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THE INFLUENCE OF ATHLETIC SPORTS ON THE PHYSICAL STATE.
717 tried in cases of sleeping sickness. I am sending a copy of bulk of the polypus is composed of well-formed fibrous tissue, this note to Sir David Bruce in Uganda for his consideration rich in blood-vessels, the majority of which possess a wellScattered amongst the fibrous and I propose to carry out experimental work in this direc- developed muscular coat. tion here as soon as possible. If the idea has been voiced stroma are extensive areas of round-celled infiltration, the The beforehand I can only plead the difficulty of getting at the cells of which are mainly polynuclear leucocytes. full literature on the subject and apologise for having, as one tumour is obviously a vascular fibroma which has undergone " an inflammatory change as a result of irritation of the surface may say, ’’ carried coals to Newcastle." and subsequent besmearing with boric acid in its previous I am, Sir, yours faithfully, ANDREW BALFOUR, M.D. Edin., treatment. I am disposed to regard the condition as one of Director, Wellcome Research Laboratory, Khartoum. great rarity in a child so young. Dr. John T. Hewetson has my best thanks for helping me to examine and report this I am, Sir, yours faithfully, THE INFLUENCE OF ATHLETIC SPORTS specimen. LEWIS GRAHAM. -..
ON THE PHYSICAL
STATE.
To the Editor of THE LANCET.
SIR,-For
some
years
past I have had the opportunity of
the athletic undergraduate of this University in health and sickness at close quarters, and have been able to convince myself that his physical state is different from that of the undergraduate who does not take part in athletic exercises, and that this state is one of slow development which can be watched, and these men cannot be judged by the standards applicable to healthy men who are not athletic. When it is watched some points become evident ; for instance, the fall in the rate of the pulse, the decrease in the difference between the rates of the morning and before exercise and the evening and after exercise, both changes becoming more and more marked, while the healthy man continues regularly to take part in hard physical exercises. There are other points which can be seen to become prominent. To observe these changes carefully it is necessary Not to see the man before and after exercise occasionally. always does the progress of the various changes continue to be uninterrupted; it may cease or the changes may tend to disappear. All this can be noted and the man warned to rest for a time. This change of condition seems to me to bear upon the question of the effect produced by athletics at schools, inasmuch as it can be seen to be present in school athletes who have lately come up to the University, some of whom are under 18 years of age and many under 19. Would it not be worth while to have every boy who wishes to take part in any form of athletics examined on his arrival at school at the beginning of term, and again after any unusual trial of strength, until the medical man on the spot can satisfy himself that the boy has the power to develop along the right lines.-I am, Sir, yours faithfully, ROBERT MICHELL.
watching
THE CLINICAL VALUE OF HÆMOMANOMETER OBSERVATIONS. To the Editor
of THE LANCET.
SIR,—I have read Dr. William Russell’s book on Hypertonus and Arterio-Sclerosis " and other of his writings, and I cannot find any proof of his contention that the obliteration method fails to give the true readings of blood pressure
in man. It may fail; the arterial wall may come into play ; but we want definite proofs, not opinions. Dr. Martin Flack and I have put forward two methods of testing the accuracy of this method, which have been communicated to the Physiological Society and without adverse criticism. The first method is to apply one armlet to the arm and another to the leg and to note the obliteration in the radial and posterior tibial arteries and see whether in different postures the readings vary in accordance with the column of blood which separates the two armlets. It is highly improbable that this will occur if the arterial wall comes into the readings. The second method is to place one armlet round the upper and a second round the lower arm (on the Find the pressure required in the upper armlet same side). to obliterate the radial pulse-say 150 mm. Hg. Lower the pressure 5 mm. Hg in this armlet and keep it The veins blocked by that pressure will fill at that. Raise the pressure as the arterial blood comes through. in the lower armlet to over 150 mm. Hg. Choose a vein Stroke it empty past the next valve. above this armlet. Relax the pressure in this armlet until the vein fills from below and read the pressure then. If it comes out at 145 mm. Hg the obliteration pressure which was found to be 150 mm. Hg is correct within 5 mm. Hg, for none will assert that the wall of a superficial vein takes any measurable pressure to obliterate it. Here are two good methods, and I would ask clinicians to investigate their cases of high TRANSPOSITION OF THE VISCERA pressure by these methods. As far as we have gonewe have OCCURRING IN BROTHERS. not found serious error in the obliteration method. I am, Sir, yours faithfully, To the Editor of THE LANCET. LEONARD HILL. SIR,-In an article on the above in your issue of Feb. 13th Dr. Louis Lowenthal says : " I have been unable to find on 20 the Editor of THE LANCET. perusing the literature of the subject a’single recorded case of transposition of the thoracic and abdominal organs SIR,—Might I claim a little more of your space in order to occurring in brothers and diagnosed during life." There is thank Dr. Russell for his consideration of my criticisms but at present in this institution a patient (epileptic) who shows also to reply, as I do not think he has put quite a fair conthe condition. His only brother (resident in the neighbour- struction on my contention ? I hope Dr. Russell does not hood) is similarly abnormal. As it is not improbable that attribute to me the suggestion that contraction of the vessel these cases were reported some years ago I am making lowers the blood pressure inside it, for there is nothing in my inquiries on the point. Should such prove negative then I letter suggesting this. The heart, I take it, requires a shall publish a report at a future date. certain pressure in the aorta in order that an adequate Tam. Sir. vours faithfullv. blood-supply may be maintained in the coronary vessels, D. MCKINLAY REID, M.B., Ch.B. Glasg. and the mechanism by which this is carried out is a correlative one between ventricle and systemic vessels ; therefore, contraction of the periphery does play a part in diminishing the work of the heart, for although the FIBROMA OF VULVA IN A CHILD. blood pressure may be maintained the same the output ’.1’0 t2e 1G’CLOT OJ THE LANCET. at each emptying of the ventricle need be less or the SIR,--I have recently seen a case in a child, two and a half rhythm need be slower. This to my mind is a state of years old, of a tumour springing from the fossa navicularis things which does exist in cases of ventricular failure in just below the hymen. The mother had noticed the little which compensation can just be established with the patient mass protruding through the vulva for a few months and at complete rest; but when any greater demand is put upon desired its removal. It was one inch long and one-third the periphery necessitating increased blood-supply, the of an inch wide and somewhat soft and slippery on examina- ventricle is unable to sustain the necessary pressure in the tion. It was removed by snipping through the pedicle after arteries to maintain the required supply and failure of comits ligation. On microscopical examination the polypus has pensation is at once manifest. the following appearances. The surface is everywhere With reference again to Dr. Russell’s case in which he covered by a layer of stratified squamous epithelium show- suggests a pressure not exceeding 20 millimetres in the aorta, ing in places oedematous and catarrhal changes. The great I venture to remark that if such was the case he would not
ON THE PHYSICAL
STATE.
To the Editor of THE LANCET.
SIR,-For
some
years
past I have had the opportunity of
the athletic undergraduate of this University in health and sickness at close quarters, and have been able to convince myself that his physical state is different from that of the undergraduate who does not take part in athletic exercises, and that this state is one of slow development which can be watched, and these men cannot be judged by the standards applicable to healthy men who are not athletic. When it is watched some points become evident ; for instance, the fall in the rate of the pulse, the decrease in the difference between the rates of the morning and before exercise and the evening and after exercise, both changes becoming more and more marked, while the healthy man continues regularly to take part in hard physical exercises. There are other points which can be seen to become prominent. To observe these changes carefully it is necessary Not to see the man before and after exercise occasionally. always does the progress of the various changes continue to be uninterrupted; it may cease or the changes may tend to disappear. All this can be noted and the man warned to rest for a time. This change of condition seems to me to bear upon the question of the effect produced by athletics at schools, inasmuch as it can be seen to be present in school athletes who have lately come up to the University, some of whom are under 18 years of age and many under 19. Would it not be worth while to have every boy who wishes to take part in any form of athletics examined on his arrival at school at the beginning of term, and again after any unusual trial of strength, until the medical man on the spot can satisfy himself that the boy has the power to develop along the right lines.-I am, Sir, yours faithfully, ROBERT MICHELL.
watching
THE CLINICAL VALUE OF HÆMOMANOMETER OBSERVATIONS. To the Editor
of THE LANCET.
SIR,—I have read Dr. William Russell’s book on Hypertonus and Arterio-Sclerosis " and other of his writings, and I cannot find any proof of his contention that the obliteration method fails to give the true readings of blood pressure
in man. It may fail; the arterial wall may come into play ; but we want definite proofs, not opinions. Dr. Martin Flack and I have put forward two methods of testing the accuracy of this method, which have been communicated to the Physiological Society and without adverse criticism. The first method is to apply one armlet to the arm and another to the leg and to note the obliteration in the radial and posterior tibial arteries and see whether in different postures the readings vary in accordance with the column of blood which separates the two armlets. It is highly improbable that this will occur if the arterial wall comes into the readings. The second method is to place one armlet round the upper and a second round the lower arm (on the Find the pressure required in the upper armlet same side). to obliterate the radial pulse-say 150 mm. Hg. Lower the pressure 5 mm. Hg in this armlet and keep it The veins blocked by that pressure will fill at that. Raise the pressure as the arterial blood comes through. in the lower armlet to over 150 mm. Hg. Choose a vein Stroke it empty past the next valve. above this armlet. Relax the pressure in this armlet until the vein fills from below and read the pressure then. If it comes out at 145 mm. Hg the obliteration pressure which was found to be 150 mm. Hg is correct within 5 mm. Hg, for none will assert that the wall of a superficial vein takes any measurable pressure to obliterate it. Here are two good methods, and I would ask clinicians to investigate their cases of high TRANSPOSITION OF THE VISCERA pressure by these methods. As far as we have gonewe have OCCURRING IN BROTHERS. not found serious error in the obliteration method. I am, Sir, yours faithfully, To the Editor of THE LANCET. LEONARD HILL. SIR,-In an article on the above in your issue of Feb. 13th Dr. Louis Lowenthal says : " I have been unable to find on 20 the Editor of THE LANCET. perusing the literature of the subject a’single recorded case of transposition of the thoracic and abdominal organs SIR,—Might I claim a little more of your space in order to occurring in brothers and diagnosed during life." There is thank Dr. Russell for his consideration of my criticisms but at present in this institution a patient (epileptic) who shows also to reply, as I do not think he has put quite a fair conthe condition. His only brother (resident in the neighbour- struction on my contention ? I hope Dr. Russell does not hood) is similarly abnormal. As it is not improbable that attribute to me the suggestion that contraction of the vessel these cases were reported some years ago I am making lowers the blood pressure inside it, for there is nothing in my inquiries on the point. Should such prove negative then I letter suggesting this. The heart, I take it, requires a shall publish a report at a future date. certain pressure in the aorta in order that an adequate Tam. Sir. vours faithfullv. blood-supply may be maintained in the coronary vessels, D. MCKINLAY REID, M.B., Ch.B. Glasg. and the mechanism by which this is carried out is a correlative one between ventricle and systemic vessels ; therefore, contraction of the periphery does play a part in diminishing the work of the heart, for although the FIBROMA OF VULVA IN A CHILD. blood pressure may be maintained the same the output ’.1’0 t2e 1G’CLOT OJ THE LANCET. at each emptying of the ventricle need be less or the SIR,--I have recently seen a case in a child, two and a half rhythm need be slower. This to my mind is a state of years old, of a tumour springing from the fossa navicularis things which does exist in cases of ventricular failure in just below the hymen. The mother had noticed the little which compensation can just be established with the patient mass protruding through the vulva for a few months and at complete rest; but when any greater demand is put upon desired its removal. It was one inch long and one-third the periphery necessitating increased blood-supply, the of an inch wide and somewhat soft and slippery on examina- ventricle is unable to sustain the necessary pressure in the tion. It was removed by snipping through the pedicle after arteries to maintain the required supply and failure of comits ligation. On microscopical examination the polypus has pensation is at once manifest. the following appearances. The surface is everywhere With reference again to Dr. Russell’s case in which he covered by a layer of stratified squamous epithelium show- suggests a pressure not exceeding 20 millimetres in the aorta, ing in places oedematous and catarrhal changes. The great I venture to remark that if such was the case he would not