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Annotations.

VOCATIONAL SELECTION.

" Ne quid nimis."- "

INDUSTRY has great need for guidance with regardto vocational selection, and is coming more and moreto appreciate this need. Dr. C. S. Myers stated lastweek at the first annual meeting of the NationalInstitute of Industrial Psychology that employeesare as yet more sympathetic than employers tothe claims of industrial research. Nevertheless,it is clear that greater productivity ensues for theemployer, and greater contentment and wages forthe operative if he is well suited for what he has todo. The Industrial Fatigue Research Board has beeninvestigating the subject, recognising that work isperformed with greater ease and less fatigue when aman and his work are well mated. Three studies arenow published in the form of a report, the major partof which deals with an inquiry conducted by Mr. B.Muscio among compositors. Much ingenuity and skillwas displayed in devising certain tests, performanceof which is admittedly intended to imitate variousprocesses actually performed by compositors. Thesuccess achieved is measured by comparing the effortsof compositors to perform these tests with the opinionheld by their foremen as to their skill as craftsmen.So far a high measure of success is recorded; butat best Mr. Muscio only appears to have found out,by using his tests, which were the better workers ;this information could surely have been obtained byasking a few questions and without applying any tests.The expectation that a new-comer who possesses innatecapacity for type composition can be discovered byhis skill at performing these tests may be likened to,an attempt to select a University crew from theperformances of freshmen in a tub-pair ! The testsmight be of value when engaging a skilled craftsman ;but probably his testimonials would be of morevalue. This important subject can be pursued on moreuseful lines, for Mr. Muscio himself in the second studyhas turned to establishing certain fundamental physicaldifferences between two groups of youths, one comingfrom Essex and the other from Manchester. The twogroups differed markedly in height, weight, andmuscular power. The advantage lay with the Essexgroup, and approximated to 2 in. in height, 10 lb.in weight, and 41, 3 kilogrammes in strength of grip. Theresult of the inquiry is to throw doubt upon the valueof the Martin strength test which has been recentlymuch used in the United States ; and to establishthat either weight or grip alone give a useful and prac-tical measure of physical capacity. The Smedleydynamometer was used to test strength of grip. Givena grading of occupations and processes according totheir need for physical strength, the capacity of appli-cants for work can be readily tested in this way, andcandidates can be sorted out. Other requirements foroccupations, whether physical, physiological, or mental,require to be similarly investigated in order to evolveequally simple tests. Then occupations and applicantscould be re-grouped for each requirement. In this waythe combination of natural characteristics possessedby any applicant could be rapidly ascertained along- with the work for which he is naturally fitted.

The third study reported upon by Mr. E. Farmerapplies the principles here advocated to definiteindustrial processes. He proceeded by taking variousmeasurements of the hands of workers employedin sweet factories. After excluding measurementswhich showed no relation to the processes investi-gated-i.e., those of the packing and the packet anddipping departments-he found two distinct types,the long spanned and the short spanned. A tendencywas found for the best packers to belong to the long

1 Three Studies in Vocational Selection. The IndustrialFatigue Research Board. Report No. 16. 1922. Pp. 86.H.M. Stationery Office. 1s. 6d.

spanned type, but for the best dippers to belong to theshort spanned type. The conclusion is drawn thatphysical type, related to the work in question, plays apart in proficiency ; but that there are also otherpowerful factors, such as psychological qualities, whichmay in some cases so far over-ride physical capacity asto enable a worker with no physical advantages tobecome proficient. Nevertheless, sight should not belost of the fact that physical capacity is fundamental,and must be present before psychological qualitiescan be brought into play. Note should also be madethat the physiological make-up of the worker--i.e.,the way in which the physical machine acts-should beobserved before inquiries are pursued into the moreabstract realms of psychology. We are not clearwhether the physical qualities found may not haveresulted from practice ; or whether they were theresult of selection brought about either by the manage-ment excluding the poorer workers, or by theseworkers on their own account turning to a processfor which they are better fitted. These preliminaryresults suggest further scientific guidance in vocationalselection. ————

THE AMYOSTATIC SYNDROME AS A LATEMANIFESTATION OF ENCEPHALITIS.

Parkinsonian symptoms as sequelae of cases of acuteepidemic encephalitis have apparently not attractedas much attention in this country as on the continent,although in an article, which we publish this week,Prof. A. J. Hall mentions cases of partial racoveryowing to persistence of the Parkinsonian reflex invarying severity. The symptoms have also beendescribed by Farquhar Buzzard and S. A. K.Wilson, but there seems to have been little attemptto coordinate them to the general pathology of thedisease, except by Prof. Economo, of Trieste. Inthe first number (November, 1921) of a new Italianperiodical, Mine1’l’a Jledica, published at Turin,Prof. A. Ceconi contributes an elaborate and illumi-nating paper on the subject. The clinical picture ofthe disease, in relation to the multiplicity of thelesions of nerve tissue, is so rich in symptoms andso protean in their grouping, that its pathogenesishas remained hitherto somewhat unprecise. Certainfacts, however, stand out-for instance, the mask-likeexpression due to paresis of the facial nerve is notaccompanied by any trace of reaction of degenerationor of atrophy, and, therefore, the lesion must resideelsewhere than in the bulbar nuclei. Again, theocular paresis, which is present in conjunction withvertigo, muscular asthenia, and diminished reflexes,may be interpreted as the result of damage to Deiter’snucleus or the fibres which connect it with the cere-bellum and mesencephalic nuclei. Prof. Ceconi drawsattention to the frequency of very chronic cases inwhich the initial acute symptoms pass off more orless completely; the patients have perhaps beenthought recovered, but gradually develop theParkinsonian syndrome ; so much so that Ceconi issceptical of the complete cure of the disease. Heremarks that even in the acute stage of the affection,of whatever form or gravity, two symptoms are almostalways present, amyosthenia and muscular rigidity;these may escape observation, being lost in theremaining symptomatology or being considered ofminor importance. But the importance of these twosymptoms comes to light later on when, the acutestage having=passed an d the prominent symptoms beingmodified, so that the patient is considered on the roadto recovery, it is noticed that these same symptomsare still present, and are more evident because theyare isolated and perhaps also because they are moreaccentuated than they were at the beginning. Andtheir importance becomes very striking when, after acertain time, they are observed still to persist andto be gradually increasing; then it is realised thatthe disease, instead of being cured, survives in thesetwo manifestations which represent the dominantchronicity. When developed the syndrome consists of amore or less generalised hypertonia of the muscles withtendency to immobility and contracture, with tremors

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and adiadochokinesis, normal deep and superficialreflexes, and general amyosthenia. It is evident thatthese symptoms must have an extra-pyramidal origin,and are distinct from diseases having a similar syn-drome-for example, Wilson’s disease, in which thereis a hepatic lesion, the pseudo-sclerosis of Strumpell,the Oppenheim-Vogt disease, with its characteristiclordosis, and Homen’s disease, with its psychic changes.

In the present state of our knowledge the post-encephalitic symptomatology, as far as concerns theamyostatic syndrome, must be considered the resultof a lesion of the basic nuclei, more especially thelenticular and of the motor tracts in relation to it.The lesion being frequently bilateral has a corre-

sponding bilateral symptomatology, as is seen inWilson’s disease and in pseudo-sclerosis, but caseswith unilateral or nearly unilateral symptoms are

sometimes met with. One point remains somewhatobscure in the course of the malady. There isevidently an inflammatory localisation as anatomicalsubstratum, and the lesion being primary there isno reason for admitting the action of hepatic toxinswhich have been called to help in the interpretationof Wilson’s disease and pseudo-sclerosis. Cure mustbe brought about by autolysis and absorption ofthe exudate material, with rapid or gradual dis-appearance of all the symptoms. This is what actuallyhappens in a small number of cases ; in others thedisease is gradually reduced to a minimum ofsymptoms. But these fortunate results are notfrequent; more often, as Prof. Ceconi shows in hiscases, when the first acute stage is passed the diseaseruns a chronic course, progressive in its characteristicmotor symptoms, so as to render the physicalcondition of the patients very precarious. In othercases, still more frequent, after the acute stage, aperiod of relative well-being ensues which may beprolonged for several months, during which thepatients are believed cured, although the amyosthenia,and especially the mask-like expression, are alwaysin evidence even if little pronounced. The symptomsthen at a certain moment resume their interruptedcourse, and eventually develop as in the precedingcases. The reason for this apparent arrest andrecurrence is obscure. It may be that, during theacute period, not all the nerve fibres which traversethe area involved in the inflammatory process arecut off, nor all the cellular elements involved, but thatsome of each preserve their integrity and function.Nor must the possibility of the process diffusing itselfby successive poussées" be forgotten. This hypo-thesis seems justified by some recent histologicalresearches of Economo in a subject who died fourmonths after apparent cure, in whom there was shownto exist infiltration into the grey matter from thebasal ganglia to the bulb as extensive and abundantas is observed during the acute stage.

GERMAN EXPERIENCE IN CURING CANCER.

STATISTICS collected from several of the largeGerman hospitals reveal the extremely unsatisfac-tory results of operation on malignant growth, evenwhen removal has been extensive. Thus carcinomaof the stomach was cured in only 15 to 25 per cent.of the operated cases ; carcinoma of the breast in40 per cent., and of the thyroid gland in 10 per cent.Among 37 cases of carcinoma of the tongue, only threewere found free from recurrence after three years.The figures for rectal carcinoma are rather variable,40 per cent. of cures being given from one clinic,while from another, out of 170 patients all operatedupon, 39 per cent. lived more than one year, 15 percent. more than two years, 10 per cent. more thanthree years, 4 per cent. more than four years, and onlyone patient lived more than five ; 20 per cent. of cureswere obtained in carcinoma of the cervix uteri. Anattempt is made to compare these results with thoseobtained by X ray and radium treatment, but the

1 F. Sauerbruch and Dr. M. Lebsche: Deutsche medizinischeWochenschrift, Jan. 19th and 26th and Feb. 2nd, 1922.

figures are necessarily rather difficult to obtain, as inmany cases treatment was combined with operation.Of 58 cases of columnar-celled carcinoma of the cervixtreated by X rays, in most cases combined withradium, a complete cure-freedom from recurrence

after five years-was recorded in 20 per cent., a per-centage similar to that given for operative results. By acombination of operative and rontgen therapy, thefigure of 31 per cent. was reached. From the FreiburgerKlinik, absolute cure of cancer of the body of theuterus, after the combined treatment, was reported as53 per cent. and from the Leipziger Frauenklinik75 per cent. Disappointment was caused by X raytreatment of carcinoma of the rectum, owing to thetenesmus and pain often produced, and repeateddoses were found adversely to affect the generalcondition of the patient. On the other hand, incarcinoma of the skin, including rodent ulcer, com-plete cure was obtained in 70 to 90 per cent.After experiments on malignant disease of the mouth,lips, fauces, and pharynx, the general opinion wasformed that operation should be undertaken whereverpossible, and only those cases that are entirelyinoperable should be submitted to the X rays. Earlycarcinoma of the breast was said by Krönig tobe amenable to X rays to the extent of 40 to60 per cent., but Sauerbruch doubts the accuracy ofthese figures. According to the statistics of theFreiburger Klinik only 14 per cent. of the operablecases were cured by X rays.

Sauerbruch points out that before the value of anymethod can be rightly estimated, the followingquestions must be cleared up : (1) Does spontaneoushealing of malignant growths take place ? (2) Howis such spontaneous healing produced ? (3) How canthe natural processes be increased by artificial means ? PHe quotes a number of cases, microscopically provedto be malignant, in which spontaneous healingoccurred. In the majority, spontaneous cure tookplace after an acute infective process had attackedthe tumour. Exanthemata were responsible for a few,and in two cases severe bleeding was followed by cure.One or two healed independently of adverse affections.Sauerbruch believes that spontaneous healing takesplace more often than is usually believed. One of hisown cases was a woman of 56 years, who was brought.into the hospital in a deplorable state, suffering froma large ulcerating carcinoma of the breast. The foulsloughing surface was scraped, and the intense painrelieved by large doses of morphia. A comatosecondition resulted, which lasted eight to ten days,during which all food was refused. Suddenly the con-dition changed, and improvement rapidly took place,both in the local and general condition. She took food,put on weight, and left the hospital in six to sevenweeks’ time, the wound having become covered withepithelium and the tumour having almost entirelydisappeared. Unfortunately, the case was lost sightof owing to the outbreak of the war. A second case ofspindle-celled sarcoma of the fascia of the thigh wasfirst treated with X rays, with the result that thetumour increased in size. An attempt was then madeto remove the tumour, but it was found to extend intothe pelvis, and a large portion of it had to be leftbehind. Thrombosis subsequently developed and ledto gangrene of the leg. Large doses of morphia andscopolamine were necessary to combat the pain.After going downhill for 14 days the patient suddenlyrallied, the tumour dwindled, and the patient put onweight and recovered. The gangrenous leg was

amputated, and seven months later the patient wasin excellent health and the tumour had entirely dis-appeared. It has been shown that in these cases ofspontaneous recovery the tumour cells become shutoff and eventually strangulated by newly-formedfibrous tissue. Sauerbruch suggests that through astudy of the process of spontaneous healing weshould arrive at some means whereby we can stimulatethe normal tissue to activity. Rontgen rays of variouslengths and strengths might have the desired effect,and the resistance of the patient might also be increased