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IN MEMORY OF HUXLEY.
36
Annotations. "13e quid nimis." IN
MEMORY OF HUXLEY.
said that the only instruction of educative value that he had ever received was that given in the lectures on physiology delivered by Wharton Jones at Charing Cross Hospital Medical School. It is therefore peculiarly fitting for the lecture founded at Charing Cross Medical School in Huxley’s memory to be delivered by a physiologist. Of the 11 lectures held since his death in 1895, three have now emanated from the heads of physiological laboratories. In 1896 Sir Michael Foster inaugurated the lectureship with a discussion of the influence on subsequent medical thought and procedure of three physiological discoveries made at about the time that Huxley was a student-the work of the brothers Weber on the inhibitory action of the vagus, the experiments of Bernard leading to the conception of the vaso-motor system, and the researches of Waller on nerve degeneration. In 1906 Professor J. P. Pavlov gave an account of his experimental investigations into the psychical faculties of the higher animals ; and this year Professor Gowland Hopkins, no less illustrious than his physiological predecessors, has given the important exposition of the present ideas on nutrition which we publish on p. 1. In a few remarks introductory to his lecture Professor Hopkins spoke of the responsibility felt by him on this occasion, which was the greater inasmuch as the lectures had suffered interruption through the catastrophe which had made a breach in the continuity of most things. He pointed out that the passage of these tragic years seemed to have given a disproportionate remoteness to the life and times of Huxley; for it was now no more than a quarter of a century since Huxley died, and barely 40 years since the days of his main activities. Professor Hopkins said that to many, if not to most, of his predecessors in the lectureship, Huxley was personally known, but that he himself had no memories due to such acquaintanceship, and it was to be feared that they would not belong to many of those who would follow him. These lectures indeed were fated soon to lose a particular character which had hitherto been attached to them. A very few more years and the thoughts of the audiences would be directed towards a figure wholly historic, even as elsewhere they were directed on similar occasions to the personalities of the older heroes of medicine and of science. But yet for mid-Victorian science Huxley’s gifts provided both sword and buckler. It is not too much to say that in those days the younger biologists, while profiting from his scientific labours, worked with a definite sense of his protection. Professor Hopkins voiced the regret of us all that in his peculiar position as the champion of scientific aims Huxley has had no true successor. His pen would have seen to it that the services of science to the nation during the war should not fade from the public memory as they are fading to-day. We miss the gifts we commemorate.
Huxley
once
CHRONIC GASTRIC DISORDERS. SPEAKING from an experience of nearly 30 years and almost a thousand hospital gastric cases, Mr. A. E. Maylard, in the first of three interesting James Watson lectures delivered last year in Glasgow, and now published in booklet form, deals with chronic gastric disorders dependent upon other causes than those of an ulcerative, carcinomatous, or obstructive nature; and he points out that, owing to the great successes of gastric surgery during the last 25 years, a large number of patients come under the care of the surgeon for gastric symptoms which are not due to organic disease of the stomach or duodenum. Therefore, he draws attention to the care required in diagnosis and the need for collaboration between physician and surgeon, so that operations should not be undertaken for gastric symptoms due to organic or
functional disease of the nervous system, such as locomotor ataxy, hysteria, neurasthenia, or to such distant sources of infection as dental caries and diseases of the nasal sinuses. He speaks of three primary essentials to be cleared up in every case :" (1) Whether it is the stomach itself that is the cause of the symptoms; (2) whether it has become the seat of functional or organic derangement as the result of mischief elsewhere; or (3) whether the symptoms are merely apparently connected with the viscus ; that is to say, the stomach is quite healthy in itself, but the symptoms which appear to be gastric are merely the referred indications of disease in some other part of the body."
The need is also pointed out for regarding an operation for gastric symptoms as an exploration of the whole abdomen, so that causes of reflex gastric symptoms, such as cholecystitis, chronic pancreatitis, and diseases of the intestines, appendix, and female genital organs, may not be overlooked. Mr. Maylard considers that the frequency and importance of appendical dyspepsia has been greatly exaggerated. In many cases an exploration is still necessary to settle the diagnosis, so that organic disease, such as chronic ulcer and carcinoma, may be found and treated in its early and hopeful
stages. For the treatment of chronic gastric ulcer Mr. Maylard leans to partial gastrectomy, disregarding the teaching of long experience that gastro-jejunostomy, with or without excision or cauterisation of the ulcer, cures the large majority of these patients with a much For diagnosis he relies chiefly on smaller risk. the clinical symptoms and expert radiographic examination. He does not believe much in " test-meals," but apparently has no experience of repeated examinations at short intervals after a meal-a method which, when well established, may make us all change our views. For duodenal ulcer he recommends that " if the part of the duodenum implicated cannot be freely mobilised so that the involved bowel can be excised, gastro-jejunostomy must alone suffice," but excision of the ulcer-bearing area appears tous unnecessarily severe, especially when such a comparatively safe and simple operation as gastro-jejunostomy cures over 90 per cent. When there has been serious haemorrhage Mr. Maylard recommends, in addition, exclusion of the duodenum by " completely severing the stomach at its pyloric extremity," because he believes that bleeding is less likely to recur when the food cannot pass over the ulcer and the peristaltic wave may be interrupted. With regard to gastric carcinoma he quotes Dr. C. H.
Mayo:" The most common cancer is that of the stomach. More than one-third of the cancer in men, and more than one-fifth of the cancer in women appear in this organ; and, inasmuch as the condition in nearly one-half of such patients who come to the physician for examination is inoperable, there is room for some improvement in the matter of securing earlier recognition of the disease"(Annals of Stirriery, 1919,
p. 236). He also advocates that steps should be taken to educate the public upon this subject, so that patients should seek treatment while the disease is in its early stages. Mr. Maylard divides the causes of pyloric obstruction into anatomical and pathological, the latter depending on new growths. As regards the former, he pointed out in 1904 that, quite apart from congenital hypertrophic stenosis of the pylorus, a developmental narrowing of the orifice existed in some cases, and very gradually gave rise to obstructive symptoms. He has himself operated on 36 patients suffering from this condition with satisfactory results. Landerer had previously and drawn attention to the same condition, which is due to an excess of reduplication of the pyloric fold whereby the width of the valve is increased and the channel diminished, so that it will not admit the index finger. As a result of this partial obstruction the stomach hypertrophies and ultimately dilates when the muscular power gradually diminishes. For this condition Mr. Maylard prefers gastro - jejunostomy to Finney’s operation, and he advocates gastro - jejunostomy also for ordinary pyloric obstruction following ulceration; in this case he makes his anastomosis
independently
Annotations. "13e quid nimis." IN
MEMORY OF HUXLEY.
said that the only instruction of educative value that he had ever received was that given in the lectures on physiology delivered by Wharton Jones at Charing Cross Hospital Medical School. It is therefore peculiarly fitting for the lecture founded at Charing Cross Medical School in Huxley’s memory to be delivered by a physiologist. Of the 11 lectures held since his death in 1895, three have now emanated from the heads of physiological laboratories. In 1896 Sir Michael Foster inaugurated the lectureship with a discussion of the influence on subsequent medical thought and procedure of three physiological discoveries made at about the time that Huxley was a student-the work of the brothers Weber on the inhibitory action of the vagus, the experiments of Bernard leading to the conception of the vaso-motor system, and the researches of Waller on nerve degeneration. In 1906 Professor J. P. Pavlov gave an account of his experimental investigations into the psychical faculties of the higher animals ; and this year Professor Gowland Hopkins, no less illustrious than his physiological predecessors, has given the important exposition of the present ideas on nutrition which we publish on p. 1. In a few remarks introductory to his lecture Professor Hopkins spoke of the responsibility felt by him on this occasion, which was the greater inasmuch as the lectures had suffered interruption through the catastrophe which had made a breach in the continuity of most things. He pointed out that the passage of these tragic years seemed to have given a disproportionate remoteness to the life and times of Huxley; for it was now no more than a quarter of a century since Huxley died, and barely 40 years since the days of his main activities. Professor Hopkins said that to many, if not to most, of his predecessors in the lectureship, Huxley was personally known, but that he himself had no memories due to such acquaintanceship, and it was to be feared that they would not belong to many of those who would follow him. These lectures indeed were fated soon to lose a particular character which had hitherto been attached to them. A very few more years and the thoughts of the audiences would be directed towards a figure wholly historic, even as elsewhere they were directed on similar occasions to the personalities of the older heroes of medicine and of science. But yet for mid-Victorian science Huxley’s gifts provided both sword and buckler. It is not too much to say that in those days the younger biologists, while profiting from his scientific labours, worked with a definite sense of his protection. Professor Hopkins voiced the regret of us all that in his peculiar position as the champion of scientific aims Huxley has had no true successor. His pen would have seen to it that the services of science to the nation during the war should not fade from the public memory as they are fading to-day. We miss the gifts we commemorate.
Huxley
once
CHRONIC GASTRIC DISORDERS. SPEAKING from an experience of nearly 30 years and almost a thousand hospital gastric cases, Mr. A. E. Maylard, in the first of three interesting James Watson lectures delivered last year in Glasgow, and now published in booklet form, deals with chronic gastric disorders dependent upon other causes than those of an ulcerative, carcinomatous, or obstructive nature; and he points out that, owing to the great successes of gastric surgery during the last 25 years, a large number of patients come under the care of the surgeon for gastric symptoms which are not due to organic disease of the stomach or duodenum. Therefore, he draws attention to the care required in diagnosis and the need for collaboration between physician and surgeon, so that operations should not be undertaken for gastric symptoms due to organic or
functional disease of the nervous system, such as locomotor ataxy, hysteria, neurasthenia, or to such distant sources of infection as dental caries and diseases of the nasal sinuses. He speaks of three primary essentials to be cleared up in every case :" (1) Whether it is the stomach itself that is the cause of the symptoms; (2) whether it has become the seat of functional or organic derangement as the result of mischief elsewhere; or (3) whether the symptoms are merely apparently connected with the viscus ; that is to say, the stomach is quite healthy in itself, but the symptoms which appear to be gastric are merely the referred indications of disease in some other part of the body."
The need is also pointed out for regarding an operation for gastric symptoms as an exploration of the whole abdomen, so that causes of reflex gastric symptoms, such as cholecystitis, chronic pancreatitis, and diseases of the intestines, appendix, and female genital organs, may not be overlooked. Mr. Maylard considers that the frequency and importance of appendical dyspepsia has been greatly exaggerated. In many cases an exploration is still necessary to settle the diagnosis, so that organic disease, such as chronic ulcer and carcinoma, may be found and treated in its early and hopeful
stages. For the treatment of chronic gastric ulcer Mr. Maylard leans to partial gastrectomy, disregarding the teaching of long experience that gastro-jejunostomy, with or without excision or cauterisation of the ulcer, cures the large majority of these patients with a much For diagnosis he relies chiefly on smaller risk. the clinical symptoms and expert radiographic examination. He does not believe much in " test-meals," but apparently has no experience of repeated examinations at short intervals after a meal-a method which, when well established, may make us all change our views. For duodenal ulcer he recommends that " if the part of the duodenum implicated cannot be freely mobilised so that the involved bowel can be excised, gastro-jejunostomy must alone suffice," but excision of the ulcer-bearing area appears tous unnecessarily severe, especially when such a comparatively safe and simple operation as gastro-jejunostomy cures over 90 per cent. When there has been serious haemorrhage Mr. Maylard recommends, in addition, exclusion of the duodenum by " completely severing the stomach at its pyloric extremity," because he believes that bleeding is less likely to recur when the food cannot pass over the ulcer and the peristaltic wave may be interrupted. With regard to gastric carcinoma he quotes Dr. C. H.
Mayo:" The most common cancer is that of the stomach. More than one-third of the cancer in men, and more than one-fifth of the cancer in women appear in this organ; and, inasmuch as the condition in nearly one-half of such patients who come to the physician for examination is inoperable, there is room for some improvement in the matter of securing earlier recognition of the disease"(Annals of Stirriery, 1919,
p. 236). He also advocates that steps should be taken to educate the public upon this subject, so that patients should seek treatment while the disease is in its early stages. Mr. Maylard divides the causes of pyloric obstruction into anatomical and pathological, the latter depending on new growths. As regards the former, he pointed out in 1904 that, quite apart from congenital hypertrophic stenosis of the pylorus, a developmental narrowing of the orifice existed in some cases, and very gradually gave rise to obstructive symptoms. He has himself operated on 36 patients suffering from this condition with satisfactory results. Landerer had previously and drawn attention to the same condition, which is due to an excess of reduplication of the pyloric fold whereby the width of the valve is increased and the channel diminished, so that it will not admit the index finger. As a result of this partial obstruction the stomach hypertrophies and ultimately dilates when the muscular power gradually diminishes. For this condition Mr. Maylard prefers gastro - jejunostomy to Finney’s operation, and he advocates gastro - jejunostomy also for ordinary pyloric obstruction following ulceration; in this case he makes his anastomosis
independently