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Annotations.

THE PREVAILING PANDEMIC.

" Ne quid nimis."

THE clinical features of the infectious febrile

complaint which has invaded this country are

sufficiently well known, and the following briefaccounts by our Paris and Belfast correspondentssuggest that they are dealing with the same

malady.Paris.—A widespread epidemic of grippe in a mild form is

at present invading Paris and a large part of France. It isprobably an extension of the epidemic which has recentlyattacked the whole population of Spain, from the highest tothe lowest. The cases are very numerous, but none so farof a grave nature. Complaint is made of headache, pain inthe back, naso-pharyngeal catarrh which is persistent butrarely invades the lower respiratory tract. The temperatureis moderately raised, dropping at the end of two days. Theresulting indisposition, which seems to be spreading to thetroops at the front, fortunately lasts at most a few days.

Belfast.—An extremely widespread epidemic of what iscalled "influenza" is prevalent in Belfast and surroundingdistricts. The number of deaths in Belfast for the weekending June 29th was 341, and of these 92 were from" pneumonia and 75 from other diseases of the respiratorysystem." It began apparently in the military barracks atfirst, but soon spread to munition works, mills, &c., andthence all over the city and surrounding areas. The sym-ptoms are mainly high temperature with a sudden onset,congesterl eyes, sore-throat, and headache, with muscularpains, and in uncomplicated cases the duration of the feveris about three days. Occasionally there are sickness andbronchial catarrh, but pneumonia is not common. Itresembles influenza in its sudden onset and its widespreadepidemic character, but differs from former visitations ofthat disease in comparative absence of chest complicationsand post-febrile depression. The locus of the disease seemsto lie in the throat, at the junction of pharynx and larynx.Bacteriological examination so far has shown the presenceof diplococci, streptococci, and pneumococci, but no specificorganism. It is being recommended to close the primaryschools-a measure as little likely to be effective as shuttingdown the banks, mills, munition works, and cinemas. Theepidemic seems very like the Spanish one recently reported.The paper by Captain T. R. Little, Captain C. J.Garofalo, and Captain P. A. Williams, of theCanadian Army Medical Corps, which appears inanother part of our present issue, is the firstserious contribution which we have seen to thebacteriological study of the pandemic. Theseauthors- deal with about 1000 cases occurring inseveral camps served by their mobile laboratory.After setting out three points in which the clinicalsymptoms differed from those generally ascribed toPfeiffer’s bacillus, the statement is made that in allthe cases studied one organism predominated inturecc smears TiaKen trom naso-pnarynx, tnroac, and sputum. This was a small Gram-positive diplo-coccus, flattened on its opposing surfaces. It wasfound to grow freely on legumin serum-agar plates,forming small transparent granular colonies closelyresembling those of streptococcus. No colonies ofB. influenzœ were discovered. The authors are

now working to establish Koch’s third postulate inrelation to the organism. It is noteworthy that Dr.A. MacLean, who contributes to this present issuea memorandum on an outbreak of an acute febriledisease in certain Glasgow factories, has also founda diplococcus, in this case Gram-negative, in asso-ciation with it. The disease, of which he dealt with436 cases, was of a very mild type, characterised bysudden onset with severe headache and prostration,followed by rapid recovery in 2-4 days. No deathwas recorded, but a similar outbreak was broughtto his notice in the county of Lanark, in which8 deaths occurred in 280 cases. Acting under Dr.A. K. Chalmers, medical officer of health forGlasgow, Dr. MacLean is studying further the bac-

teriology of the outbreak. We commend both theseseries of investigations to the attention of bacterio-logists in general. The loose application of the term"

influenza " to a febrile infection in which Pfeiffer’sbacillus cannot be demonstrated is, to say the least,unfortunate and we have always deprecated its use,suggesting as an alternative the term " catarrhalfever.". Mild though the present form of the

malady is in a vast majority of cases, its death-ratehas not been insignificant, and its epidemiology isa matter of very pressing importance.

ECGONINE AND ITS DERIVATIVES.

, THE Home Secretary has given notice that the

definition of "

cocaine " in Defence of the Realm

Regulation 40 B (which regulates dealings in cocaineand opium) and in the Proclamation prohibiting theimportation of cocaine has been further amended soas to include ecgonine, its salts and derivatives. Thedefinition now reads as follows:-" Cocaine includes ecgonine and any substance, whether

preparation, admixture, extract or otherwise, containing0’1 per cent. (one part in a thousand) or more of cocaine orecgonine or of any salt or derivative thereof."

Ecgonine is the parent of cocaine, which isbenzoyl-ecgonine methyl ester. There are manyother derivatives of ecgonine in the leaves of

Erythroxylon coca, from all of which ecgonine canbe separated. Cocaine is obtained economicallyfrom ecgonine by a synthetic process, using methylalcohol and benzoyl chloride. Ecgonine is theessential pharmacological group of the alkaloid.

THE DEVELOPMENT OF THE MEDICAL PRO-FESSION: THE CAVENDISH LECTURE.

Major-General Sir Bertrand Dawson, in deliveringthe Cavendish lecture this year before the WestLondon Medico-Chirurgical Society, found that thesubject which he had selected could not be intelli-gibly expounded within the compass of one lecture,with the result that on Thursday evening he con-tinued at the Royal Society of Medicine his Utopianpicture of the future of the medical profession in thiscountry. At the West London Hospital, where hehad a large audience, he made the following pointin an incontrovertible manner-that the growthof knowledge had rendered medical effort,. whetherfor treatment or prevention, a combination ofenergies. No man any longer can pretend to haveparticular equipment or special knowledge by whichhe can do the best possible for all patients in allcircumstances. There must in every case be some

point where the special knowledge not possessed byany particular doctor might have been useful, andwe shall all endorse Sir Bertrand Dawson’s pleafor the development of team-work " in medicalpractice. The need for adequate medical servicehas outstepped its provision not only for themasses but for the well-to-do, added Sir BertrandDawson, who prophesied that the unsuitability ofthe home for the treatment of the sick would soonbecome generally recognised when larger institu-tional organisation would follow as a sequel. Recon-struction of medical practice on these principles,with the general practitioner the central pillar oferection, implies that the general practitioner musthave opportunities for observation, advancededucation, and prosecution of research whichhe is now totally without, but, as the Cavendishlecturer acutely pointed out, he requires, if he is toget any advantage out of such improvement in his

, professional life, adequate repose and adequate1 THE LANCET, 1910, ii., 1289.