787

CONTROL OF THE COMMON FEVERS

THE LANCET

LONDON: SATURDAY, APRIL 2, 1938

UNDER this heading we publish to-day the firstof a series of articles on the preventive treatmentof infections. No attempt will be made to pressthese articles into a common mould. The growingpoint of our knowledge is sometimes on the

epidemiological side, sometimes in the pathologicallaboratory, and sometimes in clinical practice atschools and institutions. Scarlet fever, for instance,although it is a clinical entity, is not, like diph-theria and enteric fever, an epidemiological entity.The chief interest in diphtheria lies in the possi-bility of eradicating the disease by means ofimmunisation, whereas in measles it centres roundthe substitution of mild for severe attacks.

Dysentery has become prevalent throughout thecountry almost unnoticed, and there may be

ignorance of the very existence of undulant fever.The object of this series then is to present experi-ence of the various common fevers as the problemappears at the present time. There is reason tothink that this part of medicine is one in which

practice lags unduly far behind knowledge ; fornow that typhoid and diphtheria are no longertreated in general hospitals the medical student isless familiar with them than he was, and in under-

graduate days he sees little of such infections asmeasles and whooping-cough which are not evennotifiable.

Measles, the subject of the first article, occupiesa unique position among the few diseases that arefully controllable by specific means. Even themost violent opponents of

" inoculation " in anyform can scarcely object to the injection of humanserum ; it has none of the disadvantages, eithersentimental or practical, of horse-serum or ofimmunising agents prepared from micro-organisms.Nevertheless its proper use can be as beneficent ineffect as any form of specific therapy yet at ourdisposal. Although the serum of recent con-

valescents is the most effective, that of any adultwho has had the disease even in distant childhoodcontains the protective antibody and will serve ITgiven in somewhat larger amount. Given withinfive days of exposure to infection it will preventthe disease altogether. But this protection, like

any other form of purely passive immunisation, istransitory. Given within the next two or threedays, or in smaller amount at an earlier stage, itwill secure a modified attack, a brief period offebrile catarrh with the characteristic rash butwith little general disturbance and almost no

liability to pneumonia or other complications orto subsequent ill health. This miniature version ofwhat measles may be is nevertheless followed bypermanent immunity ; indeed, the serum of con-valescents from such an attack is said to have a

protective capacity in others equal to that ofsufferers from the fully developed disease. Thedose of serum necessary to secure these resultsvaries according to its source, the age of the childto be protected, and the stage at which it is given.A syringeful of blood which anyone can sparemay save a child from a dangerous and

debilitating illness ; a bleeding on the transfusionscale will furnish the means of protecting severaldozen children.Why is this valuable method still so little used ?

There are perhaps three reasons for this, of whichthe first is that the whole of the medical professionis not yet so conversant with it as to create a fulldemand for it or to ensure its right application.The second is the frequent difficulty of ascertainingthe date of exposure to infection and thus calcu-

lating with certainty the dose of serum and the timeof its administration to secure the desired result.As Dr. Gknsnsr points out, a legitimate-perhaps anideal-way of overcoming this difficulty is dehber-ately to expose children to infection; the old-fashionea measles tea-party," originally aimedat getting all the attacks in the family over

simultaneously, can now be revived with a betterobject. But a difficulty more serious than eitherof these is that of obtaining serum. A few hos-

pitals and local health authorities maintain supplies,of which some are available for private prac-titioners, but usually the supply is limited, and theserum is only provided for infants, in whom it isadvisable to prevent an attack altogether. Theonly product available commercially is a placentalextract which is undoubtedly an efficient prophy-lactic but may cause unpleasant reactions. Whosebusiness should it be to make good this defect ?It certainly appears to be within the province oflocal health authorities, and at the same timethere seems to be no very obvious reason whysupply should not be undertaken by commercialhouses. Many people would be willing to giveblood both for a useful cause and for the sub-stantial payment which would be made possibleby a moderate selling price. It is clearly necessarythat some responsible body should move in thismatter in order that one of the most valuable ofall remedies in medicine may become more generallyavailable.

SHORT WIRELESS WAVES INEXPERIMENTAL CANCER THERAPY

THE use of electromagnetic waves in order tosubject cancer to heat therapy as distinct fromsurgical diathermy was advocated sporadically byvarious workers in the days when only the long-wave diathermy was available. The principalobjection to the procedure was the danger ofburns, but difficulties in application by means ofdirect contact through saline pads were also con-siderable. RHODENBURG and Pftnvm and WESTER-MARK,2 however, achieved some measure of successin the treatment of animal tumours, and the

1 Rhodenburg, G. L., and Prime, F., Arch. Surg., Chicago,1921, 2, 116.

2 Westermark, N., Skand. Arch. Physiol. 1927, 52, 55.