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THE PHYSIOLOGY OF THE ADRENALS.
211
example, cannot fail to
have noticed how smooth and free from vibration is the travelling on the Great Western Railway. On the London and North-Western and the Midland Railways it is still good from this point of view, but not quite so free from shock and noise. The trains of the former company running on the Underground Railway are, however, excellent examples of smooth and comfortable travelling. The trains running south create, as a rule, an endless clatter, so that on these lines a journey, say of fifty miles, produces as much distress and fatigue as a journey of over 300 miles north by the east and west coast and the Midland routes. It is fair to add, however, that the London and South Western Railway has of late years considerably reduced the amount of shaking which passengers The Great Eastern on this line were wont to experience. Railway, though well to the fore in enterprise, is, perhaps, one of the worst from the point of view of a rattling, shaking, and noisy journey. These difterences are, of The course, easily explained on engineering grounds. character of the "run" is dependent upon the degree of perfection of the rolling stock and the track. What we should like to know is why the same standard of smoothness MULTIPLE MELANOTIC SARCOMATA RESULTING and regularity in both these engineering details cannot be FROM A MOLE. adopted by all companies alike. The question is not one The following case has recently been published by Dr. D. that affects the interests of the passengers only, because Grant.l The patient was a muscular, exceptionally healthy surely the more smoothly a train runs over the metals the less must be the wear and tear to both the train and the man, aged twenty-seven years. He had a black mole on the right arm ever since birth. Three years ago it was torn by track. It will be generally conceded that every effort the horn of a sheep and soon healed. Some time after- should be made to minimise the ill-effects which travelwards he injured it again, and it spread to the size of a ling at a high speed is apt to induce. finger-tip. A year after the first injury he showed it to a medical man, who thought little of it. Six months HOT WEATHER IN NEW YORK CITY, later he bruised it again. Healing did not take place THE weather in New York is said to have been the hottest readily, and a few satellites appeared. Another medical record for the first week in July. Heat makes itself felt on man excised the whole affected area of skin. Five months in a peculiar degree in New York owing to the humidity of in the axilla which was promptly later a lump appeared excised. However, a large number of secondary growths the atmosphere. When the thermometer approaches the in the sun. appeared. The surface of the body was thickly sprinkled with hundred mark the heat is almost unbearable from the there have been casualties effect of Already many in melanotic growths, varying size, depth, and colour, and a much larger number could be detected by touch. The whole the heat. On July 5th, when Independence Day was celeskin of the trunk was thickly infiltrated witla minute growths. brated, what with the thermometer at 94° F., and the noise This case, unfortunately, is a type of all. That melanosis and smell of the numberless crackers and other descriptions of fireworks which supplied a vent for the overflowing patriotmay result from a mole is but a commonplace doctrine; yet in no case has free excision be resorted to in the first ism of young America, life (a correspondent writes) was Without doubt, if this weather instance. The reason is that the first changes-increase in scarcely worth living. as is it predicted it will, the scenes of last July size or ulceration-appear trifling. The nature of the disease continues, will be repeated, when horses and men died in large is recognised too late -- when secondary growths have in the streets. appeared. How many more such cases must occur before it becomes generally realised that a mole is a potential sarcoma THE PHYSIOLOGY OF THE ADRENALS. and should be promptly and freely excised on showing the A LONG and interesting article on the Physiology of the slightest activity2 Suprarenal Bodies is to be found in the June number of RAILWAY NOISE AND VIBRATION AND THEIR Pfliiger’s Archiv, written by Dr. Arthur Biedl, one of the EFFECT UPON HEALTH. assistants in the Vienna Institute. The points to which he VIBRATION and noise are factors well known not only as has directed his particular attention are the vaso-motor producing temporary discomfort but also injurious effects nerves and the secretory nerves of these organs. He upon the health. In these days when travelling rapidly describes in detail the operative procedure he adopted in his from place to place is a sine q1lâ non both causes of disturb- experiments, and arrives at the conclusion that certain vasodilator fibres run in the splanchnic nerves to the adrenals, ance are to some extent inevitable, but we cannot help thinking that much more might be done to alleviate the partly because no other explanation can be offered of the distress arising from our incessant recourse to the many and rapidity with which hyperasmia follows stimulation of these various means of moving from place to place. Speed is the nerves, partly on account of the steady increase of the craze, but there is no reason why speed should not be hypersemia as the stimulation is continued, and partly attained without the discomfort due to noise and rapid because of its continuance for some time after the vibration, not to mention the, perhaps, permanently ill- cessation of stimulation quite independently of the blood effects which a constant series of joltings may have upon pressure in the arteries. He has observed that in the the nervous passenger and invalid. The various railways dog the splanchnics, after traversing the diaphragm, give running out of London afford a good illustration of what is, off on each side, before they enter into the formation of and what is not, done in this direction. Passengers, for the solar plexus, a single large branch to the adrenals, and these, he believes, contain the chief vaso-dilator fibres, 1 of 1897. Medical Journal Intercolonial since, if divided, the stimulation of the splanchnics in the Australia, May 20th,
Shaftesbury-avenue. The temptation to a famished man in the early hours of the morning, when he finds excellent food placed at the street-doors on every side, is indeed great, and so the magistrate thought, and taking that into account he sentenced the man to fourteen days’ hard labour. This case prompts us to quote an instance known to ourselves in which the milk left in a can on a doorstep had been actually tampered with. Some maliciously disposed person had opened the lid and dropped inside a vermin-killing powder containing strychnine. Fortunately it was noticed that there was something wrong with the milk by the appearance of a blue powder in it, otherwise the consequences might have been very grave indeed, and with little chance of tracing the villain. We hardly like to suggest that there are miscreants amongst us who would be guilty of committing such a heinous offence, but the ease with which it obviously can be done, and was done in this case, should be a serious warning to the public to effectually prevent any such possibility. Milk consumers should insist on their milk cans being sealed, and should reject the early morning milk if it be found that the seal is broken.
numbers
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212 thorax is without influence, whilst stimulation of the distal extremities of the divided nerves is followed by active hypeymmia. From a critical review of the researches of previous investigators he considers the facts actually established in regard to the vaso-dilator nerves distributed to the abdominal viscera to be that these nerves leave the spinal cord chiefly by the anterior roots of the lower dorsal nerves and, running in the rami communicantes, enter the sympathetic in the dorsal region and are distributed with the branches of the splanchnic nerves to the large and small intestine, the liver, kidneys, pancreas, and. adrenals. He has satisfied himself that there are ganglia on the vessels distributed to the adrenals, and that although their presence has not been anatomically demonstrated vasoThe two sets of nerves, vasoconstrictor nerves exist. dilators and vaso-constrictors, run in the same trunks, their relative proportion varying to a considerable extent. Dr. Biedl has devoted much time and attention to the secretory nerves of the adrenals. These organs belong to the class of those which have an internal secretion discharging the materials they elaborate into the blood. Various investigators have been led to the belief that the granules well known to exist in the blood of mammals proceed from the adrenals. Others have shown that the venous blood of these organs resembles arterial blood in colour, and yet another observer has demonstrated that the peculiar extract of the adrenals is not a post-mortem product, but is contained in the venous blood returning from these organs during life. Dr. Biedl, in his experiments directed especially to the determination of the changes in the morphological elements of the venous blood and the behaviour of the extract with its peculiar action on the blood pressure, found that after stimulation of the suprarenal branch or of the splanchnic nerve in the thorax the number of bright granules or little masses of protoplasm was diminished, and at the same time the number of the leucocytes of the blood was reduced, these In bodies being apparently retained within the organ. regard to the active extract, Dr. Biedl believes that the splanchnic nerves do not only contain vaso-dilators, but that they are also associated with the secretory nerves of the adrenals, which run in the same trunks, and that stimulation of these nerves leads to some, though not material, increase in the quantity of the active extract produced.
DILATATION OF THE STOMACH IN INFANCY. IT is well known that dilatation of the hollow viscera is a morbid condition commonly gradual in its development and equally, if not more, slow in its amendment. It derives, moreover, a peculiar interest from the fact that it constitutes a form of change which marks the transition between functional and organic disease-a stage at which overwork and weakness of tissue account for the whole pathology, and which is therefore often well within the hope of a healthy reversion. Additional light has recently been shed on this subject by a paper published by Dr. Comby in the Jmwnal de Olini1jlle et de Tlté’J’ape1diqne infaittiles of July 1st, 1897. The writer’s observations have been limited to the study of gastric dilatation during infancy. He finds that at an age when the newly-formed organ might be expected to be fully competent the stomach frequently shows a marked degree of dilatation. In 64 children who died in the Hospital for Sick Children, Paris, this viscus was found to be dilated, its volume varying from 200 c.c. to 310 c.c. In 16 others it was contracted. Dr. Comby explains the former condition as being due to atony produced by an auto-infection by putrescent matters resulting from an improper diet, the latter as an evidence of the refusal of such food by the child, He believes that infantile who is consequently starved. dilatation is by no means always recovered from, and that many cases of a like kind which are discovered only in the
adult or the aged have had their true beginning in the earliest months of life. As the best means of treatment besides a suitable diet, he advooates irrigation of the stomach, a catheter being passed along the gullet into the stomach, and this organ repeatedly washed out with fifty or sixty grammes of tepid boiled water or Vichy water. He has never known this method to give rise to any serious inconvenience. -
___
THE GENERAL MEDICAL COUNCIL. THE committee appointed to consider the Midwives Bill before Parliament, in pursuance of the request of the Lords of the Privy Council, will meet at the offices of the Council on Monday next, the 26th inst. It is understood that the usual July meeting of the executive committee will not be held in the absence of any urgent business.
now
CEREBRAL ABSCESS IN CHILDREN. the recent meeting of the American Pediatric Society Dr. Hott gave an account of four cases of this condition which had come under his notice. Details The first case were published in Pediatrics of June lst. was that of a child, aged six weeks, and this has the peculiar interest of being the earliest age at which an The child was intracranial abscess has been described. born easily and naturally and there was no history of injury or disease. It was a fat, healthy-looking infant, with nothing abnormal until four days before death, when swelling of the left thigh commenced. On admission to hospital the child was found to be almost moribund, with a feeble, almost imperceptible pulse, and a temperature of 99’5°F, but without coma. The thigh was incised, but no pus was found, only disorganised blood. The patient died, and examination of the brain revealed an abscess in the parietal lobe, with some recent local meningitis on the inner surface of the dura mater. The abscess cavity was 7 cm. long and 5 cm. deep, and contained two ounces of pus. The only likely source of infection was from the external ears, each of which had been punctured, and the punctures were found covered with dirty fluid encrusted with pus. The second child was three months old. The symptoms developed acutely-viz., irregular shallow respiration, retracted abdomen, and fever. There was also opisthotonos in the last few days and convulsions on the last of all. There was found to be a large abscess of the right parietal lobe, which communicated with the ventricles, and pus was found in the left petrous bone, although there was no discharge from the ear during life. The third patient was also three months old and was said to have been well and strong until seven weeks before, when it fell from the bed on to the floor. Three day’s later the patient cried out sharply and vomited. On admission to hospital there were emaciation, occasional vomiting, and discharge of blood from the left ear. Death took place suddenly, and there were found to be meningitis of the inferior surface of the cerebellum and an abscess as big as a hazel nut. The fourth case was that of a child nine months old. On admission the patient was found to be in excellent condition as regards nutrition, but there were internal strabismus, dilatation and inactivity of pupils to light, and increased knee-jerks; there was no fever. Vomiting occurred occasionally, and symptoms of irritation alternated with drowsiness. Gradually rigidity developed in the lower extremities and hands, and there were slight paralysis of the left side of the face and discharge of pus from the ear. The child died in the eighth week of the illness, and at the necropsy two abscesses of considerable size were found in the right lateral lobe of the cerebellum. These did not communicate, and no pus was found in the AT
example, cannot fail to
have noticed how smooth and free from vibration is the travelling on the Great Western Railway. On the London and North-Western and the Midland Railways it is still good from this point of view, but not quite so free from shock and noise. The trains of the former company running on the Underground Railway are, however, excellent examples of smooth and comfortable travelling. The trains running south create, as a rule, an endless clatter, so that on these lines a journey, say of fifty miles, produces as much distress and fatigue as a journey of over 300 miles north by the east and west coast and the Midland routes. It is fair to add, however, that the London and South Western Railway has of late years considerably reduced the amount of shaking which passengers The Great Eastern on this line were wont to experience. Railway, though well to the fore in enterprise, is, perhaps, one of the worst from the point of view of a rattling, shaking, and noisy journey. These difterences are, of The course, easily explained on engineering grounds. character of the "run" is dependent upon the degree of perfection of the rolling stock and the track. What we should like to know is why the same standard of smoothness MULTIPLE MELANOTIC SARCOMATA RESULTING and regularity in both these engineering details cannot be FROM A MOLE. adopted by all companies alike. The question is not one The following case has recently been published by Dr. D. that affects the interests of the passengers only, because Grant.l The patient was a muscular, exceptionally healthy surely the more smoothly a train runs over the metals the less must be the wear and tear to both the train and the man, aged twenty-seven years. He had a black mole on the right arm ever since birth. Three years ago it was torn by track. It will be generally conceded that every effort the horn of a sheep and soon healed. Some time after- should be made to minimise the ill-effects which travelwards he injured it again, and it spread to the size of a ling at a high speed is apt to induce. finger-tip. A year after the first injury he showed it to a medical man, who thought little of it. Six months HOT WEATHER IN NEW YORK CITY, later he bruised it again. Healing did not take place THE weather in New York is said to have been the hottest readily, and a few satellites appeared. Another medical record for the first week in July. Heat makes itself felt on man excised the whole affected area of skin. Five months in a peculiar degree in New York owing to the humidity of in the axilla which was promptly later a lump appeared excised. However, a large number of secondary growths the atmosphere. When the thermometer approaches the in the sun. appeared. The surface of the body was thickly sprinkled with hundred mark the heat is almost unbearable from the there have been casualties effect of Already many in melanotic growths, varying size, depth, and colour, and a much larger number could be detected by touch. The whole the heat. On July 5th, when Independence Day was celeskin of the trunk was thickly infiltrated witla minute growths. brated, what with the thermometer at 94° F., and the noise This case, unfortunately, is a type of all. That melanosis and smell of the numberless crackers and other descriptions of fireworks which supplied a vent for the overflowing patriotmay result from a mole is but a commonplace doctrine; yet in no case has free excision be resorted to in the first ism of young America, life (a correspondent writes) was Without doubt, if this weather instance. The reason is that the first changes-increase in scarcely worth living. as is it predicted it will, the scenes of last July size or ulceration-appear trifling. The nature of the disease continues, will be repeated, when horses and men died in large is recognised too late -- when secondary growths have in the streets. appeared. How many more such cases must occur before it becomes generally realised that a mole is a potential sarcoma THE PHYSIOLOGY OF THE ADRENALS. and should be promptly and freely excised on showing the A LONG and interesting article on the Physiology of the slightest activity2 Suprarenal Bodies is to be found in the June number of RAILWAY NOISE AND VIBRATION AND THEIR Pfliiger’s Archiv, written by Dr. Arthur Biedl, one of the EFFECT UPON HEALTH. assistants in the Vienna Institute. The points to which he VIBRATION and noise are factors well known not only as has directed his particular attention are the vaso-motor producing temporary discomfort but also injurious effects nerves and the secretory nerves of these organs. He upon the health. In these days when travelling rapidly describes in detail the operative procedure he adopted in his from place to place is a sine q1lâ non both causes of disturb- experiments, and arrives at the conclusion that certain vasodilator fibres run in the splanchnic nerves to the adrenals, ance are to some extent inevitable, but we cannot help thinking that much more might be done to alleviate the partly because no other explanation can be offered of the distress arising from our incessant recourse to the many and rapidity with which hyperasmia follows stimulation of these various means of moving from place to place. Speed is the nerves, partly on account of the steady increase of the craze, but there is no reason why speed should not be hypersemia as the stimulation is continued, and partly attained without the discomfort due to noise and rapid because of its continuance for some time after the vibration, not to mention the, perhaps, permanently ill- cessation of stimulation quite independently of the blood effects which a constant series of joltings may have upon pressure in the arteries. He has observed that in the the nervous passenger and invalid. The various railways dog the splanchnics, after traversing the diaphragm, give running out of London afford a good illustration of what is, off on each side, before they enter into the formation of and what is not, done in this direction. Passengers, for the solar plexus, a single large branch to the adrenals, and these, he believes, contain the chief vaso-dilator fibres, 1 of 1897. Medical Journal Intercolonial since, if divided, the stimulation of the splanchnics in the Australia, May 20th,
Shaftesbury-avenue. The temptation to a famished man in the early hours of the morning, when he finds excellent food placed at the street-doors on every side, is indeed great, and so the magistrate thought, and taking that into account he sentenced the man to fourteen days’ hard labour. This case prompts us to quote an instance known to ourselves in which the milk left in a can on a doorstep had been actually tampered with. Some maliciously disposed person had opened the lid and dropped inside a vermin-killing powder containing strychnine. Fortunately it was noticed that there was something wrong with the milk by the appearance of a blue powder in it, otherwise the consequences might have been very grave indeed, and with little chance of tracing the villain. We hardly like to suggest that there are miscreants amongst us who would be guilty of committing such a heinous offence, but the ease with which it obviously can be done, and was done in this case, should be a serious warning to the public to effectually prevent any such possibility. Milk consumers should insist on their milk cans being sealed, and should reject the early morning milk if it be found that the seal is broken.
numbers
-
-
.
-
--.
--
_A.
._-------
-
212 thorax is without influence, whilst stimulation of the distal extremities of the divided nerves is followed by active hypeymmia. From a critical review of the researches of previous investigators he considers the facts actually established in regard to the vaso-dilator nerves distributed to the abdominal viscera to be that these nerves leave the spinal cord chiefly by the anterior roots of the lower dorsal nerves and, running in the rami communicantes, enter the sympathetic in the dorsal region and are distributed with the branches of the splanchnic nerves to the large and small intestine, the liver, kidneys, pancreas, and. adrenals. He has satisfied himself that there are ganglia on the vessels distributed to the adrenals, and that although their presence has not been anatomically demonstrated vasoThe two sets of nerves, vasoconstrictor nerves exist. dilators and vaso-constrictors, run in the same trunks, their relative proportion varying to a considerable extent. Dr. Biedl has devoted much time and attention to the secretory nerves of the adrenals. These organs belong to the class of those which have an internal secretion discharging the materials they elaborate into the blood. Various investigators have been led to the belief that the granules well known to exist in the blood of mammals proceed from the adrenals. Others have shown that the venous blood of these organs resembles arterial blood in colour, and yet another observer has demonstrated that the peculiar extract of the adrenals is not a post-mortem product, but is contained in the venous blood returning from these organs during life. Dr. Biedl, in his experiments directed especially to the determination of the changes in the morphological elements of the venous blood and the behaviour of the extract with its peculiar action on the blood pressure, found that after stimulation of the suprarenal branch or of the splanchnic nerve in the thorax the number of bright granules or little masses of protoplasm was diminished, and at the same time the number of the leucocytes of the blood was reduced, these In bodies being apparently retained within the organ. regard to the active extract, Dr. Biedl believes that the splanchnic nerves do not only contain vaso-dilators, but that they are also associated with the secretory nerves of the adrenals, which run in the same trunks, and that stimulation of these nerves leads to some, though not material, increase in the quantity of the active extract produced.
DILATATION OF THE STOMACH IN INFANCY. IT is well known that dilatation of the hollow viscera is a morbid condition commonly gradual in its development and equally, if not more, slow in its amendment. It derives, moreover, a peculiar interest from the fact that it constitutes a form of change which marks the transition between functional and organic disease-a stage at which overwork and weakness of tissue account for the whole pathology, and which is therefore often well within the hope of a healthy reversion. Additional light has recently been shed on this subject by a paper published by Dr. Comby in the Jmwnal de Olini1jlle et de Tlté’J’ape1diqne infaittiles of July 1st, 1897. The writer’s observations have been limited to the study of gastric dilatation during infancy. He finds that at an age when the newly-formed organ might be expected to be fully competent the stomach frequently shows a marked degree of dilatation. In 64 children who died in the Hospital for Sick Children, Paris, this viscus was found to be dilated, its volume varying from 200 c.c. to 310 c.c. In 16 others it was contracted. Dr. Comby explains the former condition as being due to atony produced by an auto-infection by putrescent matters resulting from an improper diet, the latter as an evidence of the refusal of such food by the child, He believes that infantile who is consequently starved. dilatation is by no means always recovered from, and that many cases of a like kind which are discovered only in the
adult or the aged have had their true beginning in the earliest months of life. As the best means of treatment besides a suitable diet, he advooates irrigation of the stomach, a catheter being passed along the gullet into the stomach, and this organ repeatedly washed out with fifty or sixty grammes of tepid boiled water or Vichy water. He has never known this method to give rise to any serious inconvenience. -
___
THE GENERAL MEDICAL COUNCIL. THE committee appointed to consider the Midwives Bill before Parliament, in pursuance of the request of the Lords of the Privy Council, will meet at the offices of the Council on Monday next, the 26th inst. It is understood that the usual July meeting of the executive committee will not be held in the absence of any urgent business.
now
CEREBRAL ABSCESS IN CHILDREN. the recent meeting of the American Pediatric Society Dr. Hott gave an account of four cases of this condition which had come under his notice. Details The first case were published in Pediatrics of June lst. was that of a child, aged six weeks, and this has the peculiar interest of being the earliest age at which an The child was intracranial abscess has been described. born easily and naturally and there was no history of injury or disease. It was a fat, healthy-looking infant, with nothing abnormal until four days before death, when swelling of the left thigh commenced. On admission to hospital the child was found to be almost moribund, with a feeble, almost imperceptible pulse, and a temperature of 99’5°F, but without coma. The thigh was incised, but no pus was found, only disorganised blood. The patient died, and examination of the brain revealed an abscess in the parietal lobe, with some recent local meningitis on the inner surface of the dura mater. The abscess cavity was 7 cm. long and 5 cm. deep, and contained two ounces of pus. The only likely source of infection was from the external ears, each of which had been punctured, and the punctures were found covered with dirty fluid encrusted with pus. The second child was three months old. The symptoms developed acutely-viz., irregular shallow respiration, retracted abdomen, and fever. There was also opisthotonos in the last few days and convulsions on the last of all. There was found to be a large abscess of the right parietal lobe, which communicated with the ventricles, and pus was found in the left petrous bone, although there was no discharge from the ear during life. The third patient was also three months old and was said to have been well and strong until seven weeks before, when it fell from the bed on to the floor. Three day’s later the patient cried out sharply and vomited. On admission to hospital there were emaciation, occasional vomiting, and discharge of blood from the left ear. Death took place suddenly, and there were found to be meningitis of the inferior surface of the cerebellum and an abscess as big as a hazel nut. The fourth case was that of a child nine months old. On admission the patient was found to be in excellent condition as regards nutrition, but there were internal strabismus, dilatation and inactivity of pupils to light, and increased knee-jerks; there was no fever. Vomiting occurred occasionally, and symptoms of irritation alternated with drowsiness. Gradually rigidity developed in the lower extremities and hands, and there were slight paralysis of the left side of the face and discharge of pus from the ear. The child died in the eighth week of the illness, and at the necropsy two abscesses of considerable size were found in the right lateral lobe of the cerebellum. These did not communicate, and no pus was found in the AT