THE COMPOSITION OF BAYER "205."

663 raised standards of examination for young people, difficulty of obtaining even a small quantity of the are meanwhile to be provided German substance. They were able, however, to for. The advantage both to employers and the overcome the rigid conditions laid down by the " certifying surgeons to be gained by an extension of Bayer Company, and by une voie tres detournee," the duties of the latter is undoubted, and association they obtained a few centigrammes. Indications of of these surgeons with voluntary efforts such as the lines upon which to work were obtained by welfare schemes should certainly be encouraged. studying a series of patents taken out by the Bayer In order to give some guidance to employers and Company on complex urea-like substances, obtained surgeons on the remuneration that may fairly be by coupling the amides of amino naphthalene demanded for additional work, a scale corresponding sulphonic acids. Starting with these compounds to that paid by infant welfare centres (a guinea and armed with a knowledge of the work done on per hour’s work) is suggested as a minimum, and the salvarsan, these investigators set out on what appeared recommendation is made that charges should be to be an almost hopeless task. Chemi cally it is possible always per week, month, or year, never per visit paid. to have an infinite number of compounds, and, at It is not likely that in the present state of national the same time, it is all but impossible to be sure of the finance a comprehensive scheme of industrial medicine exact manner in which the acids are coupled in any will be introduced by any Government. The sugges- given substance. The investigators must have been tions made by the Association are likely to be useful imbued with wonderful hope and keenness. As they in the interim, and indeed might well form the basis say, " Bien des fois meme, découragés, nous avons eu on which an Industrial Medical Service could be le desir d’interrompre la poursuite d’un but qui Of especial value would be the closer semblait fuir devant nous." founded. Their courage and association of doctors with the welfare workers, and patience seem to have been rewarded, since in their the advice given to the latter on medical matters compound " 309 " they appear to have produced a connected with their duties might with advantage substance identical with Bayer " 205 " They include some talks on psychology. The factory hand reproduce the formula and state that its chemowho, when asked what troublesome factor in his therapeutic ratio-i.e., ratio of curative to toxic conditions of work he would most like removed, dose-is equal to that of the original German comreplied " the welfare worker," voiced the legitimate pound. Owing to the small quantity of " 205 " at resentment of many of his kind at tactless interference. the authors’ disposal, it was impossible to prove With the help of the factory surgeon, the efforts on beyond doubt that the two compounds were the same, the part of the welfare worker to increase the comfort but in all the reactions that they were able to try as well as the efficiency of the employee might be both substances behaved in an identical manner. guided into directions which would be appreciated The therapeutic tests were carried out on mice, and not only in increased output, but in greater content. the final clinical test has yet to be performed. The authors are making trials of " 309 " in Africa, and it is hoped that good results will be obtained. THE COMPOSITION OF BAYER "205." If these are satisfactory, as one is justified in hoping, SINCE its introduction Bayer " 205 " has always the discovery of " 309 " will form a landmark in been surrounded by an air of mystery amounting chemo-therapeutics ; but whatever the outcome of almost to romance. Its powers as a trypanocide the clinical tests may be, the zeal and patience of the were at first said to be miraculous, whilst its toxicity authors deserve the utmost commendation. was, according to all accounts, incredibly small. Its composition and formula were rigidly guarded, but A NEW TREATMENT FOR HYPEREMESIS the authorities of the Farbenfabrik Bayer stated that the substance contained neither arsenic nor GRAVIDARUM. antimony. The material was supplied only on the AMONG the various morbid manifestations which distinct understanding that it was for clinical use, happen to a pregnant woman that of vomiting, and the person to whom it was entrusted had to give may which may become uncontrollable and constitute a his word that no attempt would be made to determine danger to life, is undoubtedly the most important, and its constitution. The clinical value of " 205 " cannot its treatment has for a long time been a problem among be doubted, since many eminent authorities, including obstetricians. It is unnecessary here to enumerate the P. H. Manson-Bahr’ and F. K. Klein e,have published various and operative measures which therapeutic .series of cases treated with the remedy. A full review have been to combat this disease, but we " employed and bibliography of the clinical side of Bayer " 205 call attention to a new method which Dr. Pietro may is given in a recent article in the Annales de l’Institut Castagnahas recently put forward. He claims to Pasteur.33 It would appear that the much vaunted have obtained excellent results from the intravenous low toxicity is apparent rather than real. For instance, of a concentrated solution, 35 per cent., of injection in practically all of the recorded cases there has been chloride of calcium given in doses of 2 c.cm., a cure albuminuria, which is quite a rare symptom following having resulted after the third or second or even after salvarsan treatment. In many cases 1 g. of Bayer the first injection. His technique in order to avoid " 205 " is followed by albuminuria, whereas 0-9 g. to the perivascular tissue is as follows. Before injury of salvarsan (N.A.B.) can be given at weekly intervals inserting the needle into the vein in the elbow, care is without any such sign. The ratio of the curative to taken aspiration that it does not contain any the lethal dose may be very small, but the ratio to the trace ofby the fluid, and the injection having been made dose causing toxic symptoms appears to be fairly a little blood is aspirated several times and re-injected high. The medical, and at the same time the national, into the vein so that the walls of the needle are well value of " 205 " can hardly be over-rated. German washed out, as to ensure that after it is withdrawn from workers have gone so far as to suggest that in 205 " the vein not the least trace of the caustic fluid is left lies the key to Africa. It is thus not remarkable that in its track. By this method any sloughing action for French and English authorities to obtain this the paravascular tissues can be avoided, the upon substance was a very difficult matter, and it became slight erythema produced being easily remedied by obvious that independent research into the constitu- wet applications. Details of five cases are given, four if tion, successful, would be of the greatest possible of which were primiparee and in whom the vomiting value. Fourneau, Trefouel, and Vallee started work was of an uncontrollable character. Treatment by with this object in view, and in the article referred to oxalate of cerium had adrenalin, orexin, morphine, have put forward the formula of a substance which failed to relieve the violence of the so that they state to be identical with the German Bayer in one case rectal feeding had to bevomiting, resorted to. All 205 They were hampered at the outset by the the cases responded promptly to the injections of 1 2 chloride of calcium and the pregnancies went on to THE LANCET, 1922, ii., 1265. Ibid., 1924, i., 384. 3 Recherches de Chémiotherapie darts la Série du 205 Bayer. full term. These reports seem encouraging enough to

admittedly desirable,

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Par E. Fourneau, Mme. Jacques Tréfouel et Jean Valeé. Annales de l’Institut Pasteur, Fév., 1924. No. 2, p. 81.

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Policlinico, Practical Section, xxxi., Feb. 25th, 1924.