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THE LATE SIR DAVID FERRIER.
1238 than pain does a different type of end-organ probably involved, reacting to a lower tension.
whether in this country good work might not be done by such a body as this Association, which could consider many questions arising concerning the present and future of medical education. A voluntary association of teachers would have much greater scope than the General Medical Council. which is limited in some directions by statutory considerations.
.
" The relation of nausea and oesophageal pain is thus very similar to the sensations of pressure and painful pressure on a skeletal muscle, or of touch and pin-prick on the skin. In each case a slight stimulus produces the specific sensation and the. latter gradually disappears completely as the stimulus increases, and finally pain alone is left."
THE LATE SIR DAVID FERRIER. recognition of Sir David Ferrier’s pioneer work and scientific eminence it is the welcome idea of his friends and colleagues to perpetuate his memory in A letter has accordingly been some permanent form. sent out to members of the medical profession stating the intention of raising a fund for a Ferrier Memorial, and a committee of subscribers is being convened who will meet shortlv in order to decide what form the memorial should take. The letter is signed by Sir Charles Ballance, Dr. William Bulloch, Sir James Purves-Stewart, Sir StClair Thomson, and Dr. Aldren Turner, the last named acting as treasurer. Those who reply favourably to the invitation-and we hope that this will include all those invited and many others-will be placed among the first list of subscribers, and it may be mentioned that, for the purpose of publication in the press, the names but not the amount of the subscription will be made known. We i trust that many of our readers, whether or not in receipt of the circular letter, will support the movement and send their donations for the Ferrier Memorial Fund, either to Dr. Aldren Turner, 18, W. 1, or to the Westminster Bank, 1, Cavendishsquare, London, W., when a receipt will be received .from the bank. IN
Harley-street,
____
VISCERAL SENSATIONS AND COUNTERIRRITATION. IN his Croonian lectures, the second of which 1 - we publish this week, Dr. Charles Bolton criticises the theory of visceral sensation put forward by Dr. W. W. Payne and Dr. E. P. Poulton, who have shown2 that oesophageal pain results from a stretching force in the viscus and have attributed it to tension exerted on pain nerve-endings " in the walls. The pain, they pointed out, may be relieved either by peristaltic contraction, which overcomes the stretch, or by postural adaptation, which increases the capacity of the organ so that the tension is reduced. Tonus was defined as the tension of plain muscle during its diastole, and it was found that pain produced experimentally was associated with high tonus. The account of their further investigations, just published3 is of considerable clinical importance, the more so as nearly all the numerous experiments were made on the observers themselves, whose accuracy can be depended upon. The first part of their work is concerned with nausea, and as people disagree about the meaning of this term, they begin by defining it as a sensation felt at the back and lower part of the throat, usually unassociated with pain. It is often accompanied by -but should be distinguished from—uneasy " sinking sensation " in the pit of the stomach. Nausea was induced by swallowing lubber bags containing variable quantities of air, whose pressure was recorded on a moving drum. The sensations of the subject, as signalled, were recorded on the same drum, and their relation to changes of pressure within the bag, and therefore to tension in the oesophagal wall, could thus be noted. A general transition was observed from the sensation of " nausea, alone " to painful nausea, " and " pain alone." The fact that nausea was felt during oesophageal relaxation was held to suggest that the mechanism of its production is -essentially the same as that of visceral pain, but because nausea comes on at a lower diastolic pressure "
1 THE 2 Jour.
LANCET, June 9th, p. 1161. Physiol., 1927, lxiii., 217. 3 Ibid., 1928, lxv., 157.
is
Like visceral and Poulton
pain, nausea can be relieved. Payne consider, by peristaltic contraction or by change of posture ; conversely it can be produced by anything which increases the tension on the specific end-organs. Dr. G. H. Oriel informs them that, at sea, the sensation of nausea is felt during
the retardation of movement towards the bottom of the ship’s descent, and this observation is brought into line with their own work by the statement that the retardation tends to cause ’’ a dropping of the unsupported soft parts and, consequently, an increased degree of tension in the specific end-organs for nausea in the oesophageal wall." The next symptom investigated was the sensation of sinking " in the abdomen. A rubber bag was passed beyond the cardiac orifice and large quantities of air were introduced into the stomach through a catheter. The sinking sensation thus produced is regarded as due to increase of tonus in the wall of the viscus and is thus " analogous in every way to nausea." On the introduction of air a desire to eructate was felt deep in the mid-line about the level of the clavicle ; the feeling was that of a lump or " globus " situated here which would be dispersed by eructation. It might also be described, they say, as a feeling of " wind," and must clearly be analogous to " globus hystericus." They regard it as " different in quantity from nausea, though the two are obviously related, since they are felt in approximately the same part of the body and occur during the relaxations of an oesophageal peristaltic contraction, if the tonus is slightly increased." Other gastrooesophageal reflexes were carefullv studied, including what they call the " anti-regurgitation reflex." and it was found that the effect of gastric distension on the cesophagus depends on oesophageal activity at the time of its production. The smell of ammonia stimulates this activity ; it is abolished by swallowing iced water ; and it is found to be greater when the subject is not paying attention to the experiment. What chiefly interested the investigators, however, was the cutaneo-oesophageal reflexes, in their relation to therapeutic counter-irritation. As usual, the activity of the oesophagus was measured by means of a bag, whilst the skin was stimulated by applying turpentine stupes, mustard-leaf plasters, or lin. camph. ammon. over the sternum or by pinching or rubbing with cotton-wool or the bare hand. The type of response was independent to the method of stimulation employed, but partly varied with the activity of the viscus just before it was applied. When the oesophagus was quiet stimulation caused immediate activity, which tended to die down after When stimulation or during prolonged stimulation. the organ was already active, counter-irritation usually decreased its activity sooner or later. The effect of rubbing or otherwise stimulating the skin at a distance-i.e., on the calf—was apparently just the same. So far, these particular experiments had been painless, but as counter-irritation is used in practice to allay pain, tests were made in which almost to its full an oesophageal bag wa3 filled capacity, so as to produce continuous retro-sternal pain, and the result of rubbing the skin was again observed. The effect was comforting and the irritations caused a fall in diastolic pressure. According to Payne and Poulton’s theory of visceral pain this relief might be traced either to a reflex increase of posture leading to a fall of diastolic pressure, and hence a lessening of tonus and tension on the pain nerve-endings, or else to frequent systolic contractions of the muscle-wall which take the strain off these With an active œsophagus counterendings. ‘’
closely
whether in this country good work might not be done by such a body as this Association, which could consider many questions arising concerning the present and future of medical education. A voluntary association of teachers would have much greater scope than the General Medical Council. which is limited in some directions by statutory considerations.
.
" The relation of nausea and oesophageal pain is thus very similar to the sensations of pressure and painful pressure on a skeletal muscle, or of touch and pin-prick on the skin. In each case a slight stimulus produces the specific sensation and the. latter gradually disappears completely as the stimulus increases, and finally pain alone is left."
THE LATE SIR DAVID FERRIER. recognition of Sir David Ferrier’s pioneer work and scientific eminence it is the welcome idea of his friends and colleagues to perpetuate his memory in A letter has accordingly been some permanent form. sent out to members of the medical profession stating the intention of raising a fund for a Ferrier Memorial, and a committee of subscribers is being convened who will meet shortlv in order to decide what form the memorial should take. The letter is signed by Sir Charles Ballance, Dr. William Bulloch, Sir James Purves-Stewart, Sir StClair Thomson, and Dr. Aldren Turner, the last named acting as treasurer. Those who reply favourably to the invitation-and we hope that this will include all those invited and many others-will be placed among the first list of subscribers, and it may be mentioned that, for the purpose of publication in the press, the names but not the amount of the subscription will be made known. We i trust that many of our readers, whether or not in receipt of the circular letter, will support the movement and send their donations for the Ferrier Memorial Fund, either to Dr. Aldren Turner, 18, W. 1, or to the Westminster Bank, 1, Cavendishsquare, London, W., when a receipt will be received .from the bank. IN
Harley-street,
____
VISCERAL SENSATIONS AND COUNTERIRRITATION. IN his Croonian lectures, the second of which 1 - we publish this week, Dr. Charles Bolton criticises the theory of visceral sensation put forward by Dr. W. W. Payne and Dr. E. P. Poulton, who have shown2 that oesophageal pain results from a stretching force in the viscus and have attributed it to tension exerted on pain nerve-endings " in the walls. The pain, they pointed out, may be relieved either by peristaltic contraction, which overcomes the stretch, or by postural adaptation, which increases the capacity of the organ so that the tension is reduced. Tonus was defined as the tension of plain muscle during its diastole, and it was found that pain produced experimentally was associated with high tonus. The account of their further investigations, just published3 is of considerable clinical importance, the more so as nearly all the numerous experiments were made on the observers themselves, whose accuracy can be depended upon. The first part of their work is concerned with nausea, and as people disagree about the meaning of this term, they begin by defining it as a sensation felt at the back and lower part of the throat, usually unassociated with pain. It is often accompanied by -but should be distinguished from—uneasy " sinking sensation " in the pit of the stomach. Nausea was induced by swallowing lubber bags containing variable quantities of air, whose pressure was recorded on a moving drum. The sensations of the subject, as signalled, were recorded on the same drum, and their relation to changes of pressure within the bag, and therefore to tension in the oesophagal wall, could thus be noted. A general transition was observed from the sensation of " nausea, alone " to painful nausea, " and " pain alone." The fact that nausea was felt during oesophageal relaxation was held to suggest that the mechanism of its production is -essentially the same as that of visceral pain, but because nausea comes on at a lower diastolic pressure "
1 THE 2 Jour.
LANCET, June 9th, p. 1161. Physiol., 1927, lxiii., 217. 3 Ibid., 1928, lxv., 157.
is
Like visceral and Poulton
pain, nausea can be relieved. Payne consider, by peristaltic contraction or by change of posture ; conversely it can be produced by anything which increases the tension on the specific end-organs. Dr. G. H. Oriel informs them that, at sea, the sensation of nausea is felt during
the retardation of movement towards the bottom of the ship’s descent, and this observation is brought into line with their own work by the statement that the retardation tends to cause ’’ a dropping of the unsupported soft parts and, consequently, an increased degree of tension in the specific end-organs for nausea in the oesophageal wall." The next symptom investigated was the sensation of sinking " in the abdomen. A rubber bag was passed beyond the cardiac orifice and large quantities of air were introduced into the stomach through a catheter. The sinking sensation thus produced is regarded as due to increase of tonus in the wall of the viscus and is thus " analogous in every way to nausea." On the introduction of air a desire to eructate was felt deep in the mid-line about the level of the clavicle ; the feeling was that of a lump or " globus " situated here which would be dispersed by eructation. It might also be described, they say, as a feeling of " wind," and must clearly be analogous to " globus hystericus." They regard it as " different in quantity from nausea, though the two are obviously related, since they are felt in approximately the same part of the body and occur during the relaxations of an oesophageal peristaltic contraction, if the tonus is slightly increased." Other gastrooesophageal reflexes were carefullv studied, including what they call the " anti-regurgitation reflex." and it was found that the effect of gastric distension on the cesophagus depends on oesophageal activity at the time of its production. The smell of ammonia stimulates this activity ; it is abolished by swallowing iced water ; and it is found to be greater when the subject is not paying attention to the experiment. What chiefly interested the investigators, however, was the cutaneo-oesophageal reflexes, in their relation to therapeutic counter-irritation. As usual, the activity of the oesophagus was measured by means of a bag, whilst the skin was stimulated by applying turpentine stupes, mustard-leaf plasters, or lin. camph. ammon. over the sternum or by pinching or rubbing with cotton-wool or the bare hand. The type of response was independent to the method of stimulation employed, but partly varied with the activity of the viscus just before it was applied. When the oesophagus was quiet stimulation caused immediate activity, which tended to die down after When stimulation or during prolonged stimulation. the organ was already active, counter-irritation usually decreased its activity sooner or later. The effect of rubbing or otherwise stimulating the skin at a distance-i.e., on the calf—was apparently just the same. So far, these particular experiments had been painless, but as counter-irritation is used in practice to allay pain, tests were made in which almost to its full an oesophageal bag wa3 filled capacity, so as to produce continuous retro-sternal pain, and the result of rubbing the skin was again observed. The effect was comforting and the irritations caused a fall in diastolic pressure. According to Payne and Poulton’s theory of visceral pain this relief might be traced either to a reflex increase of posture leading to a fall of diastolic pressure, and hence a lessening of tonus and tension on the pain nerve-endings, or else to frequent systolic contractions of the muscle-wall which take the strain off these With an active œsophagus counterendings. ‘’
closely