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NEUROTIC RAILWAY WORKERS.
192 the spirit of his duties. The school doctor cannot rest content until there is a permanent improvement in the health of the child population of the country, and everything which appertains to that is within his province. And to help toward the better equipment of the school doctor it seems probable that something on the lines of Mr. Trist’s suggestion will have to be considered, but to be valuable the examination should cover everything within the sphere of influence of the medical inspector of schools. ARTERIO-VENOUS ANEURYSM OF THE FICIAL FEMORAL VESSELS.
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which, as Dr. Eisenberg expresses it, crowded the pelvis, there had been no urinary or both ureters were rectal symptoms, though dilated. moderately lesions
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NEUROTIC RAILWAY WORKERS.
THE report inspector, on
of Major Pringle, the Board of Trade the collision which occurred at
Waterloo Junction Station on Oct. 25th, 1913, and was attended, with serious loss of life, attributes the accident to faulty judgment and lack of caution on the part of one of the signal. men. This finding, taken in. conjunction with the results of inquiry in some other accidents of recent date, will strengthen the view that in the interest of public safety there is need of a somewhat more complete and more stringent medical supervision of railway employees than exists at present. Defects of colour perception are recognised as a disqualification for the railway service, and tests, if not wholly satisfactory ones, are regularly applied for their detection.; but, as this accident shows, a defect in inhibitory power or a weakness of attention may be a disability quite as serious in its consequences as the failure to distinguish the sensations of red and It is, doubtless, quite true that the green. qualities found wanting in the Waterloo signalman are not susceptible of very exact measurement even by the most elaborate methods of psycho. logical examination, but these methods might at all events furnish the data for a rough estimate of the nervous aptitudes of a given individual, from which his fitness or unfitness for certain sorts of work could be inferred with some degree of probability. And investigation by such methods might also throw light on the influence which the con. ditions of his occupation exercise on the railway worker’s efficiency. The practical importance that may possibly attach to this latter point is shown by the reference in the inspector’s report to the suggestion, which he seems to admit in a qualified way, that the sameness and routine character of the work in a busy signal box tend to deaden the capacity for thoughtfulness, and may thus help to bring about such rash and hasty action as was responsible for the Waterloo accident.
THE discovery at necropsy of lesions which had given little or no trouble during life has proved a corrective to the spirit of gloomy prognosis which is apt to dominate those who, as in the case of hospital physicians and surgeons, spend a large part of their lives in the contemplation of mortal disease. Malignant growths that have been known to exist without giving rise to ’trouble for many years, in patients who eventually die from something else, impress upon the mind of the clinician the same golden lesson that there is no such thing as a hopeless outlook. In the Journal of the American Medical Association for Dec. 13th of last year there is an account of a case of arterio-venous aneurysm, the most noteworthy features of which were the extent of the lesions, their long duration, and the unimportance of the symptoms to which they gave rise. The patient, a medical man aged 63, was admitted to St. Luke’s Hospital, New York, with symptoms of cardiac breakdown which proved fatal in a week. In addition to the symptoms and signs proper to the cardiac disease there was a tumour in the left groin, of the size of a hen’s egg, exhibiting expansive pulsation, over which a continuous bruit with a systolic emphasis could be heard. It was said that 18 years previously he had, been wounded in the thigh by a small-bore rifle bullet, but that since that date he had travelled much in South America and spent a good deal of his time in the saddle. As Dr. A. B. Eisenberg, who reports the case, remarks, this strenuous life could not have been borne had the patient suffered much from the aneurysm. At the necropsy it was found that the bullet must have perforated the superficial THE FUNCTIONS OF THE NOSE. femoral artery and vein about two and a half inches distal to the origin of the profunda femoris IT is generally agreed that the functions of the both vessels had been nose are connected with the sense of smell, respiraartery ; completely traversed, and the points of entrance and exit lay exactly tion, taste, and phonation ; but this view has been opposite each other. The adjacent portions of challenged by Dr. Owen F. Paget, medical officer of artery and vein had been incorporated with each health of Fremantle, Western Australia, who wishes other, the corresponding perforations persisting to provethat the most important function of the in the form of a communication about a third of an nose is to filter the inspired air, and that all other inch in diameter. The other hole in the artery uses to which it may be put are merely subsidiary established a channel between the vessel and a to this. He holds that nearly every healthy man small, thick-walled aneurysmal sac. There was has lost the power to breathe through the nose, probably a corresponding venous sac; but this and he explains this by the fact that in inspiration part of the specimen was damaged in the process the sides of the nose collapse and the passage is of removal, and could not be accurately observed. blocked, and this occurss quite apart from any Both artery and vein were thickened and dilated abnormality such as deviation of the septum. This for a short distance below the communication, and collapse he ascribes to a loss of power of the nasal markedly so above it; constricted by their passage muscles from disuse, for he believes that all the beneath Poupart’s ligament, they were dilated again muscles of the nose except the depressor alae nasi above it, and so much contorted that this portion act as dilators of the nostril. If by one means or of both vessels was more than double the normal another respiration even when hurried could be length. Just above Poupart’s ligament the vein completely nasal, he believes that pneumokoniosis dilated suddenly to form a thin-walled sac, nearly and allied disorders would be abolished, and that three inches in length, and about two and a half there would be an enormous diminution in pulinches in diameter. In spite of these extensive monary tuberculosis, pneumonia, and influenza.
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SUPER-
which, as Dr. Eisenberg expresses it, crowded the pelvis, there had been no urinary or both ureters were rectal symptoms, though dilated. moderately lesions
____
NEUROTIC RAILWAY WORKERS.
THE report inspector, on
of Major Pringle, the Board of Trade the collision which occurred at
Waterloo Junction Station on Oct. 25th, 1913, and was attended, with serious loss of life, attributes the accident to faulty judgment and lack of caution on the part of one of the signal. men. This finding, taken in. conjunction with the results of inquiry in some other accidents of recent date, will strengthen the view that in the interest of public safety there is need of a somewhat more complete and more stringent medical supervision of railway employees than exists at present. Defects of colour perception are recognised as a disqualification for the railway service, and tests, if not wholly satisfactory ones, are regularly applied for their detection.; but, as this accident shows, a defect in inhibitory power or a weakness of attention may be a disability quite as serious in its consequences as the failure to distinguish the sensations of red and It is, doubtless, quite true that the green. qualities found wanting in the Waterloo signalman are not susceptible of very exact measurement even by the most elaborate methods of psycho. logical examination, but these methods might at all events furnish the data for a rough estimate of the nervous aptitudes of a given individual, from which his fitness or unfitness for certain sorts of work could be inferred with some degree of probability. And investigation by such methods might also throw light on the influence which the con. ditions of his occupation exercise on the railway worker’s efficiency. The practical importance that may possibly attach to this latter point is shown by the reference in the inspector’s report to the suggestion, which he seems to admit in a qualified way, that the sameness and routine character of the work in a busy signal box tend to deaden the capacity for thoughtfulness, and may thus help to bring about such rash and hasty action as was responsible for the Waterloo accident.
THE discovery at necropsy of lesions which had given little or no trouble during life has proved a corrective to the spirit of gloomy prognosis which is apt to dominate those who, as in the case of hospital physicians and surgeons, spend a large part of their lives in the contemplation of mortal disease. Malignant growths that have been known to exist without giving rise to ’trouble for many years, in patients who eventually die from something else, impress upon the mind of the clinician the same golden lesson that there is no such thing as a hopeless outlook. In the Journal of the American Medical Association for Dec. 13th of last year there is an account of a case of arterio-venous aneurysm, the most noteworthy features of which were the extent of the lesions, their long duration, and the unimportance of the symptoms to which they gave rise. The patient, a medical man aged 63, was admitted to St. Luke’s Hospital, New York, with symptoms of cardiac breakdown which proved fatal in a week. In addition to the symptoms and signs proper to the cardiac disease there was a tumour in the left groin, of the size of a hen’s egg, exhibiting expansive pulsation, over which a continuous bruit with a systolic emphasis could be heard. It was said that 18 years previously he had, been wounded in the thigh by a small-bore rifle bullet, but that since that date he had travelled much in South America and spent a good deal of his time in the saddle. As Dr. A. B. Eisenberg, who reports the case, remarks, this strenuous life could not have been borne had the patient suffered much from the aneurysm. At the necropsy it was found that the bullet must have perforated the superficial THE FUNCTIONS OF THE NOSE. femoral artery and vein about two and a half inches distal to the origin of the profunda femoris IT is generally agreed that the functions of the both vessels had been nose are connected with the sense of smell, respiraartery ; completely traversed, and the points of entrance and exit lay exactly tion, taste, and phonation ; but this view has been opposite each other. The adjacent portions of challenged by Dr. Owen F. Paget, medical officer of artery and vein had been incorporated with each health of Fremantle, Western Australia, who wishes other, the corresponding perforations persisting to provethat the most important function of the in the form of a communication about a third of an nose is to filter the inspired air, and that all other inch in diameter. The other hole in the artery uses to which it may be put are merely subsidiary established a channel between the vessel and a to this. He holds that nearly every healthy man small, thick-walled aneurysmal sac. There was has lost the power to breathe through the nose, probably a corresponding venous sac; but this and he explains this by the fact that in inspiration part of the specimen was damaged in the process the sides of the nose collapse and the passage is of removal, and could not be accurately observed. blocked, and this occurss quite apart from any Both artery and vein were thickened and dilated abnormality such as deviation of the septum. This for a short distance below the communication, and collapse he ascribes to a loss of power of the nasal markedly so above it; constricted by their passage muscles from disuse, for he believes that all the beneath Poupart’s ligament, they were dilated again muscles of the nose except the depressor alae nasi above it, and so much contorted that this portion act as dilators of the nostril. If by one means or of both vessels was more than double the normal another respiration even when hurried could be length. Just above Poupart’s ligament the vein completely nasal, he believes that pneumokoniosis dilated suddenly to form a thin-walled sac, nearly and allied disorders would be abolished, and that three inches in length, and about two and a half there would be an enormous diminution in pulinches in diameter. In spite of these extensive monary tuberculosis, pneumonia, and influenza.
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