ANATOMY.

1916 as a midwife but not registered, the reason the young women that they needed treatment he made not the in a summons to he did attend case to why response pretended medical examinations, necessitating the removal The would him fee if the do so. have paid a case of portions of their clothing, a procedure which, as the guardians had been one under the Midwives Act, but as the person magistrate pointed out, might have been made the ground of attending was not a midwife qualified under the Act to prac- a charge of indecent assault. tise he would have had to attend without any hope of payment. The case, therefore, was one for the interveriANATOMY. tion of the relieving officer and the medical officer of the lhe Eflect of Specialisation on Anatomy. union.

person acting

When we come to review the progress in anatomy from year to year we are more and more impressed by the fact that the modern specialisation in the practice of medicine is being attended by a rapid progress in our knowledge of the anatomy of the human body. The specialist studies the anatomy ani physiology as well as the diseases of the part to which he has devoted himself, hence new facts regarding the structure of the eye and orbit, the ear, the nose, the pharynx and larynx we owe largely to the specialist. Radiologists are now the anatomists of the living; year by year they are vitalising the still-life studies of the dissectingThe rhinoscope, laryngoscope, bronchoscope, oesoroom. phagoscope, gastroscope, cystoscope, and proctoscope give the specialists an opportunity of examining in life parts IN THE POLICE COURTS. which the anatomist can only see when they are changed Cases of quackery : a Bogus Death Certificate.-A man by death. Old descriptions have to be altered to meet named BANKS was fined £25 at the Clerkenwell police court the new appearances. With specialisation in the pracwith the alternative of three months’ imprisonment, who was tice of medicine there has been a compensatory geneproved to be unqualified, to have attended a woman, stated ralisation in the study of fundamental subjects. The lines to have suffered from bronchitis, until she died, and to have which divide the anatomist, physiologist, and pathosigned a certificate of the cause of death, thus necessitating logist are disappearing. We see anatomists crossing subsequent rectification of the register by statutory declara- the border line and studying the function and pathotion. The accused was believed by the husband of the logy of the part at the same time as they work out deceased to be a medical man, and was known as Dr. its structure. Many of the best contributions to modern BANKS, in which capacity he prescribed for a gentleman anatomy have been made by physiologists. Oar present sent to call upon him by the Medical Defence Union who knowledge of the anatomy of the peripheral nervous system suffered from no disease, but who, he said, was affected by we owe to GASKELL, SHERRINGTON, HEAD, and LANGLEY. various complaints, including consumption. The best available description of the anatomy of the pituitary An Unycalified -Foreigner Falsely Pretending to be a body is from the pen and microscope of a physiologist-Dr. Registered Medical Practitioner.-At the North London P. T. HERRING. The modern movement which has revolupolice-court it was proved that a man named WERNER had tionised our conception of the anatomy of the heart was pretended that he was a medical practitioner, in which initiated five years ago by a pathologist-Professor ASCHOFF capacity he had prescribed for, and taken a fee of 5s. from, of Freiburg. Indeed, modern research on the anatomy of the a representative of the Medical Defence Union, which was heart is largely in the hands of pathologists, such as Professor responsible for the prosecution. He had also attended a MONCKEBERG, Dr. WALTER KOCH, and Dr. IVY MACKENZIE. man who had taken poison and died, had attended at the A line cannot now be drawn between the experimental which and had evidence followed, inquest given stating pharmacologist, experimental pathologist, and experimental himself to be a registered medical practitioner. In advertise- physiologist-all are, at the same time, experimental ments in a newspaper he was described as a " French anatomists. " Contributions by Zoologists. specialist. Wontan as a Leeds The Midwife.—At Unregistered Practising professional zoologist and comparative anatomist add three cases, heard in the police court on two consecutive their quota to our knowledge of the human body. In our days, called attention to the illegal practice as a midwife pages during the year has appeared a notice of the discovery of a woman who, in defence to one summons, contended of a peculiar structure in the human brain by Professor A. that she did not act as a midwife for payment, but only DENDY and Mr.LG. E. NICHOLS of King’s College, London. made a charge for nursing. She was not believed and They named it the "mesocœlic recess." It is situated on was fined £5. In another case it was found that the same the roof of the aqueduct of Sylvius, just behind the posterior woman’s daughter had been confined at her mother’s house, commissure. They have traced this structure from the but had registered the birth at a false address. For this she lowest to the highest members of the vetebrate kingdom. sought to excuse herself by alleging that she did it in order Sir VICTOR HORSLEY had observed it in the brain of the to avoid having her child vaccinated, the suggestion of the monkey. Its nature is obscure, but it may prove to be of the prosecution being that the real reason was to prevent atten- nature of an orienting organ. The prolonged researches into tion being called to her mother’s illegal practice as a the origin and nature of the trophoblast and foetal memmidwife. branes, by Mr. RICHARD ASSHETON, lecturer on zoology at An Indecent Rogue.—A man, described as a clerk, was Guy’s Hospital, are opening up a sure access to a more comconvicted of obtaining money from young women by falsely plete understanding of these structures in man. It seems a pretending that he was a medical man who was connected "far cry"from the skeleton of man to the skeleton of with two London hospitals and that he could obtain for his sponges, yet no one who has read the studies made by victims treatment in certain institutions, for admission to Mr. W. N. F. WOODLAND, assistant professor of zoology at which preliminary fees were required. In order to convince University College, London, on the formation of calcareous

Technical Grounds for Refusing Payment.-In another instance recorded by a correspondent, and relevant to the last paragraph, a medical man sent in his claim to a board of guardians for attending two cases to which he had been summoned on the recommendation of a registered midwife. He received the following replies : As to (1), that he was out of date, although no limitation of date was named in a circular on the subject which he had received; as to (2), that the claim was not for attendance on a viable child. He was also informed that the guardians would see what they could do if he would satisfy them that he had taken reasonable steps to secure his fees from the persons attended.

1917

spicules flood of

in sponges, can fail to see that he has thrown a light on the behaviour of the osteoblast of the human

body. to note another anatomical event of discussion by anatomists and zoologists of the year-the Gaskellian theory of the origin of vertebrates. Many medical men will refuse to believe that there is any connexion whatever between Dr. GASKELL’S zoological speculations and their future practice, but it is highly probable that there is. Dr. GASKELL has devoted 15 years to an inquiry into the origin of vertebrate animals, and he concludes that their ancestry must be sought for in the primitive crustacean stock, and not in Amphioxus and Tunicates. If this is so, then it is certain that an experimental study on such primitive forms of crustacea as now exist would solve many of the obscure problems of human physiology, especially those which relate to the organs of internal secretion. Dr. GASKELL has succeeded in throwing light on so many parts of the human and vertebrate body that were formerly obscure that there must be a large element of truth in his speculations, yet as regards other parts of the vertebrate body his hypothesis appears to break down. A zoological jury, empanelled by the Linnean Society during the present year, returned a verdict of"not proven," a verdict with which Dr. GASKELL and his followers do not agree.

Here, too, is the place

the

canals could be functionally stimulated, and to explain the various forms of nystagmus which may occur in cases of disease of the labyrinth. Anatomy of the Head and Neck. Mr. F. G. PARSONS has drawn attention to the highly artificial nature of the dissected layers described under the name of the cervical fascia ; the fascia is really the packing of connective tissue in which the structures of the neck are set, the only real demarcated interfascial space being the postpharyngeal. Professor PETER THOMPSON dealt with the development of the thyroid body in his Arris and Gale lectures, and pointed out that the median outgrowth formed, not only the isthmus, but a considerable part of the lateral lobes. Mr. F. D. THOMPSON has investigated the origin and structure of the parathyroid bodies. He agrees with Dr. DAVID FORSYTH that these bodies may come to contain colloid vesicles and resemble the thyroid in structure, but regards them as different in origin and in nature. Mr. J. E. FRAZER of King’s College, London, has made important communications on the development of the human larynx, pharynx, and mouth. The lung bud he found to arise between the fifth (last pair) visceral (branchial) arches ; the Eustachian tube and middle ear he found were composite in their origin, not, as usually supposed, merely a widening of the upper part of the first visceral cleft. The lower end of the pituitary outgrowth he observed to become drawn into the posterior border of the nasal septum during development, an observation which explains the occurrence of pituitary remnants there. Professor E. FAWCETT of the University of Bristol continues to revolutionise our conception of the development of the bones of the human face and skull ; nor must we forget to mention the inquiries of Professor FITZGERALD into the dimensions and correlations of the pituitary fossa in the base of the skull. It is remarkable how little we know of the anatomy and nature of the tonsil of the naso-pharynx, seeing how often-perhaps more frequently than any other part of the human body-it is the subject of operation. Professor J. SYMINGTON of Belfast has made a most welcome contribution to our knowledge of its anatomy ; he describes its situation as extending in the roof of the naso-pharynx from the septum of the nose to the mid-point of the basilar process of the occipital bone. Mr. ARTHUR H. CHEATLE has drawn attention to the " foetal " cells which occur constantly in the outer wall of the mastoidal antrum, and to the fact that this wall at birth may be composed of dense or of diploetic bone. In 20 per cent. of adults the diploetic form persists, and the dense form in little over 1 per cent.

NervOtlS System. to deal with the more strictly anatomical contributions of the year, the first place must be given to Professor G. ELLIOT SMITH’S Arris and Gale lectures on "Some Problems Relating to the Evolution of the Brain," which were published in our pages in January last. It must be owned that, in spite of a clear easy style and an ample supply of simple, accurate, and original illustrations, these lectures are not easily read. They are packed with new fact and close reasoning, but those who master them will have their reward. For the first time we are presented with an evolutionary history of the various parts of the brain, a history on which comparative anatomists and physiologists must base their future work. Side by side with these lectures of Professor ELLIOT SMITH at the Royal College of Surgeons of England must be placed the Goulstonian lectures at the Royal College of Physicians of London by Dr. J. S. BOLTON. Dr. BOLTON’s lectures contain the results of many years of investigation of the structure of the cerebral cortex in health and in disease. He has given us the material on which a pathology of mental conditions may be firmly based, and on which we may be able to correlate mental ability and nerve structure. Lectures by Dr. F. W. MOTT have served to direct The Thorax, 7/etM, and Lnngs. attention to much that is obscure in our knowledge of the One of the most striking observations of the year is that structures and spaces concerned with the cerebro-spinal fluid by Dr. F. WOOD-JoNES, assistant lecturer on anatomy at -a system which increases in importance with the wider St. Thomas’s Hospital, regarding the nature of the subapplication of spinal analgesia and the diagnosis and treat- clavian groove on the first rib. From time immemorial it ment of meningeal conditions. Dr. J. S. BARR has shownhas been taught that this groove is caused by the subthat the human cerebro-spinal fluid system can be irrigated or Iclavian artery ; Dr. WOOD-JoNES has shown conclusively that washed out in life by introducing the irrigating fluid into theit is caused by the pressure of the lowest cord of the brachial lateral ventricle and draining it away at a lumbar puncture. plexus. The observation has a direct clinical bearing. He ] Dr. JOHN CAMERON continues his researches on the multi-inoted, when the second dorsal nerve made a large contribucellular formation of nerves ; with Dr. W. MILLIGAN he has 1tion to the lowest cord of the plexus, that the groove was published an account of the development of the auditoryJnot only well marked, but that the rib itself was bent downnerve, the nerve nbrillse of which they regard as a deposit by1wards at the point at which the lowest cord crossed itneuroblasts which occur along the track of the developing Eevidence of pressure by the cord on the rib. When a cervical auditory fibres. Dr. WILFRED HARRIS has worked out the i’ib is present it either stops short at the cord or carries the sensory distribution of the divisions of the fifth cranial nerve(;ord, and is marked by a groove. It is well known that the as seen after injections of alcohol for the relief of neuralgia.Ipressure between the lowest cord and a cervical rib may lead No better example of the manner in which the clinician can t;o a partial paralysis of the arm ; it is possible this may also assist the anatomist and physiologist could be cited than cIccur in cases where no cervical rib is present, but where the Mr. SYDNEY ScoTT’s Arris and Gale lecture on the internal t)rachial plexus is low in its origin. The same observer has ear. He was able to show how each of the semicircular ddrawn attention to the relationship of the thoracic duct to

Coming

now

1918 c just above it ; Dr. A. KEITH, unaware of Professor apices of the lungs and to the bodies of the vertebrse, occur l possibility of tuberculous infection from the intestinesKfLLlAN’s discovery, has described the upper aesophageal isphincter and also given its relationship to pharyngeal reaching the lungs and vertebrse by the duct.

the

and the

Further observations have been made on the diaphragm ; diverticula. ( Dr. HERTZ denies the presence of a midthe "massive collapse" of the basal part of the lung, casesgastric I sphincter in the human stomach, and in this he is of which have been recorded by Dr. W. PASTEUR, show howsupported by Dr. BARCLAY. The position assigned to the directly the diaphragm acts on the basal lobes, for in all ofimid-gastric sphincter corresponds to the point at which the these cases the diaphragm was paralysed or limited in its pyloric movements commence. The pyloric sphincter is movements. Radiology of the thorax presents the anatomy continuously in action. of the chest in a new aspect. Mr. A. C. JORDAN has Several further instances of hypertrophy of the pyloric described and illustrated the appearance and position of the sphincter in young children have been published by Mr. F. arch of the aorta in normal and pathological conditions. BARKER and Dr. L. MACKEY in our pages. The latter has Observations by Mr. R. J. GODLEE, Dr. STCLAIR THOMSON, pointed out how difficult it is to estimate the degree of Mr. FAULDER, and Professor C. vorr EICKEN have thrown hypertrophy by any system of measurements, and that cases a new light on the position, movements, and behaviour of of hypertrophy of this sphincter occur in children without* the trachea, bronchi, and oesophagus in the living. giving rise to symptoms. In connexion with this matter As regards the anatomy of the heart, we see our knowledge attention may be directed to a new line of investigation extending in several directions. One of these concerns opened up by Professor D. WATERSTON of King’s College, the distribution of what may be named the specialised London. As is well known, the tissues of the body survive musculature of the heart-musculature which is more for some time after the death of the individual. JOHN directly concerned with the initiation and conduction of HUNTER showed that the arteries of the umbilical cord lived the heart-beat than with the act of contraction. The dis- for three and a half days after separation from the child. covery by Dr. A. KEITH and Dr. MARTIN FLACK some years Professor WATERSTON has observed that formalin has a ago of a specialised node of muscular tissue (sino-auricular selective action on the musculature of the alimentary canal, node) at the junction of the superior vena cava and the right provided that the injection of a solution is made before death auricle, has been the starting point for much further research. of the muscular tissue has occurred. The sphincteric By means of the electro-cardiograph Dr. THOMAS LEWIS has muscular fibres are specially affected, so are the fibres of the traced the initial sign of the heart-beat to the region of the pyloric part of the stomach, especially at the site where sino-auricular node. A paper by Dr. KEITH and Dr. Ivy peristaltic waves are observed to commence in life. In a MACKENZIE has summarised in our pages the more recent manner the action of formalin on non-striated musculature researches on the anatomy of the specialised musculature of recalls the action of adrenalin. the heart. One of the most puzzling facts is the absence of Dr. P. T. CRYMBLE of Queen’s University, Belfast, has. the auriculo-ventricular bundle in the bird’s heart; Dr. Ivy published a most useful communication on the band of MACKENZIE found that the bird’s heart is also characterised muscle which suspends the termination of the duodenum by being supplied with peculiar neuro-muscular end-organs. muscle of and the relation of this band to the Treitz) (the Another line of research concerns the nature and anatomy duodeno-jejunal fossse. The series of cases published in our of the infundibulum of the right ventricle. Evidence hasi pages by Dr. N. I. SPRIGGS illustrate well the various forms been accumulating for some time that this part of the of congenital occlusion of the intestine, especially those mammalian heart represents a separate chamber of the lower which occur at the entrance of the common bile-duct and near Professor PETER the terminal part of the ileum, the usual site of a Meckel’s. vertebrate heart the bulbus cordis. THOMPSON in his Arris and Gale lectures demonstrated that diverticulum. Dr. A. KEITH dealt with congenital occluthe human sions and diverticula of the alimentary canal in demonat first a separate chamber comparable to the bulbus cordis, strations at the Museum of the Royal College of Surgeons of and that it becomes incorporated in the right ventricle as the England. Several cases of acquired diverticula of the intesinfundibulum of that chamber. Further research will likely tine have been described by Mr. GORDON TAYLOR and Dr. show that the function of the infundibulum is also different C. E. LAKIN and Mr. R. P. ROWLANDS, and the relationship from that of the rest of the right ventricle. between such diverticula and inflammatory conditions have A third line of research which is adding to our knowledge been elucidated. of the anatomy of the heart concerns its shape, its size, and The Pelvis and Uro- Genital Organs. its movements in various positions and physiological condiAs regards progress of our knowledge of this part of thetions of the body as observed during transillumination the work of Dr. R. H. PARAMORE stands pre-eminent. of the thorax. It is clear that the arbitrary topographical body again, we see the advantage of clinical aims being markings given by text-books as guides to the clinician need Here, carried out by combining with them the methods of the a complete revision in this matter. anatomist and physiologist. In his Hunterian lectures he The Alimentary Canal. traced the evolution of the muscular floor of the pelvis The researches which have been carried out by Dr. A. F. throughout the whole kingdom of vertebrate animals, and HERTZ, Dr. A. E. BARCLAY, Mr. A. C. JORDAN, and others, showed that from its inception in fishes to its highest evoluby studying the form, position, and movements of the tion in man the musculature of the pelvic floor is part of the alimentary canal in the living after administration of a musculature of the body wall, and directly concerned with bismuth-laden meal, materially improve our knowledge of the support of viscera and the regulation of intra-abdominal applied anatomy. The form, the size, and the position of pressure. In further publications he has applied his observahollow viscera cannot be made to conform to any conven- tions and deductions to the human body and gynsecological tional description ; they have a separate form for every phase practice, his main thesis in mechanical displacethat being of functional activity. We see that at certain points the ments of the pelvic viscera of the female the first endeavour canal is kept functionally closed. The circular musculature of the clinician must be to try to restore the muscular pelvic at the beginning and end of the oesophagus forms a func- diaphragm to a normal condition. Like every reformer, Dr. tional sphincter. Professor KILLIAN described the upper PARAMORE may find that the merit of his work gains but a cesophageal sphincter two years ago, and recognised that it tardy recognition ; like all good work which is widely based on accurate observation, its acceptance cannot be long was the cause of the pharyngeal diverticula which may -

in the development of

heart the infundibulum is

,

1919 Dr. LEON MACAULIFFE which appeared columns bears directly on the relationship between the in viscera of the abdomen and pelvis and the musculature of the abdominal wall and perineal floor. Dr. MACAULIFFE calls attention to the observations of SIGAUD of Lyons, showing that the tonicity of the abdominal muscles is regulated by the condition of the abdominal viscera. Clinical observations are made daily which show the close relationship which exists between the viscera and the muscular parietes which support them through a reflex nerve mechanism. Other observations of anatomical interest are those of Dr. B. P. WATSON (two cases of bicornuate uterus), of Dr. A. H. N. LEWERS (a cyst of Gartner’s duct), and of Dr. V. BONNEY and Dr. B. GLENDINNING (adenomatosis of the vagina). Dr. F. WOOD-JONES has published further embryological evidence in support of Dr. BERRY HART’S explanation of the formation of the prepuce. Dr. BERRY HART regards the prepuce not as a fold of skin which has grown over the glans and thus covered it, but as the primitive outer sheath of the glans which has been separated by an ingrowth of epithelium, commencing its invasion in the region of the meatus. Dr. W. WRIGHT and Mr. T. H. C. BENIANS have reinvestigated the anatomy of the trigone of the bladder, and explained its relationship to the ureters and to the internal sphincter of the bladder. Professor J. KAY JAMIESON and Mr. J. F. DOBSON of the University of Leeds have continued their researches on the distribution of lymphatics, their latest paper being a description of the lymphatics of the testicles. These end in from four to eight collecting vessels, which enter the chain of lymphatic glands placed in the retroperitoneal lumbar region. Attention may also be drawn to two cases of torsion of the testicle reported by Mr. A. G. BATE, for there can be no doubt that the possibility of torsion depends on an imperfect atrophy of the primitive mesentery of the testicle. Reasons of space preclude a full reference to observations As in other parts of on the applied anatomy of the limbs. the body, the application of X rays is steadily altering our conception of the relationship and action of parts. Mention must be made of Mr. K. H. DIGBY’s paper on the attachments, movements, and function of the semilunar cartilages of the knee, and of Professor DixoN’s study of the internal structure of the upper extremity of the femur. It is wonderful that a comparatively limited structure like the human body should have afforded so many generations of anatomists full scope for their inquiries, and yet more wonderful that in spite of an increasing annual output of observations the finality of anatomical knowledge, so often announced by famous anatomists of past times, seems as far off as ever.

-delayed.

A note

by

our

Service

length

were

in

mate in

and detailed at These approxiin to force for entrance into the rules ways nominations (except from Corps;

promulgated early in the year, issue of May 14th (p. 1358).

our

some

Army Medical

the Royal colonial universities) are no longer allowed; successful candidates are not at once given commissions as surgeons, but are appointed acting surgeons during the time of their course of instruction ; on passing the examination at the end of the course they receive commissions as surgeons ; these, however, will date back from the date of the entrance examination. Once in every eight years every medical officer is required to undergo a post-graduate course of instruction at a metropolitan hospital, during which time he will receive full pay, and will reside at the Royal Naval Greenwich. These altered conditions are to be welcomed, as tending to professional efficiency ; but the regulation as to living at the Greenwich College will not be popular with married officers.

College,

Powers of Oommand. in the interior economy of the service was hinted at in an Admiralty circular issued in April. This stated that it was contemplated 11 that the command of all officers of branches, other than the military branch, over their subordinates in their own departments shall be as definite as that of officers of the military branch." This direct disciplinary control of the sick-berth staff is one of the matters that have been most urgently insisted on by the heads of the Medical Service as necessary for the proper working of their hospital establishments. An

important change

Medical Cons7tltative Board. The Medical Consultative Board that has been established, analogous to the Advisory Board of the Army Medical Service, is presided over by the Medical Director-General, and has three civilian members, Sir W. WATSON CHEYNE, Sir DYCE DuCKWORTH, and Professor W. J. R. SIMPSON, together with Inspector-General H. TODD as naval member. There is also an Examining Board, including civilian teachers of eminence, analogous to the Board of the Army Medical Service. Personal. The Director-General, Inspector-General JAMES PORTER, has been promoted to a Knight Commandership of the Bath, Two veteran to the general satisfaction of the service. officers have joined the majority : Inspector-General THOMAS BOLSTER and Inspector-General ROBERT GRANT, C.B. The former had seen no war service ; the latter was ashore in the Kaffir War of 1877, also in the Zulu War (1879) and in the Eastern Sudan operations in 1884.

THE ARMY MEDICAL SERVICE. We have again to chronicle an uneventful year in the military forces as far as active service is concerned. The THE NAVAL, MILITARY, AND INDIAN MEDICAL officers of the Royal Army Medical Corps have been steadily SERVICES. carrying on researches in various fields of work which will THE ROYAL NAVY MEDICAL SERVICE. prove to be of permanent value. Adrniral Durnford’s Committee of Inquiry. Scientific Work of the Army flledical Service. The report of the committee, presided over by Sir JOHN The Sleeping Sickness Commission, presided over by DURNFORD, that was appointed to consider various questions Colonel Sir DAVID BRUCE, returned from Uganda in April. connected with the medical service of the Royal Navy, has The Commission had during the earlier researches come to been presented to the Admiralty, but is still under considera- the conclusion that the carrier fly, Glossina palpalis, lost tion ; what its recommendations may be, and whether they its infective power 48 hours after having fed on the blood have been accepted or not, are matters as to which no of an infected person. At the end of 1908 KLEINE, in information has been given to the public. This committee German East Africa, showed that G. palpalis could convey was appointed in March, 1909-that is, nearly two years ago. Trypanosoma brucei even 50 days after it had fed on an It held some 60 sittings, its discussions extended over nine infected animal. A large number of experiments have months, and it submitted a unanimous report. So long a been conducted by the Commission, and it has been delay in promulgating regulations that will deal with the found that infectivity with T. gambiense remains up to 75 questions at issue is much to be regretted. days, the trypanosomes undergoing development within the NMV Reg1dationsjor Adozission. body of glossina. After prolonged investigation it appeared New regulations for admission into the Royal Navy Medical that the proportion of infected flies that retain infectivity for ___