293RENAL EXTRACTS IN THE TREATMENT OF NEPHRITIS.

as in the general population. Meylan, who investi-gated the history of Harvard oarsmen, came tosimilar conclusions. R. W. Michell, of Cambridge, whoexamined 1200 rowing men and 410 players of Rugbyfootball, found cardiac dilatation which persisted afterexercise only in men with a history of eitherdiphtheria or rheumatic fever, who had taken strenuousexercise while untrained. It is clear that on physicalgrounds no objection can be made to a habit of lifewhich involves strenuous exercise, provided theindividual is physically sound and properly trained.The available evidence is almost entirely confined tomen, but there is no reason to doubt that it would beconfirmed by investigations of the after life of womenathletes. The various federated associations con-

cerned with promoting sporting events for women inFrance have instituted a medical service and proposeto insist on a certificate of fitness before candidatesare allowed to enter for any event; this precaution, iffollowed up, might well form the basis of valuablestatistical information. The efforts made to collectevidence to prove that exercise does no physicallyobservable harm is a sign of the conviction, difficult toprove, but widely held, that a condition of trainedphysical efficiency not only leads to happiness andwell-being, but goes hand in hand with general andespecially mental efficiency.

OPTOCHIN IN OPHTHALMOLOGY.

CUPREINE is an alkaloid which occurs with quininein cuprea bark, and the important property of ethyl-hydrocupreine is that it destroys pneumococci. It hasbeen used medicinally in pneumonia, but it is mainlyemployed as the hydrochloride salt (optochin)in a one or two per cent. solution in eye affections,especially in pneumococcal ulcer of the cornea.

Unfortunately its employment in this disease isattended by much pain. Dr. S. H. Browning,at the recent Oxford Ophthalmological Congress,suggested that it should not be applied direct to thecornea after it has become infected with the pneumo-coccus, but that the parasite should be attackedwhile it is still in the lacrymal sac, before the corneahas become infected. The popularity of optochinamong ophthalmologists has suffered from its chemicalname, for it is generally supposed that it is a derivativeof copper and is therefore a dangerous substance touse on the eye. In fact copper does not enter intoits composition at all, and the patient may be assured-that the pain caused by its application does notindicate damage to delicate tissues.

RENAL EXTRACTS IN THE TREATMENT

OF NEPHRITIS.

THE outlook in chronic nephritis is, as a rule, sobad that anything which offers hope demands everyconsideration. The possibility of a new therapeuticapproach was mentioned in an annotation in ourcolumns not long ago, when it was suggested that

injections of phosphate may perhaps be found useful.We observe that another line of possible treatment isbeing explored by Prof. Stejskal of Vienna, who haspublished2 a small series of cases of advanced renaldisease in which injections of fresh extract of kidneywere given. Organotherapy has been abused so oftenthat attempts of this kind are naturally received withreserve ; but Stejskal’s idea is neither altogether newnor devoid of foundation. A similar experiment wasmade as long ago as 1892, by Dieulafoy, and thetheory of an internal secretion of the kidneys datesback to Brown-Sequard. It has often been suggestedthat in contracted kidney broken-down renal paren-chyma is absorbed into the blood, and that suchproducts are responsible for the high blood pressureand other changes found in this condition; and investi-

1 THE LANCET, July 27th, p. 183.2 Stejskal, K.: Med. Klin, 1929, xxvii., 1015.

gation has in some respects confirmed this hypothesis.Goldzieher3 and others, injecting emulsions of kidneysubstance subcutaneously into rabbits, producedalbuminuria and casts in the urine, and sometimesdeath. At the same time the adrenal bodies werefound to be markedly enlarged with an excessivehyperplasia of the medulla. These and other experi-ments led him to the view that resorption of diseasedkidney tissue caused an over activity of the adrenalmedulla which was an important factor in the rise ofblood pressure in cases of contracted kidney. Muchmay be said for this opinion ; thus we know that ifserum from a nephritic patient is added to a solutionof adrenalin the pressor effect of the latter is con-siderably increased. Again, it is possible to have avery high blood pressure without obvious nitrogen-retention, which is evidence against the alternativehypothesis that such retention is alone responsible forthe hypertension. Possibly both factors are con-

cerned in producing so-called interstitial nephritis ;thus primary impa,irment of the function of thekidney may lead to resorption of diseased renal tissue,which increases the liberation of adrenalin, whilstthe subsequent accumulation of nitrogenous wasteproducts in the blood may cause stimulation of thesympathetic, which acts again upon the adrenalmedulla. At all events, whatever may be the con-nexion between renal damage and hyperpiesis,Stejskal is able to record a remarkable reduction inblood pressure following injection of extracts ofkidney. He used a sterile watery extract, containingas far as possible the unchanged renal lipoid bodies,but almost practically free from protein. This wasinjected in quantities of 2 to 5 c.cm. intradermally(so that absorption should be gradual) once or moreinto ten patients suffering from advanced contractedkidney, some in the late stages of uraemia itself.Injection was always followed by a fall in bloodpressure, which was gradual and progressive, and insome cases this was persistent. This fall was notseen after injection of other tissue extracts and onlyoccurred in cases of renal hypertension-that is tosay, the renal extract appeared to be truly " organ-specific." The falls observed in the cases recorded wereof 80, 40, 70, 120, 120, 90, 130, 90, 80, and 120 mm.of mercury-an average of approximately 100 mm.All were cases with very high values before theinjection and obvious signs of terminal nephritis.Symptoms other than hypertension were not con-sistently affected, nor did the outcome of the diseaseseem to be much influenced, but the figures are certainlynoteworthy. The theory is advanced that the fallmay be due to some effect on the blood-vessels,perhaps of some hormone in the extract, whichrelaxes their powerful tonic contraction.

THE INDUSTRIAL HEALTH RESEARCH BOARD

THE change of title announced in its ninth annualreport4 by the Industrial Fatigue Research Boardindicates that in future its object will be to studynot merely the negative or pathological aspect ofindustrial activity, but also its positive side of pro-moting and maintaining good health. This step is inaccord with the trend of modern medicine, for thedoctor attempts to teach the patient how to be welland keep well, rather than to seek for cure of illsearned by wrong living. The body to be knownas the Industrial Health Research Board came intoexistence to follow up war-time research into theevil effects of long hours and heavy work, but hasnow as its primary aim the acquisition of knowledgeabout conditions and methods of work most favour-able to the workers. A glance at the variety ofinquiries recently completed or in progress displaysthe wide scope of the Board’s activities. Hours ofwork, the heating and ventilation of factories, visionand lighting in relation to output, the effects of noise

3 Goldzieher, M.: The Adrenals. London, 1929, p. 223 et seq.4 Ninth Annual Report of the Industrial Health Research

Board to Dec. 31st, 1928. H.M. Stationery Office. 1929.

294 THE EVOLUTION AND PURPOSE OF THE LARYNX.

and vibration, accident causation, labour turnover,repetitive work, vocational guidance and selection,sickness prevalence among printers, cardroom opera-tives and miners, humidity in mines, weight carrying,the physiology of exercise, the transfer of acquiredskill, and the relation of age to the acquisition ofdexterity, are all included among the subjects receiv-ing consideration. Some activities concern problems iof wide industrial importance ; for others the imaterial has been submitted by Government depart-ments and industrial associations, while yet othersare experimental researches carried out in laboratories.Knowledge is being gained ; it remains to bring it tothe attention of industry for practical application,for it should bring with it not only increase in healthfor the great working population, but increase inproductive activity and wealth for the nation.A notable example of the type of information made

available by the publications of the Board is thereport just published, dealing with monotony in work. IiThe investigation was made on workers employed onsuch repetitive processes as filament winding, soapwrapping, chocolate packing, and tobacco weighing.Boredom was found to be a fairly general experience ;only about one quarter of the workers escaping it.Boredom was held to be responsible for reducing therate of work by from 5 to 10 per cent., and was moreprevalent when operatives were paid on a time-basisthan on piece-rates. It caused irregularity in rate ofwork, and affected particularly workers of superiorintelligence whose productive efficiency was above theaverage. Workers doing entirely automatic work didnot suffer much from boredom, for their thoughtscould safely be detached from work and directed tomore interesting subjects; it will be rememberedthat Auguste Comte claimed that chances forphilosophic thought lay in such occupations, andlooked to find pupils among such operatives. Bore-dom occurred most in semi-automatic processes whichrequire enough attention to prevent mind-wandering,but not enough for the complete absorption of mentalactivity. Continued exposure to monotonous workcauses adaptation, so that what is initially tediousand unpleasant may finally be tolerated or even

mildly enjoyed. The suggestion made in thisreport that, by completing the mechanisation of thetask, boredom is avoided and thought stimulated isdecidedly unexpected. On this assumption massproduction by repetitive work, when carried to a fineart, would cure the very trouble it has always beenaccused of causing. Here is a problem, elusive anddifficult of approach, wherein progress must neces-sarily be slow ; but the theories now put forward areready for practical trial.

THE EVOLUTION AND PURPOSE OF THE

LARYNX.

SOME years ago Mr. V. E. Negus set himself thetask of tracing the reasons for the existence of thelarynx and the steps of its evolution in response tothe many demands made upon it. He started uponhis researches without preconceived ideas, andallowed them to follow the directions which seemedto be indicated by his attempts to correlate structureand function of this organ throughout the range ofanimal life. He has examined the anatomy andphysiology of the larynx, with its associated organs,from its earliest inception in the lung-fishes, and onthis study has founded theories which he expoundswith good argument in a recent publication. 6 Thesuperficial idea that the larynx is ’’ the organ of thevoice " is obviously untenable from the evolutionarypoint of view. The primitive larynx is a valve placed

5 The Effects of Monotony in Work. By S. Wyatt and J. A.Fraser. Report No. 56. Industrial Fatigue Research BoardH.M. Stationery Office. 1929.

6 The Mechanism of the Larynx. By V. E. Negus, M.S. Lond.,F.R.C.S. Eng., Junior Surgeon for Diseases of the Throat andNose, King’s College Hospital, London. With an Introductionby Sir Arthur Keith, F.R.S. London : Wm. Heinemann, Ltd.1929. Pp. 528. 45s.

on the floor of the pharynx at the top of the pul-monary outgrowth to prevent water and food fromentering the lung sac ; in the most primitive forms itis surrounded by a muscular sphincter only, but insome lung-fishes dilator fibres are also present, andin the axolotl lateral cartilages have appeared withthe function of keeping the valve open when air is

: entering the sac. From this point Mr. Negus tracesthe evolution of the larynx with a wealth of detailwhich is of absorbing interest. The nose is primarilyintended for olfaction ; in fish, with few exceptions,it does not communicate with the mouth, but in air-breathing animals it is necessary for olfaction that airshould pass through the nose. In order to retain thispassage of air while the mouth is open during eatingthe epiglottis has been developed, and all keen-scented animals have a big epiglottis lying normallyin contact with a long soft palate. As a secondaryfunction in many rapidly running animals the longepiglottis reaching into the nasopharynx is valuablefor maintaining a straight and open air-way to thelungs. In many lowly animals the larynx is of adomed shape, a configuration which prevents theentrance of air except when muscular action providesan opening. Some of the higher animals possesssecondary valvular folds formed by specialisation ofthe thyro-arytenoid muscle; these prevent theentrance of air with the minimum expenditure ofmuscular energy, and the best instances are to befound in arboreal animals, particularly activelyclimbing monkeys, and in the higher apes and man.Mr. Negus believes that the primary function of thesevalves is to hold the thorax rigid, and so to give afixed point of origin to the pectoral muscles. These-valvular folds, which are the vocal cords of man, weowe to our arboreal ancestry ; they have been furtherdeveloped by the specialised use of our fore-limbs,and their employment for gpeech is a secondaryfunction. These theories and other matters relatingto the forms and functions of the larynx throughoutthe animal kingdom are supported by carefulobservations minutely recorded. The book givesevidence of much specialised knowledge as wellas of original thought, and will be of interest to

biologists as well as medical men. ,

RETINAL ADAPTATION AND FLICKER.

THE fact that the sensation produced by a visualstimulus persists after the stimulus itself has come toan end has long been recognised. In 1765 D’Arcymade the first recorded attempt to measure the-persistence of an image by the rate at which a burningstick had to be whirled before it would give an impres-sion of a continuous circle of light. The modernmethod is to fix a rotating disk, with one or moresectors cut out, in front of a source of light andincrease the speed of its revolution until the flickeringimpression gives way to a sensation of continuouslight. A recent report to the Medical ResearchCouncil shows that appreciation of rapid stimulivaries in different regions of the retina and is dependenton the condition of adaptation of the eye. Toproduce the sensation of flicker the subject beingexperimented on is seated in a cubical box with a.

minute window through which he can view a testpatch, either directly (foveal vision) or at an angle(peripheral vision) ; the sectored disk is then made torotate in front of a gas-filled lamp. The number ofinterruptions per second necessary to do away withflicker is known as its " critical frequency " andthis varies according to the state of adaptation ofthe eye, according to the region of the retina on whichthe light falls, and according to the illumination ofthe test patch and its surroundings. During darkadaptation with high illumination of the test patchthe critical frequency falls With low illumination ofthe test patch for the peripheral retina the critical

1 Privy Council: Medical Research Council, Special ReportSeries No. 134. Reports of the Committee on the Physiology ofVision. V. The Adaptation of the Eye : its Relation to theCritical Frequency of Flicker. By R. J. Lythgoe and K. Tansley.