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THE SOLDIER'S LOAD.
289 the voluntary effort may inhibit the red nucleus mechanism, and when the former is fatigued, the latter asserts itself by way of a, rebound phenomenon. That the phenomenon is one of general application to muscular effort seems clear. Prof. Graham Brown remarks that the peculiar feeling of instability experienced after depositing a heavy load-e.g., a knapsack-may be of a similar nature. J. II. Shaxby, in a later issue of Nature (Jan. 19th), points out that a similar phenomenon can be seen with the leg ; we have tried it with the forearm, pressing the hand upwards on the edge of a table, with the elbow resting on the thigh, and have obtained a good result. GANGRENE OF AN PLICATION
EXTREMITY AS A OF PNEUMONIA.
COM-
before, not caring if ofllcers and men had their regulation baggage with them every day ; thus they were able t,o pursue and capture Cronje. Before the recent war the British soldier’s load was 59lbs., but when grenades, steel hat, fur coat, &c., were added, never
it came to 80 lbs., broke down many of the less fit, and by physical exhaustion reduced marches to from 5 to 7 miles-even with the stimulus of victory. In the retreat from Mons, our men threw away luxuries first, and later even their greatcoats. Probably one of the finest marches in history will be recognised to be that of the Serbs to Belgrade in 1918, conducted by light divisions of six-year veterans, carrying only absolute essentials. It seems likely that the maximum weight to be carried by a soldier without breaking down is about one-third of his weight (10-stone man,17lbs.). In practice he is loaded heavier than a mule : a mule of 1100 lbs. carries 350 lbs., and a cavalry horse only 28-} per cent. of its weight. Possibly weight should be more considered in recruiting than height. The true instinct of Parkes led him to advise that no youth should be accepted whose age, height, and weight were under 18 years, 62 inches, and 112 lbs. respectively. The equipment once chosen, the soldier should be trained to carry his whole equipment over long marches, as Wellington advised, and as the French and Germans practised before the late war. Yet in advancing into Belgium the Germans, carrying 60 lbs., threw much of their kit away, while many fell, fainting or dying, by the roadside ; their good marching, however, did much to win them their Russian campaigns. In war the soldiers’ aim is to anticipate the enemy, hence great commanders have always developed light divisions. The lighter equipped an army is, the fewer men will fall out, and the stronger will it be at the decisive moment. Major Lothian has our thanks for his careful study of, and luminous report on, the unwisdom of overloading the soldier, even with the purpose of increasing his comfort.
IN view of the extreme rarity of arterial thrombosis embolism occurring in an extremity as a sequela of pneumonia, a case recently reported by Drs. W. D. Wise and E. E. MayerI is of some interest. The authors, who have made a careful search of the literature for the past 25 years, have found very few reports of cases of this condition, the 12 that were noted including three by Gibson in 1903, who found no mention in the literature of any other, one case seen by Osler and four referred to by him-Kredel’s case of popliteal thrombosis, Seidelmann’s of gangrene of the fingers and thumbs of both hands, Hjelt’s case of embolism of the abdominal aorta, and Aldrich’s of embolism of the lenticulo-optic artery; two instances mentioned by Frazier in Keen’s " Surgery," and two reported by Dr. W. F. Lockwood and Dr. Mercur, of Pittsburgh, in personal communications, in one of which, however, there was a possibility of an associated endocarditis. The present case was that of a girl of 7 with a typical lobar pneumonia of the left lung, who, four days after the crisis, when convalescence appeared to be normal, suddenly developed a severe pain in the left leg just above DISSECTING ANEURYSMS OF THE AORTA. the knee. By the next day there was great discolouration of large areas in the leg, extending to and including IN a review of the literature with a report of four the toes, no pulsation being felt in the leg or foot. personal cases in patients, aged from 50 to 71, admitted The gangrene was of the typical dry type, and rapidly to the Cook County Hospital, Dr. P. D. Crowell,l of increased, a line of demarcation forming immediately Chicago, remarks that Mannoir was the first to give below the knee. Amputation was performed just the name of dissecting aneurysm to the condition in below the middle of the thigh, no tourniquet being 1802. In 35 per cent. of the 215 cases reviewed by used in the operation. No thrombi were seen in the writer, in which the state of the aortic lining was the vessels at the point of amputation, the blocking described. there was advanced sclerosis with ulceration being apparently high in the femoral artery. The and calcification ; in 42 per cent. there was a marked authors briefly discuss the aetiology of the condition, or moderate amount of fatty change or fibrous especially with regard to the question as to whether plaques, and in 9 per cent. only a few such plaques. the pulmonary lesion might have been an infarct, In about one-third of the remaining 14 per cent. the but they conclude that in the absence of any heart aorta had a thin wall or dilated lumen or both ; in 16 lesion the straightforward history of pneumonia the vessel was thought to be normal. In 80 per cent. followed by arterial embolism or thrombosis is of the 215 cases the age was 40 years or more, the extreme limits being 13 and 95. The condition was clearly cause and effect. 1.64 times more frequent in men than in women. In 52 cases in which the state of the kidneys was THE SOLDIER’S LOAD. noted chronic nephritis was found in 66 per cent. IN concluding, in the Jozcrraal of the Royal Arrrty The progress of the disease has been divided by Medical Corps for January, his memorandum on the observers into three stages, the first being rupture of soldier’s load, Major N. V. Lothian2 tells us that at the internal coats of the aorta, the second dissection the time of the Crimean War the soldier, wearing an I and possible rupture externally, and the third, awkward equipment, carried from 57 to 68 pounds. ’, recanalisation. According to this division 86 per cent. As Parkes said later, no great marches have ever been of the cases collected by Dr. Crowell ended in the made by men so loaded. Ilenderson, in his " Life of second stage, and 14 per cent. in the third stage. Stonewall Jackson," described how the soldiers in the The origin of the aneurysm is almost always in the American Civil War devised a practical kit; once they ascending portion of the arch, usually just above the had taken to living in the open, overcoats were soon aortic cusps. In most cases there have been multiple tears, usually from 1-3 cm. long, but the whole discarded, blankets and waterproof sheets,were worn circumference of the vessel may be involved. The and the haversack carried all rolled, indispensable is of the intima and most or all of rupture primary necessaries. So equipped, they marched 14 miles a layers of the media. The dissection takes place in day in the Shenandoah Valley for six weeks. In the Ashanti the British soldier marched with only a light the outer layers of the media or between the media and adventitia. Dr. Crowell remarks that very kit; greatcoat and spare clothing were carried for little attention has been paid to interference with the him. In South Africa Lord Roberts lightened the in the branches of the aorta caused by kit, and proceeded to make the infantry march as circulation splitting of the walls where these branches arise, and
or
1 Annals of Surgery, November, 1921. 2 THE LANCET, 1921, ii., 917.
1 Journal of the American Medical
Association, Dec. 31st, 1921.
EXTREMITY AS A OF PNEUMONIA.
COM-
before, not caring if ofllcers and men had their regulation baggage with them every day ; thus they were able t,o pursue and capture Cronje. Before the recent war the British soldier’s load was 59lbs., but when grenades, steel hat, fur coat, &c., were added, never
it came to 80 lbs., broke down many of the less fit, and by physical exhaustion reduced marches to from 5 to 7 miles-even with the stimulus of victory. In the retreat from Mons, our men threw away luxuries first, and later even their greatcoats. Probably one of the finest marches in history will be recognised to be that of the Serbs to Belgrade in 1918, conducted by light divisions of six-year veterans, carrying only absolute essentials. It seems likely that the maximum weight to be carried by a soldier without breaking down is about one-third of his weight (10-stone man,17lbs.). In practice he is loaded heavier than a mule : a mule of 1100 lbs. carries 350 lbs., and a cavalry horse only 28-} per cent. of its weight. Possibly weight should be more considered in recruiting than height. The true instinct of Parkes led him to advise that no youth should be accepted whose age, height, and weight were under 18 years, 62 inches, and 112 lbs. respectively. The equipment once chosen, the soldier should be trained to carry his whole equipment over long marches, as Wellington advised, and as the French and Germans practised before the late war. Yet in advancing into Belgium the Germans, carrying 60 lbs., threw much of their kit away, while many fell, fainting or dying, by the roadside ; their good marching, however, did much to win them their Russian campaigns. In war the soldiers’ aim is to anticipate the enemy, hence great commanders have always developed light divisions. The lighter equipped an army is, the fewer men will fall out, and the stronger will it be at the decisive moment. Major Lothian has our thanks for his careful study of, and luminous report on, the unwisdom of overloading the soldier, even with the purpose of increasing his comfort.
IN view of the extreme rarity of arterial thrombosis embolism occurring in an extremity as a sequela of pneumonia, a case recently reported by Drs. W. D. Wise and E. E. MayerI is of some interest. The authors, who have made a careful search of the literature for the past 25 years, have found very few reports of cases of this condition, the 12 that were noted including three by Gibson in 1903, who found no mention in the literature of any other, one case seen by Osler and four referred to by him-Kredel’s case of popliteal thrombosis, Seidelmann’s of gangrene of the fingers and thumbs of both hands, Hjelt’s case of embolism of the abdominal aorta, and Aldrich’s of embolism of the lenticulo-optic artery; two instances mentioned by Frazier in Keen’s " Surgery," and two reported by Dr. W. F. Lockwood and Dr. Mercur, of Pittsburgh, in personal communications, in one of which, however, there was a possibility of an associated endocarditis. The present case was that of a girl of 7 with a typical lobar pneumonia of the left lung, who, four days after the crisis, when convalescence appeared to be normal, suddenly developed a severe pain in the left leg just above DISSECTING ANEURYSMS OF THE AORTA. the knee. By the next day there was great discolouration of large areas in the leg, extending to and including IN a review of the literature with a report of four the toes, no pulsation being felt in the leg or foot. personal cases in patients, aged from 50 to 71, admitted The gangrene was of the typical dry type, and rapidly to the Cook County Hospital, Dr. P. D. Crowell,l of increased, a line of demarcation forming immediately Chicago, remarks that Mannoir was the first to give below the knee. Amputation was performed just the name of dissecting aneurysm to the condition in below the middle of the thigh, no tourniquet being 1802. In 35 per cent. of the 215 cases reviewed by used in the operation. No thrombi were seen in the writer, in which the state of the aortic lining was the vessels at the point of amputation, the blocking described. there was advanced sclerosis with ulceration being apparently high in the femoral artery. The and calcification ; in 42 per cent. there was a marked authors briefly discuss the aetiology of the condition, or moderate amount of fatty change or fibrous especially with regard to the question as to whether plaques, and in 9 per cent. only a few such plaques. the pulmonary lesion might have been an infarct, In about one-third of the remaining 14 per cent. the but they conclude that in the absence of any heart aorta had a thin wall or dilated lumen or both ; in 16 lesion the straightforward history of pneumonia the vessel was thought to be normal. In 80 per cent. followed by arterial embolism or thrombosis is of the 215 cases the age was 40 years or more, the extreme limits being 13 and 95. The condition was clearly cause and effect. 1.64 times more frequent in men than in women. In 52 cases in which the state of the kidneys was THE SOLDIER’S LOAD. noted chronic nephritis was found in 66 per cent. IN concluding, in the Jozcrraal of the Royal Arrrty The progress of the disease has been divided by Medical Corps for January, his memorandum on the observers into three stages, the first being rupture of soldier’s load, Major N. V. Lothian2 tells us that at the internal coats of the aorta, the second dissection the time of the Crimean War the soldier, wearing an I and possible rupture externally, and the third, awkward equipment, carried from 57 to 68 pounds. ’, recanalisation. According to this division 86 per cent. As Parkes said later, no great marches have ever been of the cases collected by Dr. Crowell ended in the made by men so loaded. Ilenderson, in his " Life of second stage, and 14 per cent. in the third stage. Stonewall Jackson," described how the soldiers in the The origin of the aneurysm is almost always in the American Civil War devised a practical kit; once they ascending portion of the arch, usually just above the had taken to living in the open, overcoats were soon aortic cusps. In most cases there have been multiple tears, usually from 1-3 cm. long, but the whole discarded, blankets and waterproof sheets,were worn circumference of the vessel may be involved. The and the haversack carried all rolled, indispensable is of the intima and most or all of rupture primary necessaries. So equipped, they marched 14 miles a layers of the media. The dissection takes place in day in the Shenandoah Valley for six weeks. In the Ashanti the British soldier marched with only a light the outer layers of the media or between the media and adventitia. Dr. Crowell remarks that very kit; greatcoat and spare clothing were carried for little attention has been paid to interference with the him. In South Africa Lord Roberts lightened the in the branches of the aorta caused by kit, and proceeded to make the infantry march as circulation splitting of the walls where these branches arise, and
or
1 Annals of Surgery, November, 1921. 2 THE LANCET, 1921, ii., 917.
1 Journal of the American Medical
Association, Dec. 31st, 1921.