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CLINICAL RESEARCH AND THE PHYSIOLOGYOF THE SPINAL CORD.

THE war has given us many opportunities of

studying the results of gross injuries of thespinal cord and cauda equina, and this studyhas firmly established the physiological principlesresulting from the clinical work of Hughlings,Jackson, the morphological investigations of’Gaskell, and the laboratory experiments ofSherrington, Langley, Anderson, and others of theCambridge School of physiologists. To an exposi-tion of certain of these phenomena the greaterportion of the last number of Brain (vol. xl.,Parts2 and 3), edited by Dr. Henry Head, is devoted.The number opens with a review of the innerva-tion of bladder and urethra, by Dr. E. G. Fearnsides,giving a retrospect of knowledge upon the in-

voluntary nervous system and its relations with’the lower portion of the spinal cord. Dr. Headand Captain G. Riddoch follow with a paper onthe automatic bladder, excessive sweating, andsome other reflex conditions, while in a third

paper Captain Riddoch discusses the reflex func-tions of the completely divided cord in man andcompares them with those of less severe lesions.All these authors agree with Sherrington thatinhibition is one of the most fundamental anduniversally applicable of all physiological concep-tions. In his masterly work on the integrativeaction of the nervous system Sherrington showedmore than a decade ago that the basis for under-standing the activities of the central nervous systemmust be sought in its integrating and adaptingfunctions and the investigations now recorded byHead and Riddoch, and by Riddoch alone, serveto emphasise the importance of the mechanismwhich Sherrington has called postural in deter-

mining the type of response in a man whose

spinal cord has been severely damaged. So longas this mechanism is intact, the impressionswhich constantly pass from the otic labyrinthsa.nd somatic muscles to the cerebellum, pons andmid-brain determine a state of tonic contrac-tion in the group of anti-gravity muscles. When

the damage is severe enough to destroy thepostural mechanism the lower portion of the spinalcord is found to react to stimuli of whateverorigin in a manner called mass-reflex by Headand Riddoch. Whenever the cord reacts in thismassive manner three types of adaptive responseonly have been determined :-

(a) Protective : A uniphasic withdrawal’of paralysed partsafter "harmful" stimulation (" flexor spasms "). (b) Excre-tory : By this form of activity the contents of the bladderand rectum are discharged, whilst the skin over the partssupplied through sympathetic fibres derived from the freedportions of the spinal cord is excited to intense sweating.r eo) Se.xual: A primitive type of reaction which is excited toactivity by stimulation of either the external organs ofgeneration or of the paralysed parts.Whenever, on the other hand, the postural

system can be proved to be still active, differen-tiation of somatic and visceral activities isfound, the massive type of response ceases,and the phenomena of inhibition, as shown bya limitation in the range of efferent motor

responses, make their appearance. The reac-

tions obtained from the central nervous systemare now di-phasic or multi-phasic, while somatic andvisceral responses are separated. The receptive fieldfor the flexion-reflex, for example, now no longerextends over the whole of the paralysed regions. Theclinical investigations recorded in jthese papersfurther go to prove that the thoracico-lumbaroutflow

of the sympathetic nerve fibres, which pass into theinvoluntary nervous system, regulate sweating andcontrol the functional activity of the bladder, are atorigin segmentally arranged ; and that the arrange-ment is closely similar to, if not absolutely identicalwith, that which Gaskell, in 1886, showed to be truefor lower mammalia. In their course these efferentfibres are closely associated with afferent fibrespassing similarly from the viscera, blood-vessels,and other parts supplied by the efferent fibres.As a part of the generalised

" mass-reflex" in

cases of severe injury to the spinal cord, ex.

cessive sweating takes place over areas of skinsupplied by sympathetic nerve fibres originatingbelow the level of the lesion. Even when thebladder is freed from all central nervous connexionsand control, it may begin to expel its contentsautomatically as early as 25 days after the injury.The form assumed by the activity of such an auto-matic bladder is entirely independent of the site ofthe lesion in the spinal canal. In the absenceof the postural mechanism automatic evacuationmay be facilitated by the most various afferentimpulses passing into the lower portion of thespinal cord, unless a cauda equina lesion preventsthe impressions from reaching the cord. Throughthe afferent fibres associated with the sympatheticoutflow, and reaching the bladder via the hypogastricnerves, a patient may be conscious of alterationsof tension within his bladder and yet be totallyunable to effect by conscious effort its automaticactivity. The lesson is drawn that in cases of

spinal lesion, whether due to injury or disease, itis essential to avoid exercising undue tension onthe bladder wall when washing out the bladder;undue pressure diminishes the power of spon-taneous evacuation and retards the recovery ofthe vesical musculature. We offer our congratula-tions to the authors named upon a piece ofbrilliant clinical research.

THE STANDARDISED INFANT.

DOGMATIC teaching is recognised as a usefulmethod of introducing students to a subject whichis new to them, and represents an economy of efforton the part of both teacher and pupil. It has its

place even in regard to subjects in a state of flux,where any standard set up must be an artificialand temporary one. Such standardisation is moreproper on the teaching than on the research sideof any study, and it may, if unchecked, lead in thelong run to stagnation and to want of progress indirections where change is the inevitable acicom-paniment of growth. In the campaign on behalfof the health of women and children, successfullywaged by the Royal New Zealand Health Societyfor many years past, standardisation of methodhas proved fruitful of great results. Initiatedby Dr. F. Truby King at the time whenLord Plunket was governor of the Dominion,and carried through with infinite patience overa period of discouragement, the scheme now

includes 35 nurses whose general training of threeyears or more has been supplemented in some casesby a further year of maternity work and in allcases by three months or more of special study atthe Karitane-Harris Baby Hospital. These Plunketnurses carry out over the whole area of NewZealand a series of health recommendations whichin course of time have crystallised into threepamphlets, written by Dr. Truby King and issuedby the Public Health Department, on the expectant

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mother, the baby in the first month, and the tfeeding and care of infants in general. Personal 1work of this kind has been assisted by wholesale i

cooperation on the part of the New Zealand press 1which prints some 200,000 copies weekly, under the heading of "Our Babies’ Column," of instructive (

matter supplied to it by the Health Society. Coming from such a successful and comprehensive scheme of dogmatic teaching, Dr. Truby King is ]now paying a welcome visit to this country in the hope of contributing to a similar health campaign, especially in the direction of forming a general consensus of opinion in regard to elementarymatters of physiology and pathology of infant life. He has undertaken the charge of a clinic

placed at his disposal by St. Thomas’s Hos-

pital. It is true that the National League forHealth, Maternity, and Child-Welfare has issuedfrom its office at 5, Tavistock-square, London,W.C., a booklet in pamphlet form dealing withmatters of maternal and infant hygiene, but therecommendations contained therein are of a

general character, arrived at in the spirit of com-promise, or in much the same way as the highestcommon factor is obtained from a group of largenumbers. Dr. Truby King uses a percentage wheymixture which has become the standard methodof artificial infant feeding at the Antipodes, andinvolves the use of lactose, which in this countryis now both scarce and costly. Here and in Americathere is still an almost infinite divergence of

practice, which may, of course, be evidence thatthe one ideal method of artificial infant feedinghas not yet been found, but it is, at all events, atestimony to the infant’s power of adaptation tohis environment amounting to little less than

genius. To take a single example, in London theinfant whose parents cannot afford to give him fatin any of the usually approved forms has shown hiscapacity to digest and assimilate linseed oil incapacity to digest and assimilate linseed oil insuitable emulsion, although the Bradford baby isstated to rebel at the substitute. The necessityof adding lactose to the milk mixture inartificial feeding has long been disproved by theexperience that any form of sugar is equallywell assimilated by the London infant if givena little time for the necessary adaptation. To

adopt in London the humanisation of artificialmilk on the New Zealand plan would thereforeappear; to be retrograde and costly, a fact to set

against the advantages of a simple dogmaticscheme of teaching infant welfare workers. Thesuccessful breeding of calves and pigs on a largescale is undoubtedly expedited by the adoption ofroutine methods, but we have seen during the lastfew months many changes dictated by war condi-tions to which the youthful cattle have.accommo-dated themselves with a good grace. It is, at allevents, arguable whether the human infant shouldbe standardised, and the more the important pointsinvolved are examined the better for our knowledge,assuming, of course, that only those speak who havepersonal experience of the subject. ,

THE TREATMENT OF STERILITY.

THE whole subject of sterility in the female isworthy of more study and research than it has yetreceived, and much of the treatment suggested ispurely empirical and not founded upon any accurateknowledge of the etiological factors. No case canbe considered to have been properly investigatedin which the husband is not subjected to as

borough an examination as the wife. This is,lowever, rarely carried out. The causes of sterilityn the female may be classified under the fourieadings of structural, bio-chemical, functional,md psychic, and the more we consider these fourclasses the less we find we know about them.Fertility requires not only the presence of healthyspermatozoa and healthy ova but also theirnormal conjugation, which probably involvescertain bio-chemical interactions, of which weare as yet quite ignorant. In a given case ofsterility it is the exception to find any re-

cognisable pathological change in the femalepelvic organs-that is, if we include only thosecases in which the patient primarily seeks advicefor her sterility. An obvious and complete obstacleto fertilisation is the closure of the two Fallopiantubes as the result of preceding salpingitis or pelvicperitonitis. The operation of salpingostomy hasbeen devised for the purpose of overcoming thisdifficulty, but it is doubtful if the successes result-ing from its performance are at all numerous. In

many cases the artificial opening made in thetube in all probability becomes secondarily closed.At a recent meeting of the Royal Academy ofMedicine in Ireland Dr. Hastings Tweedy showeda specimen of ectopic gestation removed froma tube which he had resected on two pre-vious opcasions. On the latter occasion catgutwas placed in position in the tube, and the specimenshowed that it gave free passage to spermatozoa.He attributed the ectopic gestation to the irritativeeffects of the chromicised catgut. Dr. HastingsTweedy described a method of passing silkworm gutinto the tube and removing it after three to four daysby means of a plug of iodoform gauze left in theuterus. Dr. Bethel Solomons read notes of a similarcase of ectopic gestation after resection of the tubeand the insertion of a piece of catgut to keep it open.These two cases are very interesting, but it mightbe argued that, if the tubes had only been resectedand no catgut placed in the lumen, the patientsmight not only have become pregnant as they did,but the fertilised ova might have passed into theuterine cavity and progressed normally to full term.The idea is an ingenious one and it will be interest-ing to see if any further successful cases, if thesecases merit that description, are recorded.

ALTERATIONS AND AMENDMENTS IN THEBRITISH PHARMACOPŒIA, 1914.

IN pursuance of the Medical Act, 1858, and of theMedical Council Act, 1862, the General MedicalCouncil have directed alterations in " The BritishPharmacopoeia, 1914," by withdrawing from thepublication until further notice certain medicines

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and compounds and the directions for preparingthem, and by modifying other directions containedtherein. The alterations and amendments, whichwill have effect until further notice, are set out inthe following schedule :The following are withdrawn until further notice,

namely: Linimentum Camphoras, Linimentum Chloro-formi, Linimentum Hydrargyri, Linimentum TerebinthinsaAceticum, Liquor Cresol Saponatus.The following notes are appended to the official mono-

graphs on Adeps Prseparatus, Oleum Arachis, Oleum Olivse,Oleum Ricini, Oleum Sesami, and Sevum Praeparatum,respectively, namely :-Adeps Præparatus, Sevum Præparatum.-Wool fat, or

hydrous wool fat, singly or together, with such addition(if any) of hard paraffin, liquid paraffin, soft paraffin, paraffinointment, white beeswax, yellow beeswax, or any combina-tion of these as may be necessary to impart a proper colourand consistence to the product, may be employed in making