THE ANATOMICAL STRUCTURE OF THE STOMACH
1
85 four months later, when 47, or 75-8 per cent., were I immune. Two more cases gave a negative reaction nine and fifteen months after the injections, 8 of the remaining 13 receiving a second series of three toxin-antitoxin injections, after which 5 still remained persistently positive. The result of the immunisation was to effect a decrease in the incidence of clinical diphtheria among these nurses of at least 90 per cent. as compared with a previous three years’ period. The local reactions following the injections are said to have been similar to those following prophylactic typhoid vaccination, and in only two cases were the constitutional effects at all severe, although several complained of listlessness and head- ache. Dr. Cooke concludes by emphasising the fact that it is relatively easy to protect an entire nursing staff from contracting diphtheria by the use of the Schick test and toxin-antitoxin injections. ECONOMICS OF RURAL PRACTICE. IN the issue of Health dated July 1st appears an article entitled " Taxation and the Country Doctor,’’ pointing out that whilst the rural practitioner is in most ways no more taxed than his colleagues in the towns, his transport problem is a serious one entailing considerable expense. The lightest and oldest car is heavily taxed ; frequently a motor-bicycle is the only means of conveyance for a man who finds his life already strenuous enough without such an additional strain. Holidays and illness are complicated by the difficulty of rapidly obtaining a locum-tenent who combines experience and steadiness in his profession with the ability to ride a motor-bicycle. The locum- tenent of middle age, indeed, can be seriously ham- pered by lack of mechanical knowledge in this respect, whatever may be his professional skill. Another con- dition of the times which aggravates the economic position of the country practitioner is the difficulty of the vegetable garden :- "That feature of the countryside, ’the doctor’s man,’ who drove the car, cultivated the potatoes, mothered the locum-tenent, and knew all about the income and private life of every person in the district is, alas ! becoming almost extinct. A jobbing gardener and a boy from the garage twice a week are poor substitutes for a professor in an honoured and unique position, who often served three or four successive masters in the same practice and earned the gratitude of them all." An appreciable amount of rural unemployment, it appears, results from the frequent inability of doctor and parson to employ a whole-time man at the present day, and the reasonable suggestion is made that it might be wise to allow a rebate on the income-tax of any person employing a servant who can be shown to devote a reasonable portion of his time to the care of fruit, vegetables, pigs, and poultry. THE ANATOMICAL STRUCTURE OF THE STOMACH. AT the summer meeting of the Anatomical Society, held in Edinburgh on July 23rd, Mr. Geoffrey Jefferson read a suggestive paper entitled " Some Remarks on the Anatomical Structure of the Stomach with special reference to Gastric Function." After a brief description of the gastric mucosa, the speaker passed on to the musculature, and demonstrated by means of photographs of dissections that the external coat appeared to be derived from three sources ; (1) the coarse fibres from the oesophagus deploying on to the stomach ; (2) much finer fibres which appear to arise in the course of the organ ; and (3) fibres continuous with those of the duodenum. The strong bands on front and back of the pars pylorica, the ligamenta pylori, were illustrated, together with their adhesion to the circular muscle fibres beneath. These form important intrinsic supports to this region, and are plentifully interspersed with elastic tissue. The circular musculature was seen to consist of inter- woven fibres and not of rings applied in contiguity. This arrangement, according to Mr. Jefferson, was to be expected, since the best evidence showed that the peristaltic wave was myogenic in its origin and nature. The connexions of the oblique muscle were next figured, and this coat was shown to be a, derivative of the circular muscle. The laying down of a, third coat over the cardiac portion of the viscus required some explanation, for in general in the alimentary tract the processes of digestion are satis- factorily carried out by two coats only-an inner circular and an outer longitudinal. Why should the stomach have three, and why should this third coat be applied to a part of the stomach which is relatively muscularly inactive ? Mr. Jefferson believed the answer to be that this coat is in large degree sus- pensory, that the activity of the gastric musculature is partly static or postural and partly phasic or peristaltic. These activities are interchangeable between the various coats in different bodily postures, the oblique coat taking on peristaltic powers for instance in recumbency. Mr. Jefferson does not think that the existence of a functional " gastric canal " can be said to be established, although the longitudinal bands and the inner views of the organ which he displayed in his photographs were very suggestive of its presence and presumably of its functioning-at any rate partially-during life. PLANT PATHOLOGY. THE historical evolution of pathology in this country has led to its development along a rather narrow track starting in the post-mortem room, and only now branching out into some of the many lines of obvious expansion. This restricted outlook is especially plain in bacteriology and parasitology in general. Bacteriology with us means hardly more than the study of the relatively insignificant number of organisms of immediate medical and hygienic import. General laws can never be discovered from such a limited outlook. The wonderful interest of comparative pathology-and by this we mean some- thing more than the veterinary technology which sometimes masquerades under the title-has yet to be appreciated. The wealth of material at the Zoo still remains almost unused, and Sir James Paget’s plea made many years ago seems to have had as little response as Sir John Bland-Sutton’s more recent demonstrations of what may be found in other animals to elucidate the processes of human disease. In plant pathology there are welcome signs of more active interest. Readers of THE LANCET will recall the interesting lecture by Prof. V. H. Blackman on the processes of immunity and resistance in plants as compared with animals, and at the forthcoming annual meeting of the British Medical Association at Glasgow a special Section of Microbiology apart from medical bacteriology will discuss kindred problems with a lead from Prof. Blackman and Dr. W. B. Brierley, head of the Department of Mycology at the Rothamsted Agricultural Experiment Station at Harpenden. The origin of this new section of the Association may perhaps have some connexion with the fascinating work done by its president on the growth and shedding of the deer’s antlers. The plant pathologist can doubtless get a good deal from the highly developed specialised technique of the medical pathologist, who in his turn can probably : get more from the far wider and more varied field with , which his botanical colleagues deal-" colleagues " - unfortunately in theory rather than practice. The - facility with which a worm-hole in a potato is i lined with skin recalls the behaviour of the epidermis i in a sinus, and raises the whole question of wound- i healing, Prof. S. G. Shattock’s paper on which is a rare , example of one of our animal pathologists making L an excursion into the vegetable world. The galls , produced by hymenopterous and other parasites on i plants are the most exquisite examples of specific i anatomical responses to specific stimuli : animals 1 THE LANCET, 1921, ii., 935.
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Transcript of THE ANATOMICAL STRUCTURE OF THE STOMACH
85
four months later, when 47, or 75-8 per cent., were Iimmune. Two more cases gave a negative reactionnine and fifteen months after the injections, 8 ofthe remaining 13 receiving a second series of threetoxin-antitoxin injections, after which 5 stillremained persistently positive. The result of theimmunisation was to effect a decrease in the incidenceof clinical diphtheria among these nurses of at least 90per cent. as compared with a previous three years’period. The local reactions following the injectionsare said to have been similar to those followingprophylactic typhoid vaccination, and in only twocases were the constitutional effects at all severe,although several complained of listlessness and head-ache. Dr. Cooke concludes by emphasising the factthat it is relatively easy to protect an entire nursingstaff from contracting diphtheria by the use of theSchick test and toxin-antitoxin injections.
ECONOMICS OF RURAL PRACTICE.
IN the issue of Health dated July 1st appears anarticle entitled " Taxation and the Country Doctor,’’pointing out that whilst the rural practitioner is inmost ways no more taxed than his colleagues in thetowns, his transport problem is a serious one entailingconsiderable expense. The lightest and oldest car isheavily taxed ; frequently a motor-bicycle is the onlymeans of conveyance for a man who finds his lifealready strenuous enough without such an additionalstrain. Holidays and illness are complicated by thedifficulty of rapidly obtaining a locum-tenent whocombines experience and steadiness in his professionwith the ability to ride a motor-bicycle. The locum-tenent of middle age, indeed, can be seriously ham-pered by lack of mechanical knowledge in this respect,whatever may be his professional skill. Another con-dition of the times which aggravates the economicposition of the country practitioner is the difficultyof the vegetable garden :-"That feature of the countryside, ’the doctor’s man,’
who drove the car, cultivated the potatoes, mothered thelocum-tenent, and knew all about the income and privatelife of every person in the district is, alas ! becoming almostextinct. A jobbing gardener and a boy from the garagetwice a week are poor substitutes for a professor in anhonoured and unique position, who often served three orfour successive masters in the same practice and earned thegratitude of them all."An appreciable amount of rural unemployment, it
appears, results from the frequent inability of doctorand parson to employ a whole-time man at the presentday, and the reasonable suggestion is made that itmight be wise to allow a rebate on the income-tax ofany person employing a servant who can be shown todevote a reasonable portion of his time to the care offruit, vegetables, pigs, and poultry.
THE ANATOMICAL STRUCTURE OF THE
STOMACH.
AT the summer meeting of the Anatomical Society,held in Edinburgh on July 23rd, Mr. Geoffrey Jeffersonread a suggestive paper entitled " Some Remarks onthe Anatomical Structure of the Stomach withspecial reference to Gastric Function." After a briefdescription of the gastric mucosa, the speaker passedon to the musculature, and demonstrated by meansof photographs of dissections that the external coatappeared to be derived from three sources ; (1) thecoarse fibres from the oesophagus deploying on to thestomach ; (2) much finer fibres which appear to arisein the course of the organ ; and (3) fibres continuouswith those of the duodenum. The strong bandson front and back of the pars pylorica, the ligamentapylori, were illustrated, together with their adhesionto the circular muscle fibres beneath. These formimportant intrinsic supports to this region, and areplentifully interspersed with elastic tissue. Thecircular musculature was seen to consist of inter-woven fibres and not of rings applied in contiguity.
This arrangement, according to Mr. Jefferson, wasto be expected, since the best evidence showed thatthe peristaltic wave was myogenic in its origin andnature. The connexions of the oblique musclewere next figured, and this coat was shown to be a,
derivative of the circular muscle. The laying downof a, third coat over the cardiac portion of the viscusrequired some explanation, for in general in thealimentary tract the processes of digestion are satis-factorily carried out by two coats only-an innercircular and an outer longitudinal. Why should thestomach have three, and why should this third coatbe applied to a part of the stomach which is relativelymuscularly inactive ? Mr. Jefferson believed theanswer to be that this coat is in large degree sus-pensory, that the activity of the gastric musculatureis partly static or postural and partly phasic or
peristaltic. These activities are interchangeablebetween the various coats in different bodily postures,the oblique coat taking on peristaltic powers forinstance in recumbency. Mr. Jefferson does not thinkthat the existence of a functional " gastric canal " canbe said to be established, although the longitudinalbands and the inner views of the organ which hedisplayed in his photographs were very suggestive ofits presence and presumably of its functioning-at anyrate partially-during life.
PLANT PATHOLOGY.
THE historical evolution of pathology in thiscountry has led to its development along a rathernarrow track starting in the post-mortem room, andonly now branching out into some of the many linesof obvious expansion. This restricted outlook isespecially plain in bacteriology and parasitology ingeneral. Bacteriology with us means hardly morethan the study of the relatively insignificant numberof organisms of immediate medical and hygienicimport. General laws can never be discovered fromsuch a limited outlook. The wonderful interest ofcomparative pathology-and by this we mean some-thing more than the veterinary technology whichsometimes masquerades under the title-has yet to beappreciated. The wealth of material at the Zoo stillremains almost unused, and Sir James Paget’s pleamade many years ago seems to have had as littleresponse as Sir John Bland-Sutton’s more recentdemonstrations of what may be found in otheranimals to elucidate the processes of human disease.In plant pathology there are welcome signs of moreactive interest. Readers of THE LANCET will recallthe interesting lecture by Prof. V. H. Blackman onthe processes of immunity and resistance in plantsas compared with animals, and at the forthcomingannual meeting of the British Medical Association atGlasgow a special Section of Microbiology apart frommedical bacteriology will discuss kindred problemswith a lead from Prof. Blackman and Dr. W. B.Brierley, head of the Department of Mycology atthe Rothamsted Agricultural Experiment Station atHarpenden. The origin of this new section of theAssociation may perhaps have some connexion withthe fascinating work done by its president on thegrowth and shedding of the deer’s antlers.The plant pathologist can doubtless get a good deal
from the highly developed specialised technique ofthe medical pathologist, who in his turn can probably
: get more from the far wider and more varied field with, which his botanical colleagues deal-" colleagues "- unfortunately in theory rather than practice. The- facility with which a worm-hole in a potato isi lined with skin recalls the behaviour of the epidermisi in a sinus, and raises the whole question of wound-i healing, Prof. S. G. Shattock’s paper on which is a rare, example of one of our animal pathologists makingL an excursion into the vegetable world. The galls, produced by hymenopterous and other parasites oni plants are the most exquisite examples of specifici anatomical responses to specific stimuli : animals
1 THE LANCET, 1921, ii., 935.
