NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
30
utilise as the medium by which the virus is conveyed foreign nerve material.
It follows then that in many animals, foreign nerve material, administered as we
administered it, is comparatively non-toxic. This is not so however in all cases.
Delezenne,1 Delille,2 and Marie3 have drawn attention to the toxic action of
foreign nerve material. Marie in a criticism says with regard to normal nerve
substance that it is far from being innocuous :—"Nous ferons remarquer que
les filtrats de substance normale sont au de là d'une certaine dose loin d'être
inoffensifs." Delille explains his want of success in obtaining in certain cases
a neurotoxic serum as due to the toxicity of the cerebral material of the dog
for certain animals. "La trop grande toxicité de la substance cérébrale du
chien pour ces animaux" (sheep, rabbit, guinea pig) "a d'ailleurs été
vraisemblablement la seule cause de nos insuccès." We have confirmed these
observations.
What, then, is the relation of man towards the nerve material derived from
the rabbit? We have the analogy of a foreign albumin and its effect upon man
and animals in the administration of horse serum,4 as in the use of diphtheria
anti-toxin—"Phenomenon of Arthus." The serum here is invariably horse
serum. The American writers Rosenau and Anderson 5 have shown that in a
certain number of cases toxic symptoms and even death have been produced
in man by this serum. The toxic symptoms would seem to be due to the serum
itself and not to the anti-toxin contained in it. Numerous other works have
been written on the subject of the 'serum disease,' all of which go to show that
man and animals are liable to a toxæmia from the introduction of foreign serum.
A condition of hypersensibility is set up by the first injection and the second
aggravates this condition with production of actual evidence of toxic action. If
foreign serum stuffs can set up constitutional disturbances we should expect
that foreign nerve material might be very likely to do the same. Further,
although most of the work hitherto published on this subject has reference
to foreign serum, it has also been shown6 t h a t a c o n d i t i o n o f a n a p h y l a x i a c a n
be set up by appropriate injection of a proteid such as ordinary egg albumin—a
result quite in accordance with our views of the toxic action of foreign nerve
albumin. The symptoms, too, which are described as typical of this condition
in animals are in the first two stages very strikingly similar to those which we
have sometimes observed in man in the course of anti-rabic treatment.
1 Ann. Past., 1900, p.686.
2 „ „ 1906, p. 838.
3 Bull de l' Inst., Past., 1904, p. 392.
4 Arthus. Compt. Rend. de Soc. de Biol. t. LV, pp. 817-820.
5Hype r s us c e pt i bi l i t yJ o u r n . Ame r . Me d . As s o c . , 1906, p. 1,009.
6 Vaughan and Wheeler, Journ. Inf. Dis., 1907, No. 3 , p 4 7 6 .
31
C.—Comparison of the effects of treatment by the methods of
Pasteur, Höyges and others and conclusions to be drawn there
-from.
In Höyges' system of treatment the amount of nerve material injected is very
much less than in the Pasteurian* whilst the amount of living rabies virus is at
least as great. Now, in our experience of Höyges' method we have found an
almost total absence of the concurrent symptoms which we have already referred
to, viz., local inflammation, local irritation, joint pains, anorexia, headache, fever or
urticarias. Höyges† himself states that he has never experienced as a result
of his treatment any of those 'accidents paralytiques' which have been observed
by all who make use of the Pasteurian mode of treatment. Remlinger
remarks that these 'accidents paralytiques' would seem to have been rather
more frequent where Puscariu's treatment,1in which rabies material which has
been heated instead of dried, is used. In both the Pasteurian and Puscariu's 2
methods considerable quantities of nerve substances are injected. Remlinger's
explanation of the difference of effects in the different systems is this, that
in Höyges' method there must be less rabies toxin injected than in the other two
methods. This conclusion, as will now be evident from our statements, is one
with which we do not agree. Remlinger's argument may be set forth in logical
fashion thus—
Premiss 1.—There is a rabies toxin.
Premiss 2.—Höyges' method of treatment is never followed by 'acci-
dents paralytiques' whilst the Pasteurian and Puscariu's
methods are occasionally so followed.
Conclusion.—These latter methods then must involve the inoculation of
larger quantities of rabies toxin than the former.
Our argument may be set forth:—
Premiss 1.—There is no sufficient evidence for the existence of a rabies
toxin, whilst there is abundant evidence for the toxic action
of foreign nerve material.
* Höyges ; Pasteurian (Kasauli) 1 : 72 ; this proportion is for the light schemata.
† No cases out of 25,872 persons inoculated.
1 Remlinger, Anns. de l' Inst. Past.No. 10, 1905, p. 643. A note states that MM. Puscariu and Lebell
have modified the type of their inoculation, eliminating the emulsions heated to 40,º 35° and 30° C. and
diminished the duration of the treatment. Since they did so they have had no more of these accidents.
2 Remlinger loc. cit.
32
Premiss 2.—Höyges' method of treatment necessitates the introduction
into the system of much less foreign nerve material than
either Pasteur's or Puscariu's methods.
Conclusion. —The administration of an excess of foreign material and not
of an excess of rabies toxin is the most likely explanation of
the noxious effects of those systems of treatment in which
the accidents to which we refer are found to occur.
D.—Existence of blood changes in man concurrent with or subse-
quent to anti-rabic inoculations which may be explained on the
theory of inoculation of foreign albumins.
We had intended in this connection to make a detailed comparison of the
results following anti-rabic immunisation according to the Pasteurian and
Höyges' methods. But except for the clinical observations which we have just
recorded we have not been able to carry out this intention in full. We have
however made certain observations preliminary to this investigation which are
worth recording here. The blood of certain patients complaining of local and
general symptoms (itching, joint pains, eruptions, etc.) during anti-rabic treatment
was taken and compared with the blood of untreated persons (Tables X, XI,
and XII).
The two chief blood changes to which we devoted attention were the
alkalinity and salinity. A small quantity of blood was taken from a patient and
allowed to clot. The same was done with untreated persons at the same time.
The serum which separated was used for the test. As our technique in both
these investigations is our own we give a description of it here.
Technique of estimation of alkalinity of small quantities
of blood serum.
The principle consists in determining the amount of N/100 H 2SO4 which is
able to neutralise the alkalinity of 50 cmm. of test serum. The indicator used
was neutral red. Small strips of paper were dipped in a weak stock solution of
neutral red and allowed to dry. Successive additions of N/100 acid were made
to the serum by means of one of Wright's pipettes graduated in 5 cmm. up to
50 cmm. and thereafter indicating 450 cmm. and 500 cmm. After each
successive addition of acid a very narrow strip of neutral red paper was dipped
into the mixture to determine the reaction and the strips were retained for final
comparison with one another. As little fluid as possible was taken up by the
strips so as to remove the less from the field of action. With practice only
33
three or four were necessary in making an estimation. We give an example of
the method.
TABLE X.
Test serum.
N/100 H 2 SO 4 .
Result.
5o cmm..
50 cmm.
. . . .
+
75 ,,
. . . .
+
1 0 0 , , . . .
+
1 1 0
, ,
. . .
+
120
,,
..
.
.
+
130
,,
.
+
14
,,
. . .
–
The method is sufficiently delicate to distinguish at least between N/40
and N/42.
In the above example we place the neutral point somewhere between the
addition of 120 cmm. and 130 cmm.—say 125 cmm.=N/40.
In our comparison of the alkalinity of the blood of persons treated with
that of persons untreated, we may utilise the conception of an alkalinity index.
To obtain this figure we compare the alkalinity of the former to that of the
latter taken as unity. Thus if the blood serum of a patient requires 110 cmm.
of N/100 H 2 SO4 to neutralise 50 cmm. as compared with 125 cmm. N/100
H2SO4 in an untreated person, the alkalinity index of the patient would be
1 1 0 / 1 2 5 = 0 . 8 8
The amount of N/100 H 2SO4 required to neutralise the serum of untreated
persons (average of 7 observations) was 132.14
cmm.=N/37.8. This amount
was taken as our normal in the following observations:—
F
34
TABLE XI,
Patients' names.
Day of treatment.
r
Alkalinity
of serum.
Alkalinity
index.
Normal alkalinity.
Capt. M.
.
. 11th
.
.
.
N/40
0.94
132.14 cmm. of
N/100 H2SO4 are
required to neutra-
lize 50 cmm. of
normal serum
=N/37.8.
Lt. K.
.
. .
,,
N/40
0.94
Nana
.
. .
12th
.
.
.
N/41.66
0 . 9 1
Shanker .
.
,,
. . .
N/41.66
0.91
Miss T. .
. .
,,
. . .
N/42.66
0.91
Moti Khan
.
. 11th
.
.
.
N/38.4
0.98
Pte. T. .
.
.
,,
.
.
.
N/41.66
0 . 9 1
Multan Singh .
. 13th .
. .
N/45.45
0.83
The observations are few in number, but such as they are they indicated
that the alkalinity of the blood in these persons was distinctly diminished.
Technique of estimation of salinity of small quantities of
blood serum.
The chlorides of the serum are estimated as sodium chloride with the help
of a standard solution of silver nitrate. This standard solution is one of 0.2906
per cent., of which 1 cc=.001 grm. NaCl.
The indicator is absorbent paper which has been dipped in 5 per cent.
potassium chromate and dried. Paper was used, because it enabled us con-
veniently to get indicator in sufficiently small quantities. A small strip of this
paper is added to 50 cmm. of the test serum contained in a watch-glass ; then
successive additions of the standard silver nitrate solution are made to the serum
until a permanent faint pink colour is manifest. A Wright's graduated pipette
is used here also.
We might on the same principle as in the case of the alkalinity give here a
salinity index. The normal salinity as determined by this method from nine-
observations was 0.819 per cent. The following table gives some of the results
obtained by estimation in persons undergoing anti-rabic treatment and who com-
plained of some of the symptoms which we have previously detailed :—
35
TABLE XII.
Patients' names.
Day of treatment.
Salinity.
Normal salinity.
Nana
.
.
.
12th
.
.
.
0.780 per cent.
0.819 per cent.
Shanker
.
.
. 12th
.
.
. 0.770
„
Miss T.
.
.
. 12th
.
.
.
0.760
„
Pte. T.
.
.
. 11th
.
.
.
0.770
, ,
Moti Khan
.
.
. 12th
.
.
0.760 „
L/C. R.
.
.
. 12th
.
.
. .
0.675
, ,
Multan Singh .
.
. 12th
.
.
.
.
0.777 , ,
The observations here made on alkalinity and salinity are few in number
and only form part of a scheme for a much wider investigation. The technique,
being a very simple one, seems to us worth recording.
Since this paper was written we have had an opportunity to do some
further systematic work with the help of Captain McCay, I.M.S., on the
effect of anti-rabic treatment upon patients. Captain McCay used Wright's
method1 of estimation of the salinity of the blood and confirmed the results.
which we obtained as regards diminution of the salt content of the serum.
Another important point is brought out in this investigation with regard to the
effect of inoculations in lowering blood pressure. In this case the patients tested
were not in any way selected. In the series Europeans and Indians are both
represented, as are also cases treated by the Pasteurian (light and intensive)
method and Höyges' method (light and intensive).
An inspection of the tables and charts appended shows at once a marked
difference between patients undergoing Pasteurian treatment as compared with
those treated by Höyges' method. In the former case the blood pressure rapidly
falls and there is also rapid diminution of the concentration of salt in the serum. In
the latter case the blood pressure is scarcely lowered at all and indeed may show
an actual rise, whilst the salt concentration of the serum does not fall to anything
like the same extent. The great lassitude which patients undergoing the Pasteu-
rian form of treatment almost all feel may possibly be ascribed in part to their low
blood pressure. There was no fall of weight in patients undergoing either
the one or other form of treatment. We have already stated our views on
1 Wright and Kilner, Lancet, 1904, p. 921.
, ,
a n d R o s s
„
1 9 0 5 , p . 1 , 1 6 4 .
McCay, Lancet, 1907, p. 1,483.
F 2
the subject of the causes of the marked differences which exhibit themselves in
patients treated by the one or other method, viz., that they are due to the presence
of an excessive amount of foreign nerve material in the Pasteurian system of
inoculations. That the symptoms following injection are not more frequent
or more pronounced may be due to the fact that the inoculations are made
daily. Recent work1 on anaphylaxia would seem to support this view. A very
interesting further point brought out was that in patients (only three observa-
tions) undergoing intensive Pasteurian* treatment the blood pressure
did not fall to any great extent but remained more or less level. In one of these cases,
however, a very marked fall occurred on the day of the first appearance of
symptoms of rabies—Case 13, Table XIII ; Case I, fig. VI. In these intensive
cases (Pasteurian) there was, however, the same marked fall in the salt content
of the blood as in those treated by the light method. We desire to record here
our great indebtedness to Captain McCay for the observations which he made.
The following tables and the curves record the results obtained:—Column IV,
Tables XIII, and XIV, shows the salt concentration as determined in three
observations, in the same individual, one before treatment, one in the middle of
treatment (12th or 13th day), and one towards the end of treatment. Column V
shows the blood pressure values. The blood pressure fall or maintenance, as the
case may be, is also shown graphically—figs. IV-VII.
1 Gay and Southard Journ. of Med. Res. 1907, No. 2. p. 143.
* When we use this term Pasteurian it has reference only to the method of treatment by desiccated cords.
The entire system of anti-rabic treatment as at present practised is entirely due to the genius of Pasteur
although it has undergone in some cases modification.
TABLE XI I I .
Observations on patients undergoing anti-rabic treatment, Pasteurian method.
I
II
III
IV
V
VI
No.
Caste.
Salt content equivalent of blood
in NaCl per cent.
Salt
concentration
of serum in
NaC1 per cent.
Blood
pressure.
Blood examination.
1
H.
N/50 = .1167
1 . 7 5
...
" "
N / 4 3 . 7 5 = . 1
3 3
1 . 0 6
. . .
Hb. =
68%
r. b. c. = 4,800,000.
w. b. c. = 7200.
" "
N / 4 0 = . 1 4 6
1.02
...
Hb. = 68%
r. b. c. = 5,600,000.
w. b. c. = 5600.
2
"
N
/ 4 7 . 5 = . 123
1.23
97 mm.
" "
N
/50 = .1169
.935
84 "
3 Sikh
N/60 = .097
.974
. . .
" "
N/50 = .1169
. 9 3
100 mm. Hb. = 68%
r. b. c. = 5,400,000.
w. b. c. = 6900.
" "
N/50 =
.1169
. 8 7
110 "
Hb. = 92%
r. b. c. = 5,600,000
w. b. c. = 9000.
4
H.
N/50 = .1169
.93
. . .
""
N/50 = .116
9
.877
104 mm. Hb. =
78%
r. b. c. = 6,200,000.
w. b. c. =
""
N/45 = .129
1.03
110
Hb. = 84%
r. b. c. = 5,230,000.
w. b. c. = 6700.
5
N/57.5 = .1
016
.932
...
" "
N / 5 0 = . 1 1 6
.846
. . .
Hb. = 76%
r. b. c. = 4,400,000.
w. b. c. = 7500.
" "
N/47.5 = .123
. 8 6 1
. . .
H b. = .78%
r. b. c. = 4,300,000.
w b. c. = 6800.
M = Mahommedan.
38
Observations on patients undergoing anti-rabic treatment, Pasteurian
method—contd.
I
II
III
IV
V
V I
No.
Caste.
Salt content equivalent of blood
in NaCl per cent.
Salt
concentration
of serum in
NaCl per cent.
Blood
pressure.
Blood examination.
6 Sikh
N
/40 = .146
1.096
108 mm.
"
"
N /47.5 = .123
. 8 9 96 "
Hb. = 84%
r. b. c. = 5,900,000.
w. b. c. = 8100.
"
"
N /47.5 = .123
. 9 2 2 108 "
Hb. = 82%
r. b. c. = 5,700,000.
w. b. c. = 9000.
7
"
N/67.5 = .086
. 8 6 6 107 "
Hb. = 78%
r. b. c. = 5,600,000.
w. b. c. = 5200.
"
"
N/50 = .116
. 9 2 8 93 "
"
"
N/40 = .146
. 8 7 6 105 "
Hb. = 76%
r. b. c. = 4,400,000.
w. b. c. = 6400.
8
H.
N /45 = .129
1 . 1 6 1
103 "
Hb. = 74%
r. b. c. = 4,000,000.
w. b. c. = 5800.
"
"
N /45 = .129
. 9 1 0
8 1 "
"
"
N /75 = .079
.79
99 "
Hb. = .80%
r. b. c. = 5,400,000.
w. b. c. = 7800.
9
"
N
/67.5 = .086
1 . 1 1 6
. . .
Hb. = 88%
r. b. c. = 6,800,000.
w. b. c. = 7800.
"
"
N/ 6 5 = . 0 9
1.08
. . .
"
" N
/70 = .0835
.75
. . .
H b . = 8 9 %
r. b. c. = 6,700,000.
w. b. c. = 9500.
10
"
N /67.5 = .0866
1.038
...
Hb. = 72%
r. b. c. = 5,200,000.
w. b. c. = 7100.
"
"
N / 5 7 . 5 = . 1 1 6 9
.935
...
Hb. = 80%
r. b. c. = 6,400,000.
w. b. c. = 8900.
H=Hindu.
M=Mahommedan.
39
Observations on patients undergoing anti-rabic treatm ent, Pasteurian
method—concld.
I
II
III
IV
V
VI
No.
Caste.
Salt content equivalent of blood
in NaCl per cent.
Salt
concentration
of serum in
NaCl per cent
Blood
pressure.
Blood examinaiton.
11 H.
N/55 = .10
6 2
1.484
...
Hb.
= 88%
r. b. c. = 5,050,000.
w. b. c. = 9300.
" "
N/52.5 = . 1113
. 8 3 4
. . . Hb. = 84%
r. b. c. = 4,800,000.
w. b. c. = 7800.
12
"
N / 5 0 = . 1 1 6
.928
. . .
Hb.
= 74%
r. b. c. = 4,200,000.
w. b. c. = 10930.
"
"
N/50 = .116
.812
. . .
Hb. = 82%
r. b. c. = 5,620,000.
w. b. c. = 9000.
13* M.
N/52.5 = .1114
1.002
105 mm. Hb.
= 80%
r. b. c. = 5,800,000.
w. b. c. = 11000.
""
N/50 = .116
.928
105 "
""
N/40 = 146
.803
110 "
Hb.
= 80%
r. b. c. = 6,200,000.
w. b. c. = 10500.
"
"
N/45 = .129
.806
108 "
* This case was treated by the intensive method, but rabies developed on the 19th day of treatment.
TABLE XIV.
Observations on patients undergoing anti-rabic treatment, Hoyges' method.
I
I I
III
IV
V
VI
No.
Caste.
Salt content equivalent of blood
in NaCl per cent.
Salt
concentration
of serum in
NaCI per cent.
Blood
pressure.
Blood examination.
1
Sikh
N/47.5 = .123
. 9 5 3 104 mm.
"
"
N/47.5 = .123
. 8 9 6 1 106 "
H=Hindu.
M=Mahommedan.
40
Observations an patients undergoing anti-rabic treatment, Hoyges'
method—concld.
I
II
III
IV
V
V I
No.
Caste.
Salt content equivalent of blood
in NaCl per Cent.
Salt
concentration
of serum of
NaCl per cent.
Blood
pressure.
B l o o d e x a m i n a t i o n .
1 Sikh
N/37.5 = .156
.936
108 mm.
2 H.
N / 5 0 = . 1 1 6
1.287
107 "
"
"
N / 5 2 . 5
= .113
1.244
104 "
3
I n
ten-
sive.
M.
N
/42.5 = .1375
.961
112 "
Hb.
= 80%.
r. b. c. = 5,600,000.
w. b. c. = 8750.
"
N
/ 6 o = . 097
.97
110 "
"
" N/60 = .097
.925
108 "
Hb. = 86%.
•
r. b. c. = 5,600,000.
w. b. c. = 8750.
4 H.
N / 4 0 = . 1 4 6
.876
103 "
"
"
N/47.5 = .123
.984
105 "
"
"
N/50 = .1169
.935
102 "
5 H.
N/ 65 = . 97
.67
. . .
"
"
N/70 = .083
.75
. . .
"
"
N/70 = .083
.91
...
H=Hindu.
M=Mahommedan.
41
VI.—Selection of rabbits necessary to the upkeep of the " fixity"
of rabies virus.
We may consider in this paper an interesting point which we have observed
amongst the "passage" rabbits. Pasteur in his classical researches found that
with successive passages of rabies virus in dogs and monkeys a degeneration of
the virus of a progressive nature occurred. In the case of rabbits, on the
contrary, the strength of the virus—originally derived from the dog—continued to
increase with passage until a point was reached at which no further increase of
strength was attained, as judged by the length of the incubation period. The virus
then became Pasteur's 'fixed virus,' producing symptoms of rabies in a rabbit on the
6th or 7th day after subdural inoculation. This is true to a remarkable degree, but we
have found on going into the matter closely that even with continuous subpassage
in rabbits a considerable amount of degeneration of virus can take place. We found,
however, that the virus can be kept constantly up to strength by a careful selec-
tion of the rabbits used to afford the material for subpassage. By using those
rabbits only which show marked symptoms of paresis on the 6th day it is quite
possible to obtain a virus which will invariably give rise to paresis on the 6th day.
Indeed it is quite possible to determine the oncoming of a certain amount of pare-
sis by the 4th day in the great majority of instances—the evidence for this being a
tremor of the head, distinct, though often of extremely short duration. We were
at first lead to investigate this matter by going closely into the periods of incubation
of rabies in the rabbits, which for some years past had continued to be inoculat-
ed with a virus which certainly was originally a 'fixed' virus. We found, however,
quite a marked difference in the length of the incubation periods, which varied
according to the material used for inoculation. Thus rabbits inoculated from a
given piece of rabies medulla gave an incubation period of six days, seven days,
eight days or even nine days, as the case might be when no special attention was
paid to the date on which the rabbit affording the material first showed symp-
toms. But by careful attention to taking only material for subpassage derived
from rabbits which had developed definite symptoms of paresis by the 6th day, we
succeeded in eliminating almost entirely those which after inoculation did not
develop first symptoms until the 7th, 8th, and 9th days. Prof. Höyges 1 men-
tions how he used this very method of selection in order to attain more rapidly
t o a condi t i on of ' fi xed' vi rus. What he found useful for t he rapi d at t ai nment
of this condition we have found necessary for the upkeep. The point is
an important one as it is on the criterion of 'fixity' of the virus that the stan-
dard character of the method of dosage used in anti-rabic inoculation is based.
The following tables show how this method of selection affected the constancy
of the incubation period.
1 Ann: Past., 1888, p. 134.
G
42
From a state of affairs in which only 24.5 per cent. showed paresis on the
6th day we reach a point in seven months in which 95 per cent. developed paresis
on the 6th day. Thus—
TABLE XV.
During February 1906—163 rabbits inoculated :—
24.5 per cent. developed paresis on the 6th day.
62.5
"
"
"
"
7th day.
10.4
"
"
"
"
8th day.
2.4
"
"
"
"
9th day.
During March 1906—191 rabbits inoculated :—
59.7 per cent. developed paresis on the 6th day.
38.7 "
"
"
"
7th day.
9.4 "
"
"
"
8 t h d a y .
1.05 "
"
"
"
9 t h d a y .
During May 1906—235 rabbits inoculated :—
87.6 per cent. developed paresis on the 6 t h d a y .
8.05
" "
"
"
7th day.
3.4
" "
"
"
8th day.
0 . 4 " "
"
"
9th day.
During August 1906—210 rabbits inoculated :—
95 per cent. developed paresis on the 6 t h d a y .
1.9
" "
"
"
7th day.
1.9
" "
"
"
8th day.
0.4
" "
"
"
9th day.
Whatever be the explanation of the matter the fact remains, that by careful
attention to this point—that the rabbit supplying medulla for subpassage should
show symptoms of paresis by the 6th day—it is possible to attain the result that
all or nearly all the rabbits used will show paresis by that day. Moreover this
point must continue to be attended to, even after the virus has become " fixed.''
CONCLUSION.
We have now reached the conclusion of the record of those investigations
upon rabies which we have been conducting during the past 18 months. It is
unnecessary further to draw the threads of a somewhat lengthy argument
together; we may, however, summarise our conclusions.
1. There is evidence of a direct proportion between infectivity and
duration of desiccation of rabies nerve material.
2. There is no evidence for the existence of a rabies toxin.
3. The quantity of living fixed virus and the duration of time of adminis
-tration are the only points which need be considered in making out
a scheme of anti-rabic treatment.
43
4. There is great advantage in using fresh material in anti-rabic immuni-
sation (as in Höyges' or Ferrans' methods) over dried or heated
material, because the former method involves the introduction of
less injurious foreign nerve substance and is more accurate as
regards dosage than the latter.
FI G. I I .
FIG. I.
F I G . I I I .
FIG. V.
FIG. VI.
FIG. VII.