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POSTURAL ACTIVITY OF MUSCLE AND NERVE.
520 the terms of the
Royal Warrant the disability orof the Royal Warrant, and has injury of a man, in order to qualify him for acases will have to be dealt funds. disability pension, must be due to his service as well as having originated in it, and that a Medical
public
MEASLES
Board certified whether disease was or was not due to a man’s service. He further stated that it was a mistake to suppose that there was no appeal from that decision; the medical authorities and the whole of the staff of the War Office approached the consideration of the question in a spirit of great sympathy. It might be, he said, that some Medical Boards had been unduly harsh and narrow in their interpretation of the terms of the Royal Warrant. They ought rather to consider each case on its own merits, and no general A man who has rule could be laid down. only been enlisted three or four months and is
THE order for
AND the
indicated that these with largely out of
DISTRICT NURSING. compulsory notification of
measles was, by a happy coincidence, issued just at a time when a committee of the London District Nursing Council was elaborating a scheme for the nursing of measles and whooping-cough. This im. portant scheme has been accepted by the council, and is to form the basis in London of a more efficient system of home nursing which should serve to reduce the lamentable death-rate from measles and other diseases among the children of the poorer districts. The scheme has involved a modification of the existing rules of district nursing associations in order to admit of attendance on cases of infec. tious disease. It has also dealt very carefully with the position of the nurse in regard to cases in which no doctor had been called in, and the rules have been so drawn as to prevent the district nurse from assuming any responsibility for medical treatment. We hope there may be no delay in getting to the practical application of a scheme of such beneficent intention.
then found to be suffering from pulmonary tuberculosis cannot be considered to have acquired the disease by military service. Reference has already been made in THE LANCET of Feb. 5th, p. 323, to a number of ex-sanatorium patients on active service, some of whom were known to have bacillary sputum, and we have recently heard of a private in a Scottish regiment with frequent blood in his sputum, and reduced to various expedients to conceal this and his other disabilities, whose condition was made light of by his regimental POSTURAL ACTIVITY OF MUSCLE AND NERVE. MOST skeletal muscles present the property of officer. On the other hand, if a man has been in " the army for several years, being perfectly well tone, by which is meant a slight constant tension during that period and giving no history of any which is characteristic of healthy muscle " (Hughes previous chest disease and then, after 12 months’ Bennett). It is a property which is difficult to service in France, develops the disease, it measure, and as a term it has come to be applied may be said with justice that the malady was not only to muscular action, involuntary as well as due to active service, and then undoubtedly it voluntary, but to such activities as " nerve centres," would be only fair that he should receive atten- and even the " bio-tonus " of living matter. It is tion. But between these extremes many cases supposed to signify lasting or enduring action as turn up when the decision is a difficult one. Some contrasted with evanescent or passing. It is known instances occur in which a history of previous that much of muscular tonus is reflex, and in a pulmonary tuberculosis is given and in which paper Professor C. S. Sherrington (Brain, 1915, arrest has taken place ; then, of course, the condi- vol. xxxvii., p. 191) brings forward important tion has been " aggravated " by active service ; in evidence to show that the chief function of tonus others perfect health has been previously enjoyed. may be concerned in the general maintenance of We contend, therefore, that the Medical Boards are posture in the animal, and this with the least perfectly within their duties in ascribing some of possible expenditure of energy. A valuable key to the cases to line service, the specific cause being the elucidation of this function in relation to " exposure to climate and infection," for doubtless skeletal muscle is the viewing of individual large numbers of men suffering from the disease muscles not only from their isolated activities but must be recruited from the ranks of the "chronic from their activities in relation to general purposive carrier," to the production of whom by our present efforts. For this reason reflex efforts, often inmethods of sanatorium treatment a correspondent volving complex actions, may give a surer clue to calls pointed attention in another column. In such the meaning of any individual muscular act concases full pension should certainly be given. Many cerned therein than if the muscle were studied inquestions arise as to the treatment of the men after dependently. Two supposed purposes of this skeletal discharge. If a man has been insured prior to join- tone are easily dismissed in so far as they are repreing the army the Tuberculosis Commissioners under sented as being the principal functions of this prothe National Insurance Act take charge of him, perty. That tonus merely obviates a muscle’s "taking and he is sent to a hospital or sanatorium. Much up slack " is hardly significant when the latency of a disappointment has been caused by well-meaning toneless frog’s muscle is but 1/100 of a second. So, persons assuring the patients that they will at too, the view that tonus is an important source of once be sent to a sanatorium, when it may turn out heat production is not tenable, since it is found that that a special hospital is indicated. Farther, the the chemical energy concerned in tone is remarkdifficulty that at once arises is that the men ably small. It is found that in the decerebrate hesitate to take advantage of the treatment, preparation, where tonus is a well-marked feature, especially if they are married, as they do not know this property is limited exactly to those muscles how those dependent on them will be provided for. which are in active contraction during the extensor Here again the question of a pension becomes: phase of the step ; the distribution of the tonus is paramount, and it is urgently necessary thatarranged on a plan of strict coordination. This reflex tonus embraces just those muscles which some immediate steps should be taken to provide the necessary funds. We are glad to hear from Mr. counteract the effect of gravity; it is postural Forster that the Government has set up a new body,, contraction. The afferent nerves producing this competent to deal with cases, tuberculous andL postural reflex are those of the contracting other, that fall outside the strict limits of the terms muscles themselves. The tonus can be maintained ,
.
,
____
.
521
with different tensions
or
lengths
of the
at the congress include the need for help in schemes for the clearance of insanitary areas, when the results in better citizenship and greater productive capacity, which will accompany the raising of the standard of life of the people as the outcome of the improvement of housing conditions, can be considered. Among other important questions to be discussed are the provision of homesteads with small holdings, the intensive cultivation of land, and the finding of capital to aid all classes of cultivators of the land
muscles, discussion
animals there appear to be muscles though in postural contraction and concerned separately movement respectively. Besides the afferent nerves of the muscles themselves being the source of the reflex, other sources may be present, especially those derived from the labyrinth. The centre of the reflex arc is pre-spinal, lying in or near the posterior region; the cerebellum, too, is concerned with reined adjustment and correlation. In the same way, postural contraction exists for such viscera as the bladder and stomach, the musculature in each organ being capable of maintaining an equal degree of pressure with varying lengths of muscle or varying capacity. The term ’’capacity"is in these cases similar to posture in skeletal muscle. Certain qualities of tonus are striking. For instance, the chemical energy involved by it is extremely low, very much lower than the energy consumed by a sustained tetanic contraction. It has been suggested that in postural contraction the muscle fibre or some part of it clots, changes from sol to get, and nervous impulses must be capable of causing it to unclot. The sarcoplasm would seem to be the coagulable Certain diseases, such as congenital element. myotonia and myasthenia gravis, forcibly suggest that the functional mechanical activity of muscle is two-fold in nature-tonic and non-tonic. Since it has been shown that there are two kinds of motor endings in striped muscle, it is suggested that one is concerned with tonic contraction and is derived from the sympathetic. Finally, Professor Sherrington concludes,reflex maintenance and adjustment of posture is a chief portion of the reflex work of the proprioceptive system, just as sensation of and perception of posture is a chief portion of the psychical output of that system." in
some
HOME PROBLEMS AFTER THE WAR. A VERY important movement has been begun under the auspices of the National Housing and Town Planning Council, having reference particularly to problems relating to housing and agriculture and to the possibilities of averting unemployment in the building trade. A national congress to consider " Home Problems after the War " is to be held at the Caxton Hall, London, from April llth to 14th next, and an influential Parliamentary and organising committee has been formed. A preliminary programme of the subjects to be diseussed has been drawn up. It is very rightly pointed out that the country has a debt to pay to those who have in a fine spirit of patriotism responded to her call. But unless there is shown a readiness to prepare plans and schemes to be placed in operation at the close of the war, the country may be plunged into a grave crisis of unemployment, and those men who are serving their country by land and sea may return home to face " out-of-work conditions, with all the waste of public money and individual suffering that unemployment brings in its train. It is not suggested that the State should provide capital for the purpose before the close of the war, as clearly the whole of the financial resources of the kingdom should be concentrated on war work. It is most however, that plans should be prepared, designs exhaustively considered, areas in which houses are to be built properly planned, provisional agreements for the purchase of land arranged, and allI the preliminary details completed ready for actual building operations to be commenced without delay when the war closes. The subjects for "
desirable !
financial
and
of our rural resources. The importof the work which this organisation is taking in hand is so obvious that the movement should receive widespread encouragement and support.
developers
ance
TUBERCULOSIS IN THE PIG. interesting study of the special features of porcine tuberculosis is given in two papers published in the Annales de 1’-Tnstitut Pasteur for November and December, 1915, by M. P. Chausse. The first of these contains a critical review of previous work upon this subject. From the statistics given in these papers it would appear that tuberculosis is much more common in pigs in some countries than in others, the morbidity found at different abattoirs varying from less than 0’1 per cent. in those in France to as much as 10 per cent. in the Argentine and in Germany. Reference is made to an annotation on the observations of Dr. A. Eastwood and Dr. F. Griffith published in our issue of May 2nd, 1914, in which among 24,144 pigs examined at Brighton2’73 per cent. were found to be tuberculous, of which about 1’5 per cent. showed generalised lesions. At Versailles during the four years 1910-13 the incidence was found to be from 0’44 per cent. to 0’63 per cent. As a result of his observations M. Chausse arrives at the conclusion that whereas man, the ox, and the dog are usually infected with tuberculosis by inhalation, the pig is almost exclusively infected through the tonsils and the cervical lymphatic glands. He is of opinion that this is due to the fact that the pig is often fed upon waste milk, mixed from various sources and not sterilised. It would appear that the lung of the pig is only affected when generalisation occurs, when it shares with the liver and the spleen the liability to the greatest number of lesions. The kidneys are very rarely involved, as is also the case in man, the ox, the dog, and the guinea-pig, while in the rabbit geaeralisation often involves the kidneys very severely. The tuberculous virus seems to have the smallest affinity for the kidney in the pig and the guinea-pig. M. Chausse finds that the sensitiveness of the pig to the tubercle bacillus is very great. The encysted and latent lesions so frequently seen in man and the ox do not occur in the pig, whereas generalisation of the lesions, which is relatively rare in man and the ox, is the rule in the pig. Lesions in the peripheral lymphatic glands and in the bones are particularly common in swine, and wherever the parenchyma of any organ is attacked by tubercles the regional AN
lymphatic glands
are
constantly affected provided
the animal survives for a sufficient time. Neither fibrous transformation nor any other form of retrogression occurs in porcine tuberculosis; on the other hand, caseation is early and frequent. M. Chausse explains the differences of incidence in different animals as follows. He supposes that with a tubercle bacillaemia of given intensity in the pig many of the bacilli will lead to lesions in the lungs, the liver, and the spleen, whereas in the dog and the ox a large number of the organisms are
Royal Warrant the disability orof the Royal Warrant, and has injury of a man, in order to qualify him for acases will have to be dealt funds. disability pension, must be due to his service as well as having originated in it, and that a Medical
public
MEASLES
Board certified whether disease was or was not due to a man’s service. He further stated that it was a mistake to suppose that there was no appeal from that decision; the medical authorities and the whole of the staff of the War Office approached the consideration of the question in a spirit of great sympathy. It might be, he said, that some Medical Boards had been unduly harsh and narrow in their interpretation of the terms of the Royal Warrant. They ought rather to consider each case on its own merits, and no general A man who has rule could be laid down. only been enlisted three or four months and is
THE order for
AND the
indicated that these with largely out of
DISTRICT NURSING. compulsory notification of
measles was, by a happy coincidence, issued just at a time when a committee of the London District Nursing Council was elaborating a scheme for the nursing of measles and whooping-cough. This im. portant scheme has been accepted by the council, and is to form the basis in London of a more efficient system of home nursing which should serve to reduce the lamentable death-rate from measles and other diseases among the children of the poorer districts. The scheme has involved a modification of the existing rules of district nursing associations in order to admit of attendance on cases of infec. tious disease. It has also dealt very carefully with the position of the nurse in regard to cases in which no doctor had been called in, and the rules have been so drawn as to prevent the district nurse from assuming any responsibility for medical treatment. We hope there may be no delay in getting to the practical application of a scheme of such beneficent intention.
then found to be suffering from pulmonary tuberculosis cannot be considered to have acquired the disease by military service. Reference has already been made in THE LANCET of Feb. 5th, p. 323, to a number of ex-sanatorium patients on active service, some of whom were known to have bacillary sputum, and we have recently heard of a private in a Scottish regiment with frequent blood in his sputum, and reduced to various expedients to conceal this and his other disabilities, whose condition was made light of by his regimental POSTURAL ACTIVITY OF MUSCLE AND NERVE. MOST skeletal muscles present the property of officer. On the other hand, if a man has been in " the army for several years, being perfectly well tone, by which is meant a slight constant tension during that period and giving no history of any which is characteristic of healthy muscle " (Hughes previous chest disease and then, after 12 months’ Bennett). It is a property which is difficult to service in France, develops the disease, it measure, and as a term it has come to be applied may be said with justice that the malady was not only to muscular action, involuntary as well as due to active service, and then undoubtedly it voluntary, but to such activities as " nerve centres," would be only fair that he should receive atten- and even the " bio-tonus " of living matter. It is tion. But between these extremes many cases supposed to signify lasting or enduring action as turn up when the decision is a difficult one. Some contrasted with evanescent or passing. It is known instances occur in which a history of previous that much of muscular tonus is reflex, and in a pulmonary tuberculosis is given and in which paper Professor C. S. Sherrington (Brain, 1915, arrest has taken place ; then, of course, the condi- vol. xxxvii., p. 191) brings forward important tion has been " aggravated " by active service ; in evidence to show that the chief function of tonus others perfect health has been previously enjoyed. may be concerned in the general maintenance of We contend, therefore, that the Medical Boards are posture in the animal, and this with the least perfectly within their duties in ascribing some of possible expenditure of energy. A valuable key to the cases to line service, the specific cause being the elucidation of this function in relation to " exposure to climate and infection," for doubtless skeletal muscle is the viewing of individual large numbers of men suffering from the disease muscles not only from their isolated activities but must be recruited from the ranks of the "chronic from their activities in relation to general purposive carrier," to the production of whom by our present efforts. For this reason reflex efforts, often inmethods of sanatorium treatment a correspondent volving complex actions, may give a surer clue to calls pointed attention in another column. In such the meaning of any individual muscular act concases full pension should certainly be given. Many cerned therein than if the muscle were studied inquestions arise as to the treatment of the men after dependently. Two supposed purposes of this skeletal discharge. If a man has been insured prior to join- tone are easily dismissed in so far as they are repreing the army the Tuberculosis Commissioners under sented as being the principal functions of this prothe National Insurance Act take charge of him, perty. That tonus merely obviates a muscle’s "taking and he is sent to a hospital or sanatorium. Much up slack " is hardly significant when the latency of a disappointment has been caused by well-meaning toneless frog’s muscle is but 1/100 of a second. So, persons assuring the patients that they will at too, the view that tonus is an important source of once be sent to a sanatorium, when it may turn out heat production is not tenable, since it is found that that a special hospital is indicated. Farther, the the chemical energy concerned in tone is remarkdifficulty that at once arises is that the men ably small. It is found that in the decerebrate hesitate to take advantage of the treatment, preparation, where tonus is a well-marked feature, especially if they are married, as they do not know this property is limited exactly to those muscles how those dependent on them will be provided for. which are in active contraction during the extensor Here again the question of a pension becomes: phase of the step ; the distribution of the tonus is paramount, and it is urgently necessary thatarranged on a plan of strict coordination. This reflex tonus embraces just those muscles which some immediate steps should be taken to provide the necessary funds. We are glad to hear from Mr. counteract the effect of gravity; it is postural Forster that the Government has set up a new body,, contraction. The afferent nerves producing this competent to deal with cases, tuberculous andL postural reflex are those of the contracting other, that fall outside the strict limits of the terms muscles themselves. The tonus can be maintained ,
.
,
____
.
521
with different tensions
or
lengths
of the
at the congress include the need for help in schemes for the clearance of insanitary areas, when the results in better citizenship and greater productive capacity, which will accompany the raising of the standard of life of the people as the outcome of the improvement of housing conditions, can be considered. Among other important questions to be discussed are the provision of homesteads with small holdings, the intensive cultivation of land, and the finding of capital to aid all classes of cultivators of the land
muscles, discussion
animals there appear to be muscles though in postural contraction and concerned separately movement respectively. Besides the afferent nerves of the muscles themselves being the source of the reflex, other sources may be present, especially those derived from the labyrinth. The centre of the reflex arc is pre-spinal, lying in or near the posterior region; the cerebellum, too, is concerned with reined adjustment and correlation. In the same way, postural contraction exists for such viscera as the bladder and stomach, the musculature in each organ being capable of maintaining an equal degree of pressure with varying lengths of muscle or varying capacity. The term ’’capacity"is in these cases similar to posture in skeletal muscle. Certain qualities of tonus are striking. For instance, the chemical energy involved by it is extremely low, very much lower than the energy consumed by a sustained tetanic contraction. It has been suggested that in postural contraction the muscle fibre or some part of it clots, changes from sol to get, and nervous impulses must be capable of causing it to unclot. The sarcoplasm would seem to be the coagulable Certain diseases, such as congenital element. myotonia and myasthenia gravis, forcibly suggest that the functional mechanical activity of muscle is two-fold in nature-tonic and non-tonic. Since it has been shown that there are two kinds of motor endings in striped muscle, it is suggested that one is concerned with tonic contraction and is derived from the sympathetic. Finally, Professor Sherrington concludes,reflex maintenance and adjustment of posture is a chief portion of the reflex work of the proprioceptive system, just as sensation of and perception of posture is a chief portion of the psychical output of that system." in
some
HOME PROBLEMS AFTER THE WAR. A VERY important movement has been begun under the auspices of the National Housing and Town Planning Council, having reference particularly to problems relating to housing and agriculture and to the possibilities of averting unemployment in the building trade. A national congress to consider " Home Problems after the War " is to be held at the Caxton Hall, London, from April llth to 14th next, and an influential Parliamentary and organising committee has been formed. A preliminary programme of the subjects to be diseussed has been drawn up. It is very rightly pointed out that the country has a debt to pay to those who have in a fine spirit of patriotism responded to her call. But unless there is shown a readiness to prepare plans and schemes to be placed in operation at the close of the war, the country may be plunged into a grave crisis of unemployment, and those men who are serving their country by land and sea may return home to face " out-of-work conditions, with all the waste of public money and individual suffering that unemployment brings in its train. It is not suggested that the State should provide capital for the purpose before the close of the war, as clearly the whole of the financial resources of the kingdom should be concentrated on war work. It is most however, that plans should be prepared, designs exhaustively considered, areas in which houses are to be built properly planned, provisional agreements for the purchase of land arranged, and allI the preliminary details completed ready for actual building operations to be commenced without delay when the war closes. The subjects for "
desirable !
financial
and
of our rural resources. The importof the work which this organisation is taking in hand is so obvious that the movement should receive widespread encouragement and support.
developers
ance
TUBERCULOSIS IN THE PIG. interesting study of the special features of porcine tuberculosis is given in two papers published in the Annales de 1’-Tnstitut Pasteur for November and December, 1915, by M. P. Chausse. The first of these contains a critical review of previous work upon this subject. From the statistics given in these papers it would appear that tuberculosis is much more common in pigs in some countries than in others, the morbidity found at different abattoirs varying from less than 0’1 per cent. in those in France to as much as 10 per cent. in the Argentine and in Germany. Reference is made to an annotation on the observations of Dr. A. Eastwood and Dr. F. Griffith published in our issue of May 2nd, 1914, in which among 24,144 pigs examined at Brighton2’73 per cent. were found to be tuberculous, of which about 1’5 per cent. showed generalised lesions. At Versailles during the four years 1910-13 the incidence was found to be from 0’44 per cent. to 0’63 per cent. As a result of his observations M. Chausse arrives at the conclusion that whereas man, the ox, and the dog are usually infected with tuberculosis by inhalation, the pig is almost exclusively infected through the tonsils and the cervical lymphatic glands. He is of opinion that this is due to the fact that the pig is often fed upon waste milk, mixed from various sources and not sterilised. It would appear that the lung of the pig is only affected when generalisation occurs, when it shares with the liver and the spleen the liability to the greatest number of lesions. The kidneys are very rarely involved, as is also the case in man, the ox, the dog, and the guinea-pig, while in the rabbit geaeralisation often involves the kidneys very severely. The tuberculous virus seems to have the smallest affinity for the kidney in the pig and the guinea-pig. M. Chausse finds that the sensitiveness of the pig to the tubercle bacillus is very great. The encysted and latent lesions so frequently seen in man and the ox do not occur in the pig, whereas generalisation of the lesions, which is relatively rare in man and the ox, is the rule in the pig. Lesions in the peripheral lymphatic glands and in the bones are particularly common in swine, and wherever the parenchyma of any organ is attacked by tubercles the regional AN
lymphatic glands
are
constantly affected provided
the animal survives for a sufficient time. Neither fibrous transformation nor any other form of retrogression occurs in porcine tuberculosis; on the other hand, caseation is early and frequent. M. Chausse explains the differences of incidence in different animals as follows. He supposes that with a tubercle bacillaemia of given intensity in the pig many of the bacilli will lead to lesions in the lungs, the liver, and the spleen, whereas in the dog and the ox a large number of the organisms are