Part 5

The finger or lobe of the ear is punctured as in making a blood count, and the blood is allowed to drop directly into normal saline, ·85 per cent. solution, containing about 1 per cent. sodium citrate; this decalcifies the blood and prevents clotting. The corpuscles are completely precipitated in the centrifuge, and then repeatedly washed with ·85 per cent. saline and centrifugated, until all traces of the citrate and serum are removed. After the final precipitation the saline solution is withdrawn, and the thin upper grayish layer of the sediment, the leucocytic cream, consisting for the most part of washed white blood cells, is removed.

III. THE SERUM.

Blood is obtained in the usual way, but is collected in small, bent, glass tubes, which can be readily held in the centrifuge and the serum separated. In obtaining normal serum, care must be exercised in selecting a healthy subject, or, what is better, obtain serum from the mixed blood of several normal persons’ “Pool.”

IV. STAIN.

With the exception of Malta fever and tubercle bacilli, Leishman’s stain, consisting of eosin and methylene-blue, in combination, or Jenner’s stain, is employed. Carbol-fuchsin is employed for the tubercle bacilli.

METHOD OF OBTAINING OPSONIC INDEX.

Special capillary pipettes, graduated into equal divisions, are required; then by means of a rubber tube or bulb equal quantities of washed corpuscles, bacterial emulsion, and patient’s serum are taken up, and all blown out upon a glass slide and thoroughly mixed. The mixture is then drawn up in a small pipette, sealed, and placed in an incubator of the ordinary type, or preferably in an opsonic incubator as proposed by Freeman; it is heated to 37° to 40° C. for fifteen minutes. A similar tube is prepared, except that the normal serum or “Pool” is employed instead of the patient’s serum. At the end of fifteen minutes the smears on microscopical slides are made from each tube, fixed, and stained. A good field is selected, one containing many leucocytes, the number of germs counted in the first fifty or hundred observed, and an average per leucocyte determined. If the average in the mixture containing the normal serum is two, we would say that the normal opsonic index is two, and if the mixture containing the patient’s blood serum is one per corpuscle, we would say that his index was one-half, etc.

Wright and his pupils, as the result of numerous observations, classify diseases due to bacterial infections:

(1) “Diseases in which the bacterial process is strictly localized” or “shut off from the lymph and blood circulations.” Furunculosis, lupus, tuberculosis, etc., in fact most chronic infections, belong to this class. “In this class the opsonic index of the blood is persistently below normal, owing to the absence of immunizing stimuli.”

(2) “Diseases in which the bacterial process is but loosely shut off, especially from the lymph circulation.” In these, usually acute, infections immunizing products from the invading bacteria from time to time get into the circulation, and the opsonic index may be normal or above or below normal. Good examples of this class are tuberculous joints, etc.

(3) “Diseases in which the bacterial infection is in the blood stream.” In this class belong acute infectious diseases, septicemia, endocarditis, Malta fever, etc. In these “the opsonic index is generally below normal.”

Wright and Douglas lay down the following general principles for treating cases of bacterial infections:

(1) “Isolate in pure culture the causative microörganism.”

(2) “Estimate the opsonic power of the patient’s blood to this microörganism.”

(3) “If the opsonic index be at or below normal, prepare and standardize a vaccine from this microörganism.”

(4) “Inoculate the patient with this vaccine with appropriate doses and at proper intervals, as shown by a systematic estimation of the opsonic content of the patient’s blood.”

PREPARATION OF VACCINES.

The vaccines, with the exception of the tubercle vaccine, consist of emulsions of heated cultures of the particular germ producing the infection. Luxuriant cultures of the desired organism are grown upon inclined agar; the growth is then removed with salt solution and a glass rod, and thoroughly emulsified by shaking in a test-tube, in order to get the germs well distributed and the clumps broken up. The number of germs in a given quantity of the emulsion is then determined by comparing the number of germs and red blood-corpuscles in a mixture of one part emulsion, one part freshly drawn blood, and three parts of normal salt solution. If there are ten times as many germs as blood-corpuscles, the bacterial suspension contains approximately 45,000,000 germs per cubic centimeter. The number of germs present will of course vary with the density of the emulsion. The bacterial suspension is heated at the lowest temperature and for the shortest possible time to kill it. The amount of sterilization will differ with different organisms; 60° C. or less maintained for thirty minutes or less is usually sufficient. Cultures from the vaccine are finally made to insure that it is sterile and safe and some preservative added.

_Tubercle Vaccine._—This is the “New Tuberculin Koch,” an opalescent fluid, containing the active principle of tuberle bacilli obtained according to the method of Koch.

THERAPEUTIC APPLICATION.

After a proper diagnosis has been made, the patient’s opsonic index taken, and the appropriate vaccine prepared, the patient receives his initial injection of several hundred millions more or less of the heated bacteria, and his opsonic index is watched. A short time after the inoculation is made the opsonic index falls lower than it was previous to the injection. This Wright has named the “negative phase.” Sooner or later, from a few hours to several days, the opsonic index rises above the starting-point. This is called the “positive phase.” The amount of the opsonins in the blood remains stationary for a variable length of time, and then diminishes. As soon as their diminution is noted, a second injection of the vaccine is given, which is followed by a negative phase, but less pronounced than before. Soon the positive phase comes on, reaching a higher level than previously. Thus the injections are repeated from time to time according to the opsonic index of the patient’s blood, and the positive phase gradually attains a higher and higher level, until it may be as high as or considerably higher than that of a normal person. In other words, if the vaccinations are properly given, “never during a negative phase,” and as a result the patient’s tissues are stimulated to an increased production of the opsonins, phagocytosis is increased, the invading bacteria are disposed of, and the patient recovers from his infection. The proper handling of patients according to this method requires the greatest attention to details of technique for obtaining the opsonic index, preparing the vaccine, and the administration of the proper dose at the proper time.

It is too early to know the ultimate results that may be expected from the use of the vaccines, but from personal observation, conversation with other workers, and numerous reports, most of which are incomplete, it seems reasonable to believe that for localized bacterial infections much may be accomplished. Especially does this seem probable for acne, furunculosis, sycosis, abscesses, and lupus, adenitis, and other similar tubercular infections.

In incipient pulmonary tuberculosis encouraging results have been obtained where minute doses of new tuberculin, 1/1000 of a milligramme more or less, have been given, which seemingly show that Koch’s original observations were well grounded in fact.

Something has been accomplished in those diseases in which the bacterial infection is in the blood stream.

After a careful consideration of the literature of the entire subject I believe we should recognize the new therapy as an experimental procedure of much promise, but until more extended observations have been made the use of the vaccines should not be looked upon as a settled method of treatment.

PHARMACEUTICAL MEETING.

The stated Pharmaceutical Meeting of the Philadelphia College of Pharmacy was held on Tuesday afternoon, February 19th, with M. I. Wilbert, Ph.M., in the chair.

Prof. Charles H. La Wall was the first speaker on the program, and presented a paper on “The Food and Drugs Act in its Relation to Public Health.” (See p. 107.) The author reviewed conditions leading up to the passage of the United States Food and Drugs Act of June, 1906, and in considering the detailed provisions of the law, paid particular attention to the section on misbranding.

Mr. Thomas H. Potts called attention to a form of deception in which it is made to appear that the serial number placed by manufacturers on packages is a Government guarantee number.

Prof. Henry Kraemer said that there is a need for more workers along this line. He referred to the work which has been done by Dr. Wiley, and said that he deserved great credit not only for his efforts in securing the adoption of the Pure Food and Drugs Act, but also for standing out so many years against the moneyed interests represented by unscrupulous manufacturers.

The subject of drug legislation was brought up and Mr. Wilbert said that pharmacists were making a mistake in not taking an active part in it. He stated that in Vermont the druggists had hesitated in the matter, and that the grocers of that State had succeeded in having a law enacted which may prove inimical to the interests of pharmacists. He then called attention to the bill introduced in the Pennsylvania legislature which is practically that of the Wholesale Grocers’ Association, and does not exempt physicians’ prescriptions and the preparations of the United States Pharmacopœia and National Formulary in those portions of the bill which relate to labelling. Mr. Wilbert further stated that this bill is being introduced in the legislatures in a number of States, while the bill formulated by the _Ladies’ Home Journal_ has now been introduced by twenty State legislatures. It was also mentioned that a bill drafted by the National Wholesale Druggists’ Association is being introduced in some States, and that still another draft is that of the Proprietors’ Association.

Mr. Potts spoke of the meeting in Chicago of the representatives of the National Association of Retail Druggists, the National Wholesale Druggists’ Association and the Proprietors’ Association, and said that an attempt was made to have a law drafted which would require both physicians and retail druggists to use labels giving details as to the composition of medicines prescribed and dispensed. He then remarked that retail druggists are not opposed to legislation which is fair, but that they are not in favor of hasty legislation, which, as proposed in some instances, would drive retail druggists out of business.

A paper on “Sunday Closing: A Means of Elevating Pharmacy,” by Clarence H. Campbell, a local druggist, was read in the absence of the author by George B. Weidemann, P.D. The paper contained the statement that at the recent conventions of the National Association of Retail Druggists held in St. Louis and Atlanta, resolutions were unanimously adopted favoring Sunday closing, and that helpful suggestions had been made as to the ways and means of bringing about this end. The writer was of the opinion that the long hours without proportionate compensation has an influence in keeping young men from taking up pharmacy in the first place, or of pursuing it after qualifying for the work. Mr. Campbell also considered some of the arguments that have already been advanced in some of the previous issues of this JOURNAL as to the necessity of reasonable rest and recreation in broadening the horizon of the pharmacist.

Mr. Thomas H. Potts also presented a communication on the subject of Sunday closing and shorter hours. After considering the need of a more liberal spirit on the part of pharmacists and the necessity for an improvement in the number of hours that the pharmacist is on duty, Mr. Potts said that he fully admitted that the public must be taken into consideration, but maintained that they can be educated, and very readily, to acquiesce in this movement if concerted action be taken by druggists.

Mr. Potts further remarked that in his opinion there is only one possible plan to adopt and that is to agitate this question on every favorable opportunity. He said that since the agitation begun last fall by the Philadelphia College of Pharmacy, a great many retailers have closed their stores on Sunday afternoons, and in conversation with some of them he was informed that they like the plan so well that they could not be induced to return to the old conditions.

R. W. Cuthbert, chairman of the committee appointed by the college to help forward the shorter-hour movement, reported that he was encouraged by the results that had already been attained.

FLORENCE YAPLE, _Secretary pro tem._

PROCTER MONUMENT FUND. GENEROUS SUBSCRIPTION.

Just as we are going to press Professor Remington informs us that Mr. John Wyeth, a graduate of the Philadelphia College of Pharmacy, of the class of 1854, has, for himself, his firm and his brother, subscribed the sum of $2,000 to the Procter Monument Fund.

Mr. Wyeth has a warm appreciation of the services of Professor William Procter, not only to the cause of education, but to everything which tended to the advancement of pharmacy, particularly his researches on percolation and fluidextracts. It is confidently hoped that Mr. Wyeth’s example will be followed by others who have equally profited by the labors of the Father of American Pharmacy.

THE NEW FOOD AND DRUGS LABORATORY.

The Philadelphia College of Pharmacy is about to erect a new laboratory, designed to give instruction in analytical chemistry, technical microscopy, and other branches of science, especially adapted for students who desire to fit themselves for chemists under the Food and Drugs Act.

The College purchased a property a number of years ago, upon which a school-house had been erected in 1825 for the Aimwell School Association. This historic building will be entirely demolished and a new laboratory erected covering the whole lot, 40 x 60 feet. Plans are being prepared and it is fully expected that it will be ready for occupancy in the early fall. A roster is being drawn up for the courses for the students in the Food and Drug Laboratory, which will be available shortly.

The College has had in contemplation for a number of years a plan for extending the instruction in this department, and the passage of the Food and Drugs Act has caused such a demand for chemists, that immediate steps have been taken to put the plans in execution.

Footnote 1:

Read before the Philadelphia Branch of the American Pharmaceutical Association, February 5, 1907.

Footnote 2:

Reprinted from _Therapeutic Gazette_, January 15, 1907.

TRANSCRIBER’S NOTES

1. Silently corrected typographical errors and variations in spelling. 2. Retained anachronistic, non-standard, and uncertain spellings as printed. 3. Enclosed italics font in _underscores_.

End of Project Gutenberg's The American Journal of Pharmacy, by Various