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1200 Annotations. "Ne quid nimis." DR. HIDEYO NOGUCHI’S DEMONSTRATION. AT a special meeting of Fellows of the Royal Society of Medicine on Monday, Oct. 20th, Dr. Hideyo Noguchi gave a most instructive demonstration of his researches on the spirochastse and on certain bodies which he had found in the lesions of poliomyelitis and of rabies. The most interesting matter discussed by Dr. Noguchi was the statement that he had found the treponema pallidum in the brain of patients suffering from general paralysis. In the first series of 70 cases he had demonstrated their presence in 14 instances, and in a second series of 130 cases in 36 instances. The term parasyphilis has been used to denote those con- ditions which, although not directly syphilitic, are dependent upon its poison. Amongst the chief of these is general paralysis. Dr. Noguchi exhibited some microscopic speci- mens and lantern slides which showed very clearly the presence of the spirochsetae in the brain tissue. Further, he had been able to effect the transmission of the treponema pallidum from the brain of a general para- lytic to the rabbit; also he had been able to produce symptoms and lesions resembling general paralysis in the rabbit by means of an intracerebral or subdural inoculation with treponema pallidum. As a result of these investigations it may be questioned whether general paralysis can any longer be regarded as a "para- syphilitic" condition, but should be placed amongst syphilitic affections, although it has not yet been definitely proved that all cases of general paralysis are due to the same origin, and it is probable that other factors are necessary in order that the brain can be attacked by the spiro- chastse. Dr. Noguchi also showed lantern slides indicating that the spirochastas multiplied by longitudinal fission. He further drew attention to the cutaneous reaction test for syphilis furnished by luetin, which he con- sidered superior to the Wassermann reaction. Another part of Dr. Noguchi’s demonstration which caused much interest was his description of the "granules" which he found in pure cultures of the virus of rabies. In 1903 Negri described certain bodies which he found included in the cytoplasm of the nerve cells or in their branches, or occa- sionally lying outside them. Such bodies are found in the great majority of cases of rabies in the dog. Dr. Noguchi said that in the rabbit Negri’s bodies could not be found, but "granules" could be detected. He showed a series of lantern slides showing Negri’s bodies and also " sporulation " forms, which in cultures gradually grew larger and finally broke down into granules pre- cisely similar to those which he had previously seen in cultures. He believed these "granules" to be the causal agent of rabies, although he was uncertain as to their exact nature. These observations appear to support those of Williams and Lowden,l who were able to demonstrate the presence of Negri’s bodies at a very early stage, and considered them to be specific to rabies, and stated that they are found in large numbers in fixed virus; I they further pointed out that very minute germs, barely visible under a 1500 diameter magnification, had been 1 discerned, which were of such great plasticity that they ( readily passed through the comparatively large pores of ] Berkefeld filters ; they looked upon these as living 1 organisms and probably as belonging to the protozoa. Dr. 1 1 Journal of Infectious Diseases, Chicago, 1906, iii. Noguchi has brought this investigation to a most interesting stage, and further developments will be awaited with interest. ____ INSURED PATIENTS AND PROPRIETARY MEDICINES. Iv connexion with the administration of medical benefit under the Insurance Act, Local Insurance Committees are considering a question of no little difficulty. The problem they are called upon to solve is that of keeping the drug bill within the limits of the allotted amount without encroaching too much upon the prerogative of the prescriber. In some districts Local Committees find that unless the practitioners prescribe in a more economical way there will not be suffi- cient funds to pay the pharmacists in full and the committees are taking steps to discourage the prescribing of proprietary medicines. In a number of cases, in fact, lists have been drawn up of drugs and preparations which chemists may not charge to the Insurance Committees and which, there- fore, panel doctors may not prescribe for insured patients. In other cases Insurance Committees without having given warning that certain articles should not be supplied have disallowed the charges for such drugs when the chemists have sent in their bills. Not unnaturally medical practitioners resent this action, and it is obviously un- reasonable on the part of the committees to refuse to pay chemists for bond fide medicines which, in the absence of any warning to the contrary, they have supplied to an insurance practitioner’s order. The kind of proprietary articles referred to are not, of course, the popular class advertised to the public, but branded products, for the most part of known composition, which are claimed to be, and often are, superior in one way or another to preparations of a similar nature but non-proprietary. Such branded products are regularly prescribed by practitioners in private practice, and the class includes some of the most valuable drugs known in medicine ; on the other hand, the class comprises many preparations which are not materially superior to cheaper compounds of the British Pharmacopoeia or other standard formularies. It is, however, obviously impossible for Insurance Committees to define those articles which are better than non-proprietary drugs and those which are not better, and in the circumstances the only proper course for the committees is to suggest to practitioners that before prescribing proprietary com- pounds they should take reasonable means to satisfy themselves that they are superior to similar products which are not sold under branded names. A short time ago the Scottish Commissioners, at the request of some of the Local Committees, issued a memorandum which now serves as a guide to the committees in Scotland. It is understood that the English Commissioners are considering the desirability of following this example. The Commissioners for Scotland in their memorandum divided "proprietary medicines" into two broad but mutually exclusive groups.. One group com- prised medicines the composition of which is not publicly dis- closed-that is to say, those which are commonly known as "patent medicines" or "secret remedies." The second group comprised medicines the composition of which is made public without reserve, though the preparation may be made up in a particular form or sold by a special name. They expressed the opinion that preparations included in the first group were not in general proper and sufficient drugs" in the sense of Section 15 (5) of the National [nsurance Act, and should not be prescribed for or supplied o insured persons. On the other hand, they expressed the )pinion that those in the second group should be supplied 3-y chemists where ordered by panel doctors. The Scottish commissioners added that they assumed that practitioners

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Annotations."Ne quid nimis."

DR. HIDEYO NOGUCHI’S DEMONSTRATION.

AT a special meeting of Fellows of the Royal Society ofMedicine on Monday, Oct. 20th, Dr. Hideyo Noguchi gavea most instructive demonstration of his researches on the

spirochastse and on certain bodies which he had found in thelesions of poliomyelitis and of rabies. The most interestingmatter discussed by Dr. Noguchi was the statement that hehad found the treponema pallidum in the brain of patientssuffering from general paralysis. In the first series of 70cases he had demonstrated their presence in 14 instances,and in a second series of 130 cases in 36 instances.The term parasyphilis has been used to denote those con-ditions which, although not directly syphilitic, are dependentupon its poison. Amongst the chief of these is generalparalysis. Dr. Noguchi exhibited some microscopic speci-mens and lantern slides which showed very clearly the

presence of the spirochsetae in the brain tissue. Further,he had been able to effect the transmission of the

treponema pallidum from the brain of a general para-

lytic to the rabbit; also he had been able to producesymptoms and lesions resembling general paralysis in

the rabbit by means of an intracerebral or subduralinoculation with treponema pallidum. As a result

of these investigations it may be questioned whether

general paralysis can any longer be regarded as a "para-syphilitic" condition, but should be placed amongst syphiliticaffections, although it has not yet been definitely provedthat all cases of general paralysis are due to the same

origin, and it is probable that other factors are necessaryin order that the brain can be attacked by the spiro-chastse. Dr. Noguchi also showed lantern slides indicatingthat the spirochastas multiplied by longitudinal fission.He further drew attention to the cutaneous reactiontest for syphilis furnished by luetin, which he con-

sidered superior to the Wassermann reaction. Another

part of Dr. Noguchi’s demonstration which caused muchinterest was his description of the "granules" whichhe found in pure cultures of the virus of rabies. In 1903

Negri described certain bodies which he found included inthe cytoplasm of the nerve cells or in their branches, or occa-sionally lying outside them. Such bodies are found in the

great majority of cases of rabies in the dog. Dr. Noguchisaid that in the rabbit Negri’s bodies could not be found,but "granules" could be detected. He showed a series

of lantern slides showing Negri’s bodies and also" sporulation " forms, which in cultures gradually grewlarger and finally broke down into granules pre-cisely similar to those which he had previously seen in

cultures. He believed these "granules" to be the causalagent of rabies, although he was uncertain as to their exactnature. These observations appear to support those of

Williams and Lowden,l who were able to demonstratethe presence of Negri’s bodies at a very early stage, andconsidered them to be specific to rabies, and statedthat they are found in large numbers in fixed virus; I

they further pointed out that very minute germs, barelyvisible under a 1500 diameter magnification, had been 1

discerned, which were of such great plasticity that they (

readily passed through the comparatively large pores of ]

Berkefeld filters ; they looked upon these as living 1

organisms and probably as belonging to the protozoa. Dr. 11 Journal of Infectious Diseases, Chicago, 1906, iii.

Noguchi has brought this investigation to a most interestingstage, and further developments will be awaited with

interest. ____

INSURED PATIENTS AND PROPRIETARYMEDICINES.

Iv connexion with the administration of medical benefit

under the Insurance Act, Local Insurance Committees are

considering a question of no little difficulty. The problemthey are called upon to solve is that of keeping the drug billwithin the limits of the allotted amount without encroachingtoo much upon the prerogative of the prescriber. In some

districts Local Committees find that unless the practitionersprescribe in a more economical way there will not be suffi-

cient funds to pay the pharmacists in full and the committeesare taking steps to discourage the prescribing of proprietarymedicines. In a number of cases, in fact, lists have beendrawn up of drugs and preparations which chemists maynot charge to the Insurance Committees and which, there-fore, panel doctors may not prescribe for insured patients.In other cases Insurance Committees without havinggiven warning that certain articles should not be suppliedhave disallowed the charges for such drugs when thechemists have sent in their bills. Not unnaturally medicalpractitioners resent this action, and it is obviously un-reasonable on the part of the committees to refuse to paychemists for bond fide medicines which, in the absence ofany warning to the contrary, they have supplied to an

insurance practitioner’s order. The kind of proprietaryarticles referred to are not, of course, the popular classadvertised to the public, but branded products, for the mostpart of known composition, which are claimed to be, andoften are, superior in one way or another to preparations of asimilar nature but non-proprietary. Such branded productsare regularly prescribed by practitioners in private practice,and the class includes some of the most valuable drugsknown in medicine ; on the other hand, the class comprisesmany preparations which are not materially superior to

cheaper compounds of the British Pharmacopoeia or otherstandard formularies. It is, however, obviously impossiblefor Insurance Committees to define those articles which

are better than non-proprietary drugs and those which

are not better, and in the circumstances the onlyproper course for the committees is to suggest to

practitioners that before prescribing proprietary com-

pounds they should take reasonable means to satisfythemselves that they are superior to similar products whichare not sold under branded names. A short time ago the

Scottish Commissioners, at the request of some of the LocalCommittees, issued a memorandum which now serves as a

guide to the committees in Scotland. It is understood thatthe English Commissioners are considering the desirabilityof following this example. The Commissioners for Scotlandin their memorandum divided "proprietary medicines" intotwo broad but mutually exclusive groups.. One group com-

prised medicines the composition of which is not publicly dis-closed-that is to say, those which are commonly known as"patent medicines" or "secret remedies." The second

group comprised medicines the composition of which ismade public without reserve, though the preparation may bemade up in a particular form or sold by a special name.They expressed the opinion that preparations included inthe first group were not in general proper and sufficientdrugs" in the sense of Section 15 (5) of the National[nsurance Act, and should not be prescribed for or suppliedo insured persons. On the other hand, they expressed the)pinion that those in the second group should be supplied3-y chemists where ordered by panel doctors. The Scottishcommissioners added that they assumed that practitioners

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would not order medicines in the second group unlessthey looked upon them as possessing recognised advantages

I

over pharmacopoeial or other non-proprietary preparationsof similar composition. The Lofal Committees are not

bound to act upon these suggestions, but in practice theyare doing so, and it is very desirable that there should bemore uniformity in the policy of English committees. It is

obviously in the interests of insured persons that there

should be no unreasonable interference with the duties ofthe doctor towards his patient.

CHILDBIRTH IN THE EIGHTEENTH CENTURY.

IT can scarcely be disputed that the eighteenth century I ’-held semi-barbaric views as to the puerperal state and wifely

I

duties in general. When, for instance, Csesarean section t

had to be resorted to, the mother was, when necessary, t

sacrificed in place of the child, whereas nowadays the

mother, as a possible producer of further offspring, is spared "

and the child is sacrificed. The theory of the old medical i

jurisprudence was that everything should be done to safe-guard the life of an heir; and a mother, as not being an heir,

1

was as often as not the victim of her infant’s claims to a

succession. She was the slave of testamentary dispositions,and at times was compelled by these to give birth to herbaby at some stated place. Often, again, during preg-nancy she was made to suffer bitterly in the cause

of dynastic or family feuds ; and often, when no feudexisted, she was bandied about during the periodof gestation in a manner horrifying to modern notionsof decency. It speaks volumes for our ancestresses that

they apparently acquiesced with much cheerfulness in

these arrangements. A historic document was issued in

1737 by George II. to all foreign ambassadors in Englandand to all British ambassadors abroad. Republished for thebenefit of the public, it appears as the very scarce pamphletentitled Letters and Messages, that passed between theKing, Queen, Prince, and Princess of Wales ; on occasion ofthe Birth of the Young Princess." It was sold to a genera-tion in sympathy with Frederick, Prince of Wales, for the

sum of 6d., and presents a perfect picture of our ancestors’attitude towards a mother in posse. Late in July, 1737, thePrincess of Wales, wife of the notorious, but not very wicked,Prince Frederick, had been to all appearances seized withlabour pains and had been hurried at dead of night fromHampton Court to St. James’s in order that she mightbecome a mother in London. The roads were rough,footpads swarmed in the neighbourhood of what is now

the Albert Memorial, the carriages even of the greathung on uneasy springs and ran on heavy iron tyres.Yet despite all this, Prince Frederick endangered his

consort’s life in order probably that the child mightbe born away from the Court and that the witty QueenCaroline might not be present at its birth. The sup-position is that of Lord Hervey, whose fascinatingmemoirs have been so often quoted by Leigh Hunt in hisdescription of the goings on at Kensington Palace whenQueen Caroline resided there ("The Old Court Suburb").On arrival at St. James’s the beds were found to be unaired,and the only lady in attendance was a reputed mistress ofthe Prince. The pains, however, abated, and a return wasmade to Hampton Court. This happened on a Mondaynight or on a Tuesday morning. On the Friday followingthe pains returned, and again the Princess was rattled toSt. James’s, only to return to Hampton Court on a Saturday.

, On Sunday, however, there could be no doubt about her con-dition. She was got to London and gave birth to a princess,sister of the future George III. The Prince, writing in thecurious Court French of the time, avers that there was

no midwife at Hampton Court, and that neither Doctors

Hollings and Broxholme nor Mrs. Hollings had dia-

gnosed the near approach of the event during the Princessof Wales’s flying visits to town. The King, however, wasvastly incensed. He thought he saw through these

excuses, and turned his son, his daughter-in-law, andtheir baby out of his London palace. Instances of

babies untimely born are legion, for the ladies of the

eighteenth century took risks with their eyes open andwith a lightness of heart, now only to be equalled amonggipsies or proletarians. In 1777, for instance, the wife

of a naval officer, afterwards one of Nelson’s admirals,narrowly escaped giving birth to her daughter in a theatre atCork, where her versatile spouse was acting in the Duenna.He had a passion for the stage as well as for war at sea.

« In the middle of the entertainment," according to

the unpublished memoirs of the daughter in question,66 may mother was taken ill, and escaped as quicklyas possible and got home only a few doors distant,but no one was in to open the door. My father, guessingwhat had occurr’d, ran. home in all his disguise andbroke the door open before the servant could be awoke

from a fainting fit into which she had fallen by reasonof the heat." " How our ancestors were born, and howthey died, would form a fascinating volume, but

mourners and survivors, from various motives, are alwaysreticent as to these desirable data. Even in the case offamous medical men the cause of death is rarely mentioned.We know that John Hunter died from heart disease, but whatdid the great Joseph Henry Green die from when, like somehero of antiquity, he said Stopped! " after his pulse hadactually ceased to beat ? If these deaths of famous men be

obscure, how much more impenetrable are the circumstancesof their births.

____

THE PERIOD OF GESTATION.

THE determination of the normal period of gestation is anatter of considerable practical importance, but up to thepresent time no very definite knowledge can be said to exist

3n this point. The problem is discussed by Dr. D. BerryHart in the current number of the Edinburg7t MedicalJ01lrnal. An obvious difficulty is encountered at the outsetof any inquiry on the subject in that the terminqts a quo-the moment when the ovum is fertilised by the spermatozoon-cannot be accurately recognised, for it is almost certain

that the male element may remain alive in the female

passage for some days, while it is exceptional in the case ofhuman beings to be able to trace a pregnancy to a single actof insemination on a known date. Hence it is necessary inthe case of mankind to reckon the probable duration of

pregnancy from a somewhat arbitrary date, that of the

beginning or end of the last previous menstrual epoch. In

the case of the domesticated animals greater accuracy isobtainable as to the time of coitus, and data are available asto the duration of pregnancy in both cattle and sheep.Regarding the latter Tessier’s observations deal with

912 ewes, and it appears that labour took place in

these between the 146th and 157th days after im-

pregnation, a very large majority of all the births

taking place between the 149th and 153rd days. If

the figures are reduced to a curve in which the birthsform the ordinates and the dates the abscissse a fairlysymmetrical figure is produced, in which the axis of thecurve corresponds with the 152nd day. It seems probablethat in the ewe only one ovum is shed at a time, andthat some, at all events, of the variation in the actual dateof the occurrence of labour is due to difference in the timetaken by the spermatozoon to meet the ovum. It may be

noted that as the 7’mtmMS ad fj11B1n is the actual birth, andthe process of labour may be prolonged, another variable