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prolonged in comparison with the rate of about thirty years ago.
The infant mortality rate of Massachusetts in 1885 was 156; for 1921 it was 76. This means that whereas in 1885 a new-born infant had only a little better than five chances in six of living to celebrate a first birthday, now less than one child in ten dies under the first year, a most creditable gain but still a fatality hazard much higher than we know to be necessary.
The death rate for pulmonary tuberculosis in 1885 was 307 per 100,000; in 1920 it was 96 per 100,000. This means that if the tuberculosis death rate had remained to-day what it was in 1885 in place of approximately 3,300 dying this year from consumption the number would have been over 12,000.
In 1885 the typhoid death rate of this commonwealth was 39 per 100,000; in 1920 it was 2.5. This means that whereas less than 100 Massachusetts people died from typhoid in 1920, had the same rate prevailed as in 1885, 1,560 would have died.
In 1885 the death rate for diphtheria in Massachusetts was 78 per 100,000 of population, in 1920, 15 per 100,000 population.
In 1885 the death rate of scarlet fever per 100,000 population was 30.2. In 1920 it was 5.5 per 100,000 population.
Or it is perhaps more graphic and comprehensible to reduce the matter to terms of average expectancy of life at birth.
In 1885 the average approximate expectancy of life for a new-born baby (male) in Massachusetts was 42 years (female), approximately, 43.5. Both
sexes average 42.75 years. In 1920 the average expectancy was 53.98 years (male); 56.33 years (female). Both sexes 55.1 years.
Dreyer was led to his research by observing that the results of the use of vaccines and sera were very uncertain. The vaccine treatment is the most logical treatment of disease we have. We can shew by experimental inoculation that the same changes are produced in the subjects of experiment as are produced by their accidental inoculation into the would-be patient; and that various antibodies are formed similar to those associated with recovery from infections. The injection of vaccines stimulates the patient's tissues to produce antibodies.
The introduction of vaccine treatment was followed by a very extensive use of vaccines. Some of them were speedily efficacious, others not. Results varied; they were often brilliant, and there were many dismal failures. The vaccine is a valuable method, but we don't know enough about it. There are some facts we don't understand. Responses have been good in many cases of staphylococcal, pneumococcal and other infections; in other cases vaccines failed completely.
Dreyer, after reviewing thousands of cases, came to the conclusion that failures in vaccine treatment were present in those cases of infection where the invading organism was gram-positive and acid-fast. There were many exceptions; but he found this a general working rule. Dreyer also had observed, as other investigators had, that acid-fastness and
gram-positiveness were associated with a high lipoid content in the bacteria-a tough, fatty substance. Dreyer concluded that where vaccines failed to act it meant that the organisms were not being digested by the tissues, or so slowly, that the patient didn't get a sufficient amount of bacterial substance to stimulate the tissues. Dreyer concluded that we must remove the fatty substance this resistant, protective, waxy or lipoid substance.
He had noticed, like others, that in a section of tuberculous tissue fixed in formalin there were fewer bacilli to be seen than in similar specimens fixed in corrosive sublimate. So he ground up his tubercular organisms with formalin, using alcohol, chloroform and various fat solvents. The bacilli were no longer acid-fast and gram-positive. This is the process of de-fatting. From this extracted material he made up a vaccine-a highly technical procedure requiring a good deal of experience. The next query was: Is this defatted antigen any good? And Dreyer has proved by a long series of experiments on rabbits and guinea-pigs that these vaccines (dead, defatted bacteria) are highly antigenic.
As to treatment, Dreyer produced tuberculosis in rabbits and guinea-pigs, and using healthy animals as controls, tried his new vaccines with good results-the tuberculosis nodules reduced in size or disappeared; some remained stationary. were cured, others improved and two died.
The next step was to test the vaccines on humans. He did not rely on himself to do this, but turned the work over to physicians on the staff of the London Hospital. These men tried the vaccine on some sixty patients suffering from tuberculosis-adeni
tis, cutaneous lesions, pulmonary (pyretic and apyretic), bones and joints, peritonitis, irido-cyclitis, and genito-urinary. There was improvement in nearly all cases and there were no toxic effects.
The principle will be applied to the treatment of other infections-streptococcal, pneumococcal, staphylococcal, etc.
We are sure Dreyer's plan will be tried out on this continent and trust that his good results will be verified.
The Mental Side
"Will not the patient of the future enter a kind of Chicago sausage factory, be whirled from one test to another, and be presented at the end with а set of graphs or even of one composite graph representing his bill of health, and a table of instructions which will bring him back to, or keep him in, the narrow path of physiological righteousness?" queries a writer in a recent number of the LANCET. "Should not the mind falter and hesitate to go forward to such mechanical triumph?" man, he says, is constantly devising systems for the economy of time and effort, and constantly becoming entangled in his own rigid creations till some thinker or poet comes to release him; and the way by which medicine will escape from the dominance of mechanics will perchance be through the altered emphasis that will be put on mental as compared with physical ailments. Civilized man seems hardly to view in their right perspectives the unhappy results of bad bodily and bad mental health. The healthy body has been made a fetish.
Daily papers exaggerate slight advances in therapeutics and paint horrible pictures of disease, leading people to think of their livers, hearts and kidneys and to seek for salvation through the extirpation of physical disease. Results are seen in a hundred ways: the only son, examined again and again for tuberculosis, whose vests are too thick, stuffed with cod-liver oil and cream. The small "prep" school with its fussy head and matron where anxious parents send the supposedly delicate boy; the tame doctor to minister to the needs of one family or even one person; the man with slightly stiff knee surrounded by his clientele of specialists, nurses and masseurs.
This critic is struck by the fact that the greater part of human misery is mental, and the part bodily ill-health plays in its production is over-emphasized. "We live," he says, "in a world of men and women potentially capable of far greater things than they accomplish-hampered by the inharmonious or under-developed working of their central nervous system. Many a man, possessed of fine intellectual qualities is a burden to himself and acquaintances, because he has never learnt to harmonize his conflicting instincts."
Mr. M. G. Brumaugh in one of our contemporaries says the United States Army recruit rejects between the ages of 21 and 31 suddenly apprised the American people of the need of a sound universal education and is an eternal indictment against a school system which failed to conserve the physical vigor of the race.