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INSURANCE FOR MEDICAL MEN.
116 membrane filled with fresh blood, or the cut ends were placed in apposition in various ways-e.g., in one case they were surrounded by a mass of brain-substance taken fresh from another guineapig. The minute histological investigation of a human case of acute tuberculous and of progressive hypertrophic interstitial di neuritis (Dejerine-Sottas) was also undertaken. ’, As Professor Kimura intends to deal with the traumatic material in a subsequent communication, his allusions to it are brief, but he points out that regeneration in section cases is different from what obtains in non-traumatic cases, to which he The devotes almost the whole of his paper. pathological changes in the nerves and muscles of birds fed on polished rice are essentially of a regressive-degenerative character. In the muscles simple atrophy anèL.fatty degeneration are the chief changes, but they are not of primary significance, for often within one week of the resumption of normal feeding wasted muscles recover their ordinary volume and apparently also their full functional power. The severity of the anatomical
ribbon-like protoplasm, beginning at the end nearest to the old axon-stump, and spreading link by link peripheral-wards. It is commonly a simple, smooth, delicate axon, with neither whorl nor endbulb formation on its course, thereby differing from what is seen in the majority of cases of regeneration after trauma. Much importance in this matter is attached by the author to the intactness of the neighbouring connective tissue supporting the For the equally interesting question of the nerve. origin of the new myelin formation these researches of Professor Kimura unfortunately do not serve; he merely indicates the possibility of part of the protoplasmic bridges within the fibre sheath being allocated to that purpose. It is to be regretted, also, that he modestly considers his experimental material too meagre for any exhaustive contribution to the problem of the pathogenesis of beri-beri, or rice-neuritis," and contents himself with a the review of literature and present state of knowledge on this vexed question. He remarks with justice that little enough attention has been paid to the actual changes in the peripheral nerves, in experimental pathology of the deficiency diseases, and is not "rice-neuritis," bears no constant parallel relation- clear that the monophagismusgroup of beriship to the clinical symptoms. In their essentials ’ beri, scurvy, Barlow’s disease, and pellagra contains they consist of a pure degeneration; in no instance I conditions essentially alike in their pathogenesis. did Professor Kimura find any sign of alterations of Whether " ein schadliehes plus beyond mere an inflammatory nature. Degeneration does not by partial starvation is essential Professor Kimura any means always commence at the periphery of the does not allow himself to say, but he quotes with nerve fibres; on the contrary, it may appear anywhere approval the opinion of Eijkman-which for that of had been expressed before-that absence of the course a sometimes at different matter along nerve, levels in different fibres of the same nerve. some essential element in food may allow the Further, normal and degenerated fibres are seen development of some nerve poison to which the The monograph is side by side. The suggestion is made that experi- symptoms are attributable. mental " neuritis"is a general affection of the illustrated with admirable coloured drawings, and nervous system, with local lesions at sites that are micro-photographs reproduced in collotype, and somehow predisposed. Lower extremities are much there is a very long bibliography. more usually affected than upper, with special incidence on the peroneal nerves. The first recogINSURANCE FOR MEDICAL MEN. nisable sign of degeneration is in the axon, THE Managing Committee of the Medical frequently noted when the myelin sheath is still met Insurance last week and found itself nor does it Agency intact, necessarily progress distally make interim allotments, able to substantial mere Wallerian for the morbid a by process, agent may attack spots beyond the original amounting to £455- £125 to the Royal Medical lesion. Once the nerve fibre gets to the stage Benevolent Fund, JE125 to the Royal Medical of complete myelin degeneration no axon can Benevolent Fund Guild, JE105 to Epsom College Royal be found in it; in fact, the latter disappears Medical Foundation, and JB100 to the Royal St. Anne’s before any complete break-up of myelin. The School. In this way the committee was fulfilling myelin fragments are, according to all appearance, one of its prime objects. For the Agency, when absorbed in situ after being dissolved or otherwise founded 12 years ago with the intention of assisting chemically modified by some (? fermentative) func- medical men to obtain the best terms of insurance tion of the cells of the sheath of Schwann, or of all kinds, has from the first kept in mind as stream in this dissolved state towards lymph and one of the chief reasons for its existence the venous channels; in the human cases, however, practical aid of the benevolent institutions of the there was evidence of direct phagocytic activity for profession. The Royal Medical Benevolent Fund the scavengering of some at least of the degenera- is the most largely benefited of such institutions tive products. When a fibre in a state of complete in the recent distribution, but its record deserves myelin disintegration is seen to contain within its that this should be so, while its offspring, neurilemma an axon, such axon, according to Pro- the Guild, is doing most admirable work, the fessor Kimura, is invariably a new formation- special feature here being the personal interest of i.e., a regenerated axon. To the problem of regenera- individual ladies in the work. It has seemed to the tion in non-traumatic " neuritishe devotes an Agency that one of the most practical means it important part of his research. His view, supported could take to help less fortunate members of the by much histological evidence, is that the way is paved profession was to contribute to the education of This it has done by subscriptions to for the new axons by protoplasmic prolongations children. of the cells of the neurilemmal sheath, that Epsom College, where boys are received on these link up to form more or less " solid the foundation, and to the Royal St. Anne’s protoplasmic paths, filling the otherwise nearly School, where girls obtain an excellent educaempty fibre. In or through this protoplasm the tion. This benevolent side of the Agency’s work new axon makes its appearance, either by direct has commended it to many members of the outgrowth from the proximal end, or-a very profession, though not to so many as might have important alternative-by differentiation from this been expected to resort to it. Last year the total
polyneuritis
"
I
"
"
.
"
117 distributed from the Agency’s medical benevolence More characteristic is the orcin reaction, best account was R1002 10s., including contributions of carried out in the form of Bial’s test. 4-5 c.cm. £ 150 to the War Emergency Fund of the Royal of Bial’s reagent (0’5 gr. orcin, 250 c.cm. fuming Medical Benevolent Fund, and JE100 to the Belgian hydrochloric acid, sp. gr. 1’195, and 12 drops of Doctors’ and Pharmacists’ Relief Fund. At the same liq. ferri perchlor.) are heated to boiling in a time the insurers received an advantage by the test-tube and 1 c.cm. of the urine added ; on return out of the commissions received by the standing a green-blue colour develops when a Agency of certain sums which in 1918 totalled f:697. pentose is present. If the solution is cooled, Since the foundation of the Agency £ 7200 have been extracted with amyl alcohol, and the extract returned in this way to insurers, a sum which examined with the spectroscope, it shows a band represents a direct saving to the profession. between the red and yellow (C and D). Glycuronic The Agency is not bound to any particular acid may give a similar reaction, but it also gives companies or forms of policy, and is able Tollen’s naphthol-resorcinol test. The most conto advise medical practitioners contemplating clusive evidence is furnished by preparing the diinsurance as to the best form of policy to suit their phenylhydrazone with a melting-point of 216-218° C. particular conditions. The life insurance business for the 1-arabinose derivative and 204-205° C. for the conducted through the Agency is considerable, and i-arabinose compound, and the parabrom-phenylit is confidently anticipated that as the conditions osazone which melts at 196-200° C. in the case of disturbed by the war become more stable this form 1-arabinose and 200-202° C. for the inactive form. of business will largely increase. The insurance As pentoses are not fermented by yeast the reducing of motor-cars is growing into an extensive branch power of the urine in cases of pure pentosuria is of energy; in spite of the difficulties in the way of not impaired by mixing it with yeast and standing motorists created by the war and the shortage of in a warm place for 24 hours. petrol and of cars the number of motor insurances has increased, and experience has proved that the PRACTICAL ISSUES ON THE ALCOHOL Agency, owing to the amount of business it conducts QUESTION. in this direction, is able to assure to its clients that the WE scientific welcome investigation of alcohol their claims shall be promptly and generously met. to reference with practical issues. No one drinks In presenting the financial report the chairman, a dilution of pure alcohol and water, and yet Dr. G. E. Haslip, was able to speak in the most ’, hopeful terms of the future of the Agency, and hitherto, whilst interesting evidence has been mentioned that vacancies, due to deaths of several accumulated, physiological experiments have, in members of the committee, had been filled by the ’, the main, been based not on the actual beverages election of Dr. E. Weaver Adams, Dr. H. A. Des consumed by the public, but literally on C2H50H Vceux, Lieutenant-Colonel R. H. Elliot, I.M.S., Dr. + H2O. That formula does not by any means present the story of such beverages as claret, R. A. Gibbons, and Dr. R. Langdon-Down. sherry, port, beer, champagne, and so forth, none of which is a mere dilution of pure alcohol, and it is well known that these various alcoholic beverPENTOSURIA. in their effects. The effervescent THE occurrence of pentoses in the urine is ages differ wine for example, has a different champagne, not so rare an event as is commonly supposed. effect from claret, though both contain the same Pentosuria is not necessarily associated with any amount of alcohol. There are important varying morbid symptoms, and does not of itself call for factors in the numerous alcoholic beverages conany particular treatment; the importance of the sumed by the public which must count in regard condition arises from the fact that its presence to their effects. A mixture of whisky and water, may lead to a hasty diagnosis of diabetes, with con- for example, is below the specific gravity of water, sequent dietetic restrictions which are unnecessary. whilst wines and beers are above this point on Two distinct types may be recognised : (1) the account of the solid matters in solution. Osmotic alimentary form, in which the sugar is 1-arabinose pressure must therefore vary, and with it the rate and the urine rotates polarised light to the right; of diffusibility of the alcohol. (2) true or essential pentosuria, in which the sugar In an important investigation undertaken for is usually i-arabinose and the urine is optically the Medical Research Committee by Dr. Edward inactive, unless some other sugar is present as well. bearing on the absorption into, and disAlimentary pentosuria is apt to cause mistakes Mellanby,’ from, the blood of alcohol under different appearance in diagnosis, especially at this time of the year these points find interesting illustration. conditions, when fruit is being eaten more extensively than It is shown that differences in intensity of intoxiat other seasons. The tolerance limit for pentoses obtained by taking the same is small, about half a gramme, and even in healthy cating symptoms amount of alcohol in one or several drinks depend people a surfeit of cherries will cause the appear- on the of beverage drunk and the interval ance of the sugar in the urine. Plums, goose- betweentype the drinks. Foodstuffs inhibit intoxicaberries, strawberries, apples, and other fruits in tion in of their action in delaying the consequence sufficient amount may give rise to a similar result. from of alcohol the alimentary canal. The absorption The amount of sugar excreted is usually small, most effective inhibitor is milk, the action of which 0’5 per cent. or under, and as arabinose does not be to some extent on its fat to appears dependent reduce as readily as dextrose the reaction is content. Its influence in delaying absorpspecific delayed and is often of a peculiar type. When, tion more than counterbalances its general effect for example, the urine is added to Fehling’s or as a fluid, and Dr. Mellanby comments upon the Benedict’s solution and boiled no change occurs for a time, but after continued boiling the colour striking differences observed in the effects of a dose of the solution suddenly changes to green, no of alcohol when given two hours after the consumpNo. 31. National Health Insurance, Medical turbidity occurring even when the heating is pro- 1 Special Report Series, Research Committee: Alcohol: Its Absorption into, and Disappearlonged. A small percentage of dextrose or other ance from, the Blood under Different Conditions. London: Published reducing substance may give a similar result. by His Majesty’s Stationery Office. ’
ribbon-like protoplasm, beginning at the end nearest to the old axon-stump, and spreading link by link peripheral-wards. It is commonly a simple, smooth, delicate axon, with neither whorl nor endbulb formation on its course, thereby differing from what is seen in the majority of cases of regeneration after trauma. Much importance in this matter is attached by the author to the intactness of the neighbouring connective tissue supporting the For the equally interesting question of the nerve. origin of the new myelin formation these researches of Professor Kimura unfortunately do not serve; he merely indicates the possibility of part of the protoplasmic bridges within the fibre sheath being allocated to that purpose. It is to be regretted, also, that he modestly considers his experimental material too meagre for any exhaustive contribution to the problem of the pathogenesis of beri-beri, or rice-neuritis," and contents himself with a the review of literature and present state of knowledge on this vexed question. He remarks with justice that little enough attention has been paid to the actual changes in the peripheral nerves, in experimental pathology of the deficiency diseases, and is not "rice-neuritis," bears no constant parallel relation- clear that the monophagismusgroup of beriship to the clinical symptoms. In their essentials ’ beri, scurvy, Barlow’s disease, and pellagra contains they consist of a pure degeneration; in no instance I conditions essentially alike in their pathogenesis. did Professor Kimura find any sign of alterations of Whether " ein schadliehes plus beyond mere an inflammatory nature. Degeneration does not by partial starvation is essential Professor Kimura any means always commence at the periphery of the does not allow himself to say, but he quotes with nerve fibres; on the contrary, it may appear anywhere approval the opinion of Eijkman-which for that of had been expressed before-that absence of the course a sometimes at different matter along nerve, levels in different fibres of the same nerve. some essential element in food may allow the Further, normal and degenerated fibres are seen development of some nerve poison to which the The monograph is side by side. The suggestion is made that experi- symptoms are attributable. mental " neuritis"is a general affection of the illustrated with admirable coloured drawings, and nervous system, with local lesions at sites that are micro-photographs reproduced in collotype, and somehow predisposed. Lower extremities are much there is a very long bibliography. more usually affected than upper, with special incidence on the peroneal nerves. The first recogINSURANCE FOR MEDICAL MEN. nisable sign of degeneration is in the axon, THE Managing Committee of the Medical frequently noted when the myelin sheath is still met Insurance last week and found itself nor does it Agency intact, necessarily progress distally make interim allotments, able to substantial mere Wallerian for the morbid a by process, agent may attack spots beyond the original amounting to £455- £125 to the Royal Medical lesion. Once the nerve fibre gets to the stage Benevolent Fund, JE125 to the Royal Medical of complete myelin degeneration no axon can Benevolent Fund Guild, JE105 to Epsom College Royal be found in it; in fact, the latter disappears Medical Foundation, and JB100 to the Royal St. Anne’s before any complete break-up of myelin. The School. In this way the committee was fulfilling myelin fragments are, according to all appearance, one of its prime objects. For the Agency, when absorbed in situ after being dissolved or otherwise founded 12 years ago with the intention of assisting chemically modified by some (? fermentative) func- medical men to obtain the best terms of insurance tion of the cells of the sheath of Schwann, or of all kinds, has from the first kept in mind as stream in this dissolved state towards lymph and one of the chief reasons for its existence the venous channels; in the human cases, however, practical aid of the benevolent institutions of the there was evidence of direct phagocytic activity for profession. The Royal Medical Benevolent Fund the scavengering of some at least of the degenera- is the most largely benefited of such institutions tive products. When a fibre in a state of complete in the recent distribution, but its record deserves myelin disintegration is seen to contain within its that this should be so, while its offspring, neurilemma an axon, such axon, according to Pro- the Guild, is doing most admirable work, the fessor Kimura, is invariably a new formation- special feature here being the personal interest of i.e., a regenerated axon. To the problem of regenera- individual ladies in the work. It has seemed to the tion in non-traumatic " neuritishe devotes an Agency that one of the most practical means it important part of his research. His view, supported could take to help less fortunate members of the by much histological evidence, is that the way is paved profession was to contribute to the education of This it has done by subscriptions to for the new axons by protoplasmic prolongations children. of the cells of the neurilemmal sheath, that Epsom College, where boys are received on these link up to form more or less " solid the foundation, and to the Royal St. Anne’s protoplasmic paths, filling the otherwise nearly School, where girls obtain an excellent educaempty fibre. In or through this protoplasm the tion. This benevolent side of the Agency’s work new axon makes its appearance, either by direct has commended it to many members of the outgrowth from the proximal end, or-a very profession, though not to so many as might have important alternative-by differentiation from this been expected to resort to it. Last year the total
polyneuritis
"
I
"
"
.
"
117 distributed from the Agency’s medical benevolence More characteristic is the orcin reaction, best account was R1002 10s., including contributions of carried out in the form of Bial’s test. 4-5 c.cm. £ 150 to the War Emergency Fund of the Royal of Bial’s reagent (0’5 gr. orcin, 250 c.cm. fuming Medical Benevolent Fund, and JE100 to the Belgian hydrochloric acid, sp. gr. 1’195, and 12 drops of Doctors’ and Pharmacists’ Relief Fund. At the same liq. ferri perchlor.) are heated to boiling in a time the insurers received an advantage by the test-tube and 1 c.cm. of the urine added ; on return out of the commissions received by the standing a green-blue colour develops when a Agency of certain sums which in 1918 totalled f:697. pentose is present. If the solution is cooled, Since the foundation of the Agency £ 7200 have been extracted with amyl alcohol, and the extract returned in this way to insurers, a sum which examined with the spectroscope, it shows a band represents a direct saving to the profession. between the red and yellow (C and D). Glycuronic The Agency is not bound to any particular acid may give a similar reaction, but it also gives companies or forms of policy, and is able Tollen’s naphthol-resorcinol test. The most conto advise medical practitioners contemplating clusive evidence is furnished by preparing the diinsurance as to the best form of policy to suit their phenylhydrazone with a melting-point of 216-218° C. particular conditions. The life insurance business for the 1-arabinose derivative and 204-205° C. for the conducted through the Agency is considerable, and i-arabinose compound, and the parabrom-phenylit is confidently anticipated that as the conditions osazone which melts at 196-200° C. in the case of disturbed by the war become more stable this form 1-arabinose and 200-202° C. for the inactive form. of business will largely increase. The insurance As pentoses are not fermented by yeast the reducing of motor-cars is growing into an extensive branch power of the urine in cases of pure pentosuria is of energy; in spite of the difficulties in the way of not impaired by mixing it with yeast and standing motorists created by the war and the shortage of in a warm place for 24 hours. petrol and of cars the number of motor insurances has increased, and experience has proved that the PRACTICAL ISSUES ON THE ALCOHOL Agency, owing to the amount of business it conducts QUESTION. in this direction, is able to assure to its clients that the WE scientific welcome investigation of alcohol their claims shall be promptly and generously met. to reference with practical issues. No one drinks In presenting the financial report the chairman, a dilution of pure alcohol and water, and yet Dr. G. E. Haslip, was able to speak in the most ’, hopeful terms of the future of the Agency, and hitherto, whilst interesting evidence has been mentioned that vacancies, due to deaths of several accumulated, physiological experiments have, in members of the committee, had been filled by the ’, the main, been based not on the actual beverages election of Dr. E. Weaver Adams, Dr. H. A. Des consumed by the public, but literally on C2H50H Vceux, Lieutenant-Colonel R. H. Elliot, I.M.S., Dr. + H2O. That formula does not by any means present the story of such beverages as claret, R. A. Gibbons, and Dr. R. Langdon-Down. sherry, port, beer, champagne, and so forth, none of which is a mere dilution of pure alcohol, and it is well known that these various alcoholic beverPENTOSURIA. in their effects. The effervescent THE occurrence of pentoses in the urine is ages differ wine for example, has a different champagne, not so rare an event as is commonly supposed. effect from claret, though both contain the same Pentosuria is not necessarily associated with any amount of alcohol. There are important varying morbid symptoms, and does not of itself call for factors in the numerous alcoholic beverages conany particular treatment; the importance of the sumed by the public which must count in regard condition arises from the fact that its presence to their effects. A mixture of whisky and water, may lead to a hasty diagnosis of diabetes, with con- for example, is below the specific gravity of water, sequent dietetic restrictions which are unnecessary. whilst wines and beers are above this point on Two distinct types may be recognised : (1) the account of the solid matters in solution. Osmotic alimentary form, in which the sugar is 1-arabinose pressure must therefore vary, and with it the rate and the urine rotates polarised light to the right; of diffusibility of the alcohol. (2) true or essential pentosuria, in which the sugar In an important investigation undertaken for is usually i-arabinose and the urine is optically the Medical Research Committee by Dr. Edward inactive, unless some other sugar is present as well. bearing on the absorption into, and disAlimentary pentosuria is apt to cause mistakes Mellanby,’ from, the blood of alcohol under different appearance in diagnosis, especially at this time of the year these points find interesting illustration. conditions, when fruit is being eaten more extensively than It is shown that differences in intensity of intoxiat other seasons. The tolerance limit for pentoses obtained by taking the same is small, about half a gramme, and even in healthy cating symptoms amount of alcohol in one or several drinks depend people a surfeit of cherries will cause the appear- on the of beverage drunk and the interval ance of the sugar in the urine. Plums, goose- betweentype the drinks. Foodstuffs inhibit intoxicaberries, strawberries, apples, and other fruits in tion in of their action in delaying the consequence sufficient amount may give rise to a similar result. from of alcohol the alimentary canal. The absorption The amount of sugar excreted is usually small, most effective inhibitor is milk, the action of which 0’5 per cent. or under, and as arabinose does not be to some extent on its fat to appears dependent reduce as readily as dextrose the reaction is content. Its influence in delaying absorpspecific delayed and is often of a peculiar type. When, tion more than counterbalances its general effect for example, the urine is added to Fehling’s or as a fluid, and Dr. Mellanby comments upon the Benedict’s solution and boiled no change occurs for a time, but after continued boiling the colour striking differences observed in the effects of a dose of the solution suddenly changes to green, no of alcohol when given two hours after the consumpNo. 31. National Health Insurance, Medical turbidity occurring even when the heating is pro- 1 Special Report Series, Research Committee: Alcohol: Its Absorption into, and Disappearlonged. A small percentage of dextrose or other ance from, the Blood under Different Conditions. London: Published reducing substance may give a similar result. by His Majesty’s Stationery Office. ’