2
652 sign was shown at the meeting by charts representing the incidence of eclampsia and non-convulsive toxaemia at different blood-pressure readings. Eclampsia was seen to occur frequently with a blood tension of below 160 mm. The mortality curve of all toxaemic patients showed the death-rate (of 105 cases) to be 5 per cent. where the tension was 150 mm. or below, 9 per cent. where the pressure reading lay between 151 and 190, and above 190 mm. the mortality rose sharply to 27 per cent. In the discussion which followed Mr. Bourne’s remarks Mr. Eardley Holland drew attention to the importance of regarding toxaemic pregnancy in the light of the possible after-history of the patient. The preliminary results of his investigations showed that at least 12 per cent. of eclamptic patients suffered some permanent functional damage to their kidneys. I A subsequent morbidity rate of this extent cannot be without influence on our expectant treatment of severe toxaemia, where every day in the undelivered state may be adding fresh irreparable damage to the kidney. Mr. Holland gave figures of eight cases to show the great danger and even futility of attempting a " cure " of a case of eclampsia which does not include delivery. Dr. Mackenzie Wallis emphasised the difference in the blood and urinary analyses of toxaemia and true nephritis, and showed how it was possible to arrive at a diagnosis of these conditions by examination of the blood and urine. Dr. Simms also gave the results of his pathological experiences, and referred to the anomalies of chloride excretion met with in toxaemia. Sir William Willcox, who presided over the meeting, summed up the chief points that had emerged from the discussion as the difficulties of immediate prognosis and the dangers of permanent fern a) da.Tnae’e. EFFICIENCY IN SILK WEAVING. THE introduction of power-driven machinery obscured for the past generation the influences exerted upon output by the human factor in industry. To-day careful observations are disclosing that this factor makes the difference between profit and loss, even though the machinery may be running perfectly. A recent report issued by the Industrial Fatigue Research Board, which deals with individual differences among silk weavers, establishes the value of the human equation in what would at first sight appear to be an extreme case of machinery controlling output. The investigator, Mr. P. M. Elton, first found that indi- viduals among groups of weavers, when distributed according to their differences in efficiency, gave a distribution similar to that of a probability curve, and that they maintained this distribution when employed on different qualities of cloth. Variations on the same kind of cloth were found, ranging from an efficiency of 43 per cent. to one of 90 per cent., which means that the earnings of the least efficient weaver and the productivity of her loom were only half that of the most efficient weaver. Careful observations of the methods used disclosed that herein lay an explanation of much of the differences observed. No little interest attaches to the way in which these observations were made and tabulated ; much of the importance of the present report for future inquiries depends on this. The better weavers, although often appearing to be less busy, adopted labour-saving methods which allowed them to devote more of their energies to production ; while poor weavers, apparently working with an excess of zeal, were doing much useless work, a fact which arose from lack of, or faulty, training. Here is exhibited the value to wage-earning, and so indirectly to health as well as to productivity, of a study of the human machine. Mr. Elton holds the observations already made have at least established that good silk weavers (1) possess good eyesight, (2) are observant, (3) are dexterous with both hands, (4) have a delicate sense of touch, and (5) can stand for long periods. Clearly, a girl who has not these qualities should not waste time 1 An Analysis of the Individual Differences in the Output of Silk Weavers. P. M. Elton. Industrial Fatigue Research Board. Report No. 17. Pp. 38. H.M. Stationery Office. 1922. is. 6d. in learning weaving, and an employer should not incur expenditure in training such a person. The advantages to industrial contentment and well-being, and to profits, from extension of work on these lines is obvious. ANÆSTHESIA FOR INTRACRANIAL SURGERY. THE best type of anaesthesia, for use in intracranial surgery was discussed at a meeting of the Section of Anaesthetics of the Royal Society of Medicine on March 3rd. Dr. Z. Mennell briefly reviewed the gradual change in the methods used during the last 20 years at the National Hospital, Queen- square. The danger of chloroform, which was at the beginning of that time commonly employed, he explained by the much higher percentage necessary in the blood for anaesthesia when the intracranial pressure was raised. Directly the tension is relieved an enormous increase takes place in the volume of blood flowing through the brain, and a dangerous or even lethal dose may suddenly bathe the medullary centres. Anaesthesia deepens directly the dura is opened, whatever anaesthetic is being used. Ether was then substituted for chloroform in the Vernon Harcourt inhaler, and later still was habitually given from a Junker bottle attached to an oxygen cylinder. Mechanical difficulties led to the substitution of infusion anaesthesia for these inhalation methods, and though, said Dr. Mennell, the technique was tire- some and expensive, hedonal gave good results till the war rendered it unobtainable. Dr. Mennell now uses intratracheal ether for all cerebellar, pituitary, or high spinal operations. This is convenient inasmuch as it permits of the extreme flexion of the neck required for some of these operations, and vomiting can be more certainly avoided than by any other method. To patients suffering temporal or parietal operations Dr. Mennell frequently gives ether and oxygen by means of a Junker inhaler, since the intratracheal method is less essential in these cases. Mr. Percy Sargent dwelt on the need of close coöpera- tion between surgeon and anaesthetist, since the variations in intracranial pressure were the most important factor during operations for cerebral tumour. The brain, he added, was tolerant of changes of pressure provided that they were brought about gradually. ____ THE NEED FOR ANATOMICAL RESEARCH. AT the recent discussion on Gastric Ulcer, which took place at the Royal Society of Medicine, several speakers alluded to the growth of knowledge concern- ing this and kindred diseases which has occurred since the advent of abdominal surgery. It would scarcely be an exaggeration to say that it is the surgeon who has stimulated all the modern interest in gastro- intestinal disease, and it is surgical initiative, and occasionally surgical mistakes, which have led to the advances. A review of present-day conceptions of the physiology of the stomach, such as that recently published by Mr. Robert Mailer in the Edinburgh Medical Journal, makes it clear, however, that the physiologists and physicians have in their turn done very notable work on these problems. Pavlov, Cannon, Hurst, and Rehfuss, each of these, and many others have produced researches which place our knowledge on a sound footing, and an examination of their findings arouses in the mind of the critic the question, " What are the anatomists doing ? " For it is very clear that these gastro-intestinal problems have reached a stage where far more precise know- ledge is required. As an example, Mr. Mailer rightly calls attention to the modification which has lately occurred in our previous ideas concerning the acid control of the pylorus ; but what, we may ask, is the nervous mechanism of pyloric action ? Anatomists to whom the question is put will vaguely talk of the vagus and sympathetic nerves ; pressed for more precise information they will say that each of these contains both motor and inhibitory fibres. And 1 Robert Mailer : Edin. Med. Journ., 1922, xxviii., 114.
