NZMJ, 1923

At the end of January, 1922, I spent several days with Mons. Henri Spahlinger at Geneva. He went to no end of trouble in explaining to me the general lines on which he manufactures his serum and vaccine and, more especially, the clinical results he has obtained up to the present.

The following is a brief description of the preparation of the serum:

ANTITOXIC SERUM.

FIRST YEAR.

The passage of various strains of tubercle bacilli through guinea pigs to increase their virulence. Those usually obtained from a case of phthisis are not sufficiently virulent to cause the production of much toxin “in vitro.”

The tubercle bacillus, according to Spahlinger, gives off many different toxins with correspondingly different results on the patient, but strains can be isolated that excrete one predominant toxin. For example, one causes caseation, another pyrexia and so on. They produce all the other toxins as well perhaps, but this special one is greatly in excess of the rest. From some strains he was unable to obtain any toxins at all.

SECOND YEAR.

This is spent in encouraging the bacillus to give forth its toxin “in vitro”. Spahlinger maintains that the toxin is in many cases a defensive mechanism on the part of the bacillus, and not an offensive; consequently, unless the bacillus is worried and forced to for its existence, it is too lazy to give out toxin. There is nutriment in abundance “in vitro,” and no attacking forces such as the body provides, so no toxin appears.

The successful application of these methods of irritation is most difficult of accomplishment, for it takes very little to hinder or completely stop the production of toxin; e.g., white light or a different reaction of the glass. The actual details are claimed as the secrets of Spahlinger’s success and have not been disclosed. One method I believe is to suddenly raise the temperature of the medium on which the bacillus is growing for two or more cultures of the day. Another is to expose it to red light.

THIRD YEAR.

He extracts the toxin from the culture medium.

FOURTH YEAR.

He injects the toxins into horses, giving rise to the corresponding antitoxin. The horses are always black as they give the biggest yield of the serum.

Very small doses of the special toxin are given for four months; then one month rest and then much larger doses up to perhaps 300ccs. at one injection. Now he takes the serum and tests it; if there is a sufficient strength of antibodies he bleeds the horse and may get 12 litres. Now one month rest, and then “pumps up” the horse again, but this time much more quickly, and he starts from much larger doses. This is done two, three or four times, but not more than four.

ANTIBACETERIAL SERUM.

The horse is vaccinated in exactly the same way as is done in the case of human beings to be described. It is then, with small amounts gradually increased, injected with living bacilli. This could only be done if the horse had been made highly resistant by vaccination. Thus is produced an antibody in the horse which is strongly antebactericidal to the bacillus itself.

COMPLETE SERUM.

This consists of 28 different antibodies—12 antiectotoxins, 7 antiendotoxins, 3 antibacterialysins, the remaining six being made from organism other than the tubercle bacillus which give rise to the so-called mixed infection.

At present Spahlinger has no “complete serum” so is compelled to use the “partial serum” which he has numbered. For instance, one case may receive No. 1 for a few weeks; if no result, say, No. 5 may be tried; and if this gives nothing definite another number is used until one is found that may show an almost immediate improvement; Spahlinger’s idea being that we have here given the corresponding antibody to the toxin most predominant in the patient’s body. Once this has been neutralised, the scale is turned in the patient’s favour and he is able to deal with the rest of the toxins. Instances of this phenomenon were shown by means of temperature charts. If the complete serum is given this method of trial is obviously unnecessary.

For surgical tuberculoses he uses in the “complete serum” 50 per cent. antibacteriolysins, and 50 per cent. Antitoxins—of the latter 20 per cent. are antiectotoxins and 80 per cent. are antiendo-toxins.

For pulmonary tuberculosis one-third antiendotoxins and two-thirds antiectotoxins; no antibacteriolysins.

As to the type of the bacillus—surgical—50 per cent. human, 50 per cent. bovine. Pulmonary—100 per cent. human.

The aim in serum treatment is progressive disintoxication of the patient by passive immunization. The injections are made intramuscularly or hypodermically according tot eh gravity of the disease and resistance of the patient. It may be several times a day up to once or twice weekly.

In abdominal tuberculosis it may be advisable to give the serum by mouth as well, and in some cases of surgical tuberculosis to inject it directly into the foci.

The length of treatment with serum varies considerably, but averages from three to six months. From the nature of the preceeding remarks it will be gathered that the serum is of more use in the in the advanced case, or, rather, that showing signs of marked intoxication. This passive immunity is short-lived and the disease is liable to recur if the serum course is not followed by a series of vaccine injections: this being a process of active immunization. This latter is also applicable alone without the serum to the afebrile cases and those predisposed to the disease.

VACCINE.

The bacillus is broken up by physico-chemical means into several component parts such as lecithin, fatty acid, albuminoid, etc. These various elements are used as antigens and injected separately into the patient to produce a corresponding series of immunity. These parts are numbered 1, 2, 3, etc. No. 1 is injected for, say, two or three weeks; then No. 1 and 2 for a similar period; then No. 1, 2, 3, and so on, until a complete series is given, when the patient receives the complete dead bacillus.

It is essential that great care be taken in the preparation of these different antigens, for any alteration in their specificity renders them less efficacious. A corresponding antibody is formed to the altered antigen and not to the original one. For instance Spahlinger does not believe in Koch’s old tuberculin, because the bacillus is killed by heat. This must alter the specificity, and in consequence the antibody formed in response to it. Spahlinger uses light to kill the bacillus instead of heat.

What Spahlinger calls a ferment is given along with the vaccine sometimes. It really consists of a partial serum and therefore contains antibodies; it is supposed to facilitate immunization and avoids undesirable effects. The vaccine takes about six months to make and the course of treatment about six months also. Both the vaccine and the serum lose one-third of their efficacy after two or three years, and should not be used.

Spahlinger attaches great importance to vaccine treatment as it is more in the nature of a preventive than a curative process.

CLINICAL RESULTS.

Spahlinger showed me numerous cases embodying all types of tuberculosis which have been treated with his serum or vaccine or both. Many had tried various other methods of treatment previously with little permanent benefit, but they improved under his care.

I have facsimiles of the reports of some of these cases made by various doctors at the beginning, during, and at the end of treatment which has been arried out mainly in Geneva under Spahlinger, or at Montana under Dr. Stephanie. It has also been used in Paris and London.

In Geneva Spahlinger has been treating patients for many years. He was originally a lawyer by profession, but in about 1910 he took up experimental bacteriology and turned his attention chiefly to the tubercle bacillus.

His patients have come from many parts of the globe, though the majority have been residents of Geneva. Very few, if any, whatever their social status, lived in really good hygienic surroundings as far as I could gather. Geneva has by no means a good climate for tuberculosis. The visitors stay in hotels and come to Spahlinger for their injections, otherwise no supervision is made. They arise and go to bed, eat and drink, and exercise or rest just as they please, and, from my experience of patients in general in Switzerland, would not over-indulge in fresh air. I mention these points, for it cannot be said that these patients, like those at Montana, were living under sanatorium conditions.

I was permitted to question and examine a number of them and found the majority showed very few, if any signs of active tuberculosis. All cases were definitely tuberculosis, as bacilli had been found in the sputum. Some were old chronic cases, but by no means all, for, judging by the physical signs and history, many must have been acutely toxic on arrival in Geneva.

Spahlinger does not claim that the serum will cure every case and he wishes to impress this fact on the medical profession. He seldom has a failure with surgical tuberculosis, but it not always successful with pulmonary disease. He is very much afraid of articles in the daily press, as he feels, and rightly so, that such writings, for which he was in now way responsible, have in the past done him an enormous amount of harm in the eyes of the medical profession.

For my own part I must admit that I went to Geneva a confirmed sceptic, but came away feeling that, if Spahlinger has not actually found a cure for tuberculosis, he is at least working on the right lines, and has made a distinct advance towards the goal for which we are all aiming. Before one can speak more definitely on the subject the serum and vaccine must be made available in sufficient quantities so that others may give them a trial. To enable this to be done Spahlinger must be relieved of his financial difficulties, and it would be a wise expenditure of private or public money devote to this end. I believe the British Red Cross Society have advanced him a sum of money to assist him to produce the serum he has at present under manufacture. It apparently involves the outlay of a large amount of time and money, and as Spahlinger has never up to the present made any charge for treatment, either to those receiving it at his hands or from others, he has been at considerable financial loss.

His laboratory, which, by the way, is duplicated in every detail in case of fire, is most elaborately fitted up and some of the contrivances he has there are most ingenious.

In common with the great majority of visitors to Spahlinger I am perfectly satisfied that he is absolutely genuine and honestly believes that he has a remedy that is going to rid the world of a terrible scourge.

CRITICISM.

Critisicism of Spahlinger is based chiefly on his failure to publish the details of his treatment, and allow competent clinicians and bacteriologists to judge its worth. He has been accused of endeavouring to commercialise his discoveries in that he is asking what seem to be large sums of money from various countries for the rights to use and manufacture his serum and vaccine. He is by many called a quack, for he is not a medical man. It is stated that Spahlinger has no satisfactory method of standardization of his serum; that he has given no satisfactory proof of the existence of toxins in the culture medium, nor antibodies in the serum, and that many of his ideas on baceteriology are quite unsound. These, and other objections of a similar nature, may be justified, for I am not sufficiently versed in bacteriology to express an opinion. But I do hold that he is not bound, morally or otherwise, to disclose his secrets, and that he is quite within his rights in endeavouring to recoup himself for all his labours and expense in the past.

The treatment has now obtained a world-wide reputation, and any publication of the details of manufacture without protection would be immediately followed by a perfect deluge of preparation by proprietary firms, stating that they had been made in accordance with Spahlinger’s directions. It is obvious that the serum cannot be made in a day and some of the technical details, according to Spahlinger, need great care and attention, otherwise the resulting product will be valueless. He is afraid that these firms, in their anxiety to put it on the market, would bring discredit on his treatment before he himself had established its value.

Again, Spahlinger has spent anything up to £100, 000 of his own money on the equipment and working of his laboratories. He is now almost penniless and unable to carry on without assistance from the British Red Cross Society.

Can we expect any man to make such a sacrifice and offer him no other recompense than that of handing down his name to posterity as the man who discovered a cure for tuberculosis?

What does it matter to us in the meantime how this serum is made whether its contetns are all that Spahlinger says they are, and whether Spahligner is right or wrong in his desire to make us pay for the use of it? To my mind the questions resolves itself into this—Is Spahlinger getting more successful results by his method of treating tuberculosis than have been obtained in the past? If so, and it is the opinion of the majority of those who have investigated his claims, that they are little, if at all, exaggerated, then is it not our duty to obtain serum and vaccine for the benefit of our tuberculous population?

It is always a difficult matter to assess the therapeutic value of a remedy and especially is this the case in a chronic disease like tuberculosis. So many “cures” have been announced in the past, and still tuberculosis seems to be as prevalent as ever. It is to be regretted that Spahlinger has given no statistical results of his treatment, though perhaps their value is not as great as one might at first imagine.

My purpose in writing this article has been to try and interest the medical profession in Spahlinger’s treatment and to put before them the true facts of the position, for the extravagant statements made at times in the daily press are often untrue and certainly misleading.

Since writing the above I have heard that Spahlinger has collected statistics of his cases, but I have none by me at present. I have one or two patients on the partial serum and the results, so far, are by no means discouraging, but it would not be fair to pass any judgment on the serum until I have tried the complete serum, which I hope to obtain in the near future. If I can give any further information to anyone interested I shall be only too pleased to do so.