British Medical Journal

1918 BMJ (Clinical Research Edition)  
Tiiun lectureshiip in ph1ysic a-t St. Jolhni's College, Canm--)bridge, founded in I526 by Thouas Linacre, remailned an ordiiiary college lectureshliip until I908, when, after the translation of the then holder, Sir Donaid MlacAlister, to Glasgow, the college anthorities clhangled the terms of the lectureslhip and invited distiniguished -strangers, if this title miiay he applied to such vellknowvn men as Sir Williamn Osler and Dr. Norman MIoore, to give an annual discourse. Professor Starling's
more » ... ofessor Starling's imzportant Linacre Lecture on ,the Law of the Heart' gives an account-of hiis recent researches, and thus differs from the restrospective essays of the twvo inasters of mlledical hiistory mlientioned above. He discusses the mechanism by whiclh the lheart muscle adapts itself to the variations in the work imposed upon it by alterationis in blood pressure. By means of an ingenious arrangemiient the isolated "leart-lung, preparation" of a dog, is provided with an artificial peripheral circulation in which all the ,mechanical conditions of the heart canl be conurolled. Two important coniclusions are tlhus at once established:I tlhat, provided the inflow of blood remainis constant, it is immaterial to the heart whlat blood pressure witlhin physiological limits (44 to 200 mIIM. Hig) it has to contend with; and the mriore tlhe blood pressure rises, the greater the quantity of blood that passes through the coronary arteries; in other words, the niore work the heart has to do, the better its blood supply. The heart has a wvonderful power of adjusting lnot only its output of mechanical energy, lbut also its total chemical changes, to thae work occasioned by the mechanical conditions of the CirCUlationi. 'When as the result of exercise the lheart receives a larger quantity of blood and lhas a higher blood pressure opposed to it, temporary dilatation with lengthening of the muscle fibres follows. Tlle change in the nmuscle fibres brings miiore active surfaces into play, and this increase in the extenlt of active surface iniereases tlle energy of the lheart miiuscle. At the same time m-lore blood passes into the coronary arteries. The tone of t-he healthy heart is thus soon restored, anld thie organ returns to its normal volume, altlhougch it is doinig more wvork. In a diseased or fatig,ued lheart, on the other haand, the organl remains dilated durina the whiole period of -increased work, and if the work be prolonged the dilatation may become permanent, anid eventually cardiac failure miayv result. The important deduction as to the con-1nexion '1)etween the length. of the mliuscle fibres and the ener(gy of the heart's conltraction justifies the labours of past physiologists on muscle-nerve preparations, 'the practical application of wllichi was elntirely obscure nt the time, and in the lecturer's closinig words slhows that tlhis, like every advance achieved in tthe quest of ,pure kinowledge, will sooner or later play its part in -he service of man. IThe Linacre Lect-ure on the IN France a Governmient departumient has been set up to supervise tlle re-education of men crippled by wounds. It lhas been.placed under the direction of a senator, M. Astier. He takes a wide view of-his duties. He recognizes that it is ani obligation on th9 state to re-educate m-len whbell crippled in its service, and that the .mere ggrant of a penlsioni, however liberal, canniot suffice to 'restore them to their pJace i society. He recognizes also that France,. rich as it is, caninot afford to do without the work in i'ndustries, agriculture, or commerce, of the thouisands 'of m-ien whose war wounds renider them incapable of' resumiiig their former occtupations; recent Frenclh legislation', wlhile it recognizes the obligation of the state to pension the wounded mian anid to re-educate him, distinctly places uponl hlim the obligationi of sul)mittiDg to this re-education. We are very much afraid that tlhings are not going at all wvell iln this respect in our own country. It is tlhe custom to speak evil of the Wa.r Office, and it has recenitly' been denounc6d in the House of Comm-iions as soulless, but in this matter it has shown more sympathy and enterprise thlani the civilian departmenit wlhich takes over the crippled miian when he is discharged from the ariy. The MIilitary Orthopaedic Departmenlt of the army, thoughli it has taken rather a long time to get established on a sufficiently broad basis, anld though it is not yet fully equipped, is a very big anid well conceived enterprise upon whiclh the country may look with real satisfaction. Sir Alfred Keog,h wisely called to his assistanice Sir Robert Jones, wNho has been able to rally rounid hiim all that is most progressive in surgical tlhough-it iln this country. As is clear from the address publislhed in our columns a fortniight ago, Sir Robert Jones is not satisfied; lhe experiences a divilne discontent,-but, NYith the goodwill of the medical clhiefs of the War Office and the loyal backing of his conlsultant colleagues, lhe has accomplished the greate.r part of hiis task, alnd will win througlh to comiiplete success. Alilitary orthopaedic centres already in existence cover tlle wvhole country fairly well, and in England, Wales, and Scotland there are special liospitals with their workshops and training schools for providing meln w-ho lhave lost limbs with artificial substitutes, alnd instructing them in their use. We are bound to say that the Wa'r Office lhas beeni brouglht to realize its duty towards soldiers crippled in the war. We say nlotlhirng of the Navy because the prohleml lhas nlot beeni so great for it, and, moreover, it lhas the kinack of mnanaging its own affairs. But we are bound to say also that the _Ministry of Pensions is not yet doiDg all that it wvas hoped it wvould speedily accomplish for the crippled man discharged fromii the army. If it be asked why the Army Council allows a soldier to be discharged before lhe is restored to the best possible colnditioni for earninig his own living, the answver is that it is in accordanice with the decision of Parliamenit, whiclh laid it down that when it was establishled that surgery haad done its best -for tlho crippled man, anid it was certain he could not be useful aaain in thie armv, he was to become the charge of the M11inistry 'of Pensions. The MIinistry lhas m-iade rules and regulations, anld it has issued a pamphlet for thie use of disabled sailors anid-soldiers, telling them "how they are being rebuilt at the nation's cost." Thle motto of this pamphlet is the statement by Mr. Hodge, Minister of Pensions, that "our first principle is restoration," and it tells the men of tlhe advant,i';ges of 1)eing medically treated alnd 122 Tun Ristmm
doi:10.1136/bmj.1.2978.122 fatcat:fnjr3n3wxnenhmzpu5pn46r3fy