance in the diagnosis of disorders of the heart and the mechanism of its beat have been followed by a more accurate knowledge of how to give digitalis and by the em ployment of quinidine in the disorders known as auricular fibrilla tion and paroxysmal tachycardia. Numerous researches have been undertaken with the view of devising reliable tests for the func tional activity of the liver, and it is clear that sugar is the food which most readily protects and repairs the damaged liver cells.

Heliotherapy.

Recent years have shown an increasing ten dency to utilize to the full the vis medicatrix naturae in open air treatment, improved ventilation, heliotherapy which has indeed been imitated by the use of ultra-violet rays (see HELIOTHERAPY), baths and waters, and exercises. The prophylactic measures based on experience and empirical use have been elaborated by the teaching of scientific research and as a result physiotherapy or physical therapeutics, which includes massage and the various forms of electrical treatment, has considerably advanced in knowl edge and application. Medical hydrology has been studied and taught on these rather than on purely empirical lines, and it may be noted that spas did excellent work during and after the War for invalided soldiers. Hand in hand with open air treatment and heliotherapy has come less surgical activity in the way of operating in tuberculous disease of bones and joints. (H. R.)