a plea for strict chronology

1
1279 THE EPIDEMIC OF TYPHOID FEVER AT LYNN. whatever Sir Henry Bardett’s views may be he has contrived to cast a slur on the rank and file of the profession. For it - cannot be good for us general practitioners that a journal of good repute and very large lay circulation should say such things of us, even on Sir Henry Burdett’s authority. , I am, Sirs, yours faithfully, ; Tillingham, Nov. 7th, 1897. F. S. D. HOGG. 4 ! F. S. D. HOGG. A NOTE ON CYCLING. To the Editors of THE LANCET. SiRS,—One of the advantages of cycling is that it renders possible a great deal of outdoor exercise without fatigue. How are we to explain the wide difference in this respect between it and the natural modes of progression ? 7 There are, I suggest, two chief reasons. In cycling (1) the legs have not to support the body ; and (2) the vascular column its shortened. 1. The legs having no work of support can devote themselves entirely to that of propulsion, whereas in walking and running much of the energy expended by the muscles of the lower extremities is spent in supporting and balancing the body. Even the mere act of standing involves a considerable expenditure of muscle energy both by the leg and trunk muscles, while in cycling not only are the leg muscles wholly freed from the work of support and balance, but the trunk muscles are largely relieved from the latter function if the proper sitting posture be assumed. What do I mean by the proper sitting posture 7 If a person sits so as to ride at ease he should hunch the back some- what, since this involves the expenditure of much less muscle energy than the bolt-upright position. This is one reason why the back should be well arched in cycling. 2. Man is distinguished from all other mammals by his erect posture. This, while securing him great advantages by enabling him to devote the upper extremities for independent purposes, places him at many disadvantages. If an intelligent extramnndane being were to see man for the first time in the horizontal posture it would surely never occur to him that it is natural for man to be erect. There is something incongruous in an animal built on the horizontal plan standing and progressing upon one end of its long axis. Yet this is what man is, and what he does, and it places him at a twofold disadvantage. First, in the matter of progression it leaves him with but two legs to walk with, and the muscles of these two, as already observed, have to expend a great deal of their energy in balancing the body, which from its upright posture is much more difficult to balance than in the case of the quadrapeds. Secondly, the height of the blood column is increased, the influence of gravity on the circulation being correspondingly increased. In particular, as Leonard l3ill has so ably shown, there is a tendency for the blood to gravitate into the splanchnic area when the erect posture is assumed, and I cannot but think that the fatigue of standing and walking is largely due to this tendency. It is normally counteracted by the contraction of the splanchnic arteries, by the pressure of the firmly-contracted abdominal muscles on the splanchnic veins, and by the negative intra- thoracic pressure, and in cycling it is much reduced and for at least three reasons : (1) the mean distance between the head and the feet is much reduced, and here we have an additional reason why the body and head should incline well forward; (2) the splanchnic veins are compressed by the rhythmic flexion of the thighs on the abdomen, the pressure being increased by the forward attitude; and (3) the aspiratory action of the thorax is increased owing to its increase in mean size, this occurring in all active exercises. That the forward attitude tends to contract the chest is an altogether fallacious notion. It will thus be seen that there are several reasons why the body should be bent forward in cycling. It may be argued that this attitude, even though physiological, is inelegant. I do not hold this view. An expert rider, properly clad, looks far better bending somewhat forward than sitting rigidly upright, the bend falling in harmony with the curves of the wheels; it suggests ease, grace, and perfect command of the machine. Women pride themselves upon sitting more upright than men, but then few of them have yet learned to ride gracefully ; moreover, they have not yet discovered a suitable cycling costume. I am, Sirs, yours faithfully, HARRY CAMPBELL, M.D. Lond. Wimpole-street, W., Nov. ftb, 1897. HARRY CAMPBELL, M.D. Lond. A PLEA FOR STRICT CHRONOLOGY. To the Editors of THE LANCET. SiES,—I have recently received the current volumes of the Transactions of various medical societies to which I belong, and I should like to call attention to the way in which their editors confound all historical truth by adding titles retro- spectively to past presidents and other worthies. Thus in the list of presidents of the Clinical Society I find under 1869 Sir James Paet, Bart., but he did not receive his title till 1871 ; under 1871 Sir William Gull, Bart., whereas he was then Dr. Gull; under 1873 Sir Prescott Hewett, who became a baronet many years later ; and then under 1881 Lord Lister I But the editor of the Medico-Chirurgical Transactions confounds history still more, for he makes Astley Cooper a baronet in 1819 and William Lawrence in 1831 instead of thirty-six years later! Let the societies take example by the College of Surgeons, in whose Calendar no titles are given unless actually existing at the time of election. I am, Sirs, yours obediently, I Nov. 8th, 1897. _______________ HISTORICUS. OVERCROWDING IN FACTORIES AND WORKSHOPS. To the Editors of THE LANCET. SIRS,-Would any of your readers be so good as to inform me whether or no a London medical officer of health is bound, legally, by the definition of the term" over- crowding" " as laid down under Section I. of the Factory and Workshop Act, 1895-namely, less than 250 cubic feet per person during ordinary working hours, and 400 cubic feet during overtime. If not so bound, what minimum standard of floor and air space-with a nearer approach to the actual physiological needs of the individual-might be adopted (with a fair prospect of success before a magistrate) in the case of toilers in (1) factories ; (2) workshops (other than " domestic" workshops which clearly come under the pro- visions of the Public Health Act) ; and (3) other workplaces- e.g., laundries. My reason for raising this vexed question of overcrowding is the noticeable fact that the death-rate from lung diseases amongst indoor workers and other dwellers in densely- crowded (and often ill-drained) districts is in excess of that which obtains in more sparsely populated neighbourhoods. I am, Sirs, yours faithfully, Nov. 7th, 1897. _______________ M.O.H. THE EPIDEMIC OF TYPHOID FEVER AT LYNN. (FROM OUR SPECIAL COMMISSIONER.) (Continued from p. 1219.) To continue the story of the past sanitary history of Lynn, previously to the outbreak at Lynn in 1892 there had been cases of typhoid fever at Gaywood above the intake of the Lynn water. The house where these cases occurred had a box privy, and the contents of the box were emptied in a garden that slopes down to the river, which is only at a distance of fifty yards. Later, during the course of the illness, the dejecta from the patients were emptied into a shallow pit dug at only thirty-five yards distance from the river. This pit was but two feet deep and two feet square. From February 14th to 21st there fell 1’24 inches of rain and snow. It was at the latter date, when the thaw occurred, that the greater part of this water was able to run down into the river, and seven days later the diarrhoea patients at Lynn began to manifest symptoms of enteric fever. By analysis it was also shown that the water of the river is much more polluted after a heavy fall of rain. Naturally a heavy flow of water brings down to the river the manure from the fields, the contents of shallow privies, and the human excrement which is spread out over the gardens. The connexion between the water-supply and the typhoid fever epidemic of 1892 was thus clearly established, and the inhabitants of the town of Lynn had these facts set before them in a masterly manner by Dr. Bruce Low, who reported on the subject to the Local

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Page 1: A PLEA FOR STRICT CHRONOLOGY

1279THE EPIDEMIC OF TYPHOID FEVER AT LYNN.

whatever Sir Henry Bardett’s views may be he has contrivedto cast a slur on the rank and file of the profession. For it- cannot be good for us general practitioners that a journal ofgood repute and very large lay circulation should say suchthings of us, even on Sir Henry Burdett’s authority. ,

I am, Sirs, yours faithfully, ;Tillingham, Nov. 7th, 1897. F. S. D. HOGG. 4 !F. S. D. HOGG.

A NOTE ON CYCLING.

To the Editors of THE LANCET.

SiRS,—One of the advantages of cycling is that it renderspossible a great deal of outdoor exercise without fatigue.How are we to explain the wide difference in this respectbetween it and the natural modes of progression ? 7 Thereare, I suggest, two chief reasons. In cycling (1) the legshave not to support the body ; and (2) the vascular columnits shortened. 1. The legs having no work of support candevote themselves entirely to that of propulsion, whereas inwalking and running much of the energy expended by themuscles of the lower extremities is spent in supporting andbalancing the body. Even the mere act of standing involves a considerable expenditure of muscle energy both by the legand trunk muscles, while in cycling not only are the legmuscles wholly freed from the work of support and balance,but the trunk muscles are largely relieved from the latterfunction if the proper sitting posture be assumed. What doI mean by the proper sitting posture 7 If a person sitsso as to ride at ease he should hunch the back some-what, since this involves the expenditure of much lessmuscle energy than the bolt-upright position. This isone reason why the back should be well arched in

cycling. 2. Man is distinguished from all other mammalsby his erect posture. This, while securing him greatadvantages by enabling him to devote the upper extremitiesfor independent purposes, places him at many disadvantages.If an intelligent extramnndane being were to see man for thefirst time in the horizontal posture it would surely neveroccur to him that it is natural for man to be erect. There is

something incongruous in an animal built on the horizontalplan standing and progressing upon one end of its long axis.Yet this is what man is, and what he does, and it places himat a twofold disadvantage. First, in the matter of progressionit leaves him with but two legs to walk with, and the musclesof these two, as already observed, have to expend a greatdeal of their energy in balancing the body, which from itsupright posture is much more difficult to balance than in thecase of the quadrapeds. Secondly, the height of the bloodcolumn is increased, the influence of gravity on the circulationbeing correspondingly increased. In particular, as Leonardl3ill has so ably shown, there is a tendency for the blood togravitate into the splanchnic area when the erect postureis assumed, and I cannot but think that the fatigue ofstanding and walking is largely due to this tendency. It isnormally counteracted by the contraction of the splanchnicarteries, by the pressure of the firmly-contracted abdominalmuscles on the splanchnic veins, and by the negative intra-thoracic pressure, and in cycling it is much reduced and forat least three reasons : (1) the mean distance between thehead and the feet is much reduced, and here we have anadditional reason why the body and head should incline wellforward; (2) the splanchnic veins are compressed by therhythmic flexion of the thighs on the abdomen, the pressurebeing increased by the forward attitude; and (3) the aspiratoryaction of the thorax is increased owing to its increase inmean size, this occurring in all active exercises. That theforward attitude tends to contract the chest is an altogetherfallacious notion.

It will thus be seen that there are several reasons why thebody should be bent forward in cycling. It may be arguedthat this attitude, even though physiological, is inelegant.I do not hold this view. An expert rider, properly clad,looks far better bending somewhat forward than sittingrigidly upright, the bend falling in harmony with the curves ofthe wheels; it suggests ease, grace, and perfect command ofthe machine. Women pride themselves upon sitting moreupright than men, but then few of them have yet learned toride gracefully ; moreover, they have not yet discovered asuitable cycling costume.

I am, Sirs, yours faithfully,HARRY CAMPBELL, M.D. Lond.

Wimpole-street, W., Nov. ftb, 1897.HARRY CAMPBELL, M.D. Lond.

A PLEA FOR STRICT CHRONOLOGY.To the Editors of THE LANCET.

SiES,—I have recently received the current volumes of theTransactions of various medical societies to which I belong,and I should like to call attention to the way in which theireditors confound all historical truth by adding titles retro-spectively to past presidents and other worthies. Thus inthe list of presidents of the Clinical Society I find under1869 Sir James Paet, Bart., but he did not receive his titletill 1871 ; under 1871 Sir William Gull, Bart., whereas hewas then Dr. Gull; under 1873 Sir Prescott Hewett, whobecame a baronet many years later ; and then under 1881Lord Lister I But the editor of the Medico-ChirurgicalTransactions confounds history still more, for he makesAstley Cooper a baronet in 1819 and William Lawrence in1831 instead of thirty-six years later! Let the societies take

example by the College of Surgeons, in whose Calendar notitles are given unless actually existing at the time ofelection. I am, Sirs, yours obediently,

I Nov. 8th, 1897.

_______________

HISTORICUS.

OVERCROWDING IN FACTORIES ANDWORKSHOPS.

To the Editors of THE LANCET.

SIRS,-Would any of your readers be so good as to informme whether or no a London medical officer of health isbound, legally, by the definition of the term" over-

crowding" " as laid down under Section I. of the Factory andWorkshop Act, 1895-namely, less than 250 cubic feetper person during ordinary working hours, and 400 cubic feetduring overtime. If not so bound, what minimum standardof floor and air space-with a nearer approach to the actualphysiological needs of the individual-might be adopted(with a fair prospect of success before a magistrate) in thecase of toilers in (1) factories ; (2) workshops (other than" domestic" workshops which clearly come under the pro-visions of the Public Health Act) ; and (3) other workplaces-e.g., laundries.My reason for raising this vexed question of overcrowding

is the noticeable fact that the death-rate from lung diseasesamongst indoor workers and other dwellers in densely-crowded (and often ill-drained) districts is in excess of thatwhich obtains in more sparsely populated neighbourhoods.

I am, Sirs, yours faithfully,Nov. 7th, 1897.

_______________

M.O.H.

THE EPIDEMIC OF TYPHOID FEVERAT LYNN.

(FROM OUR SPECIAL COMMISSIONER.)(Continued from p. 1219.)

To continue the story of the past sanitary history of Lynn,previously to the outbreak at Lynn in 1892 there had

been cases of typhoid fever at Gaywood above the intake ofthe Lynn water. The house where these cases occurred hada box privy, and the contents of the box were emptied in agarden that slopes down to the river, which is only at adistance of fifty yards. Later, during the course of the

illness, the dejecta from the patients were emptied into ashallow pit dug at only thirty-five yards distance from theriver. This pit was but two feet deep and two feet

square. From February 14th to 21st there fell 1’24 inchesof rain and snow. It was at the latter date, when the thawoccurred, that the greater part of this water was able to rundown into the river, and seven days later the diarrhoeapatients at Lynn began to manifest symptoms of entericfever. By analysis it was also shown that the water of theriver is much more polluted after a heavy fall of rain.Naturally a heavy flow of water brings down to the river themanure from the fields, the contents of shallow privies, andthe human excrement which is spread out over the gardens.The connexion between the water-supply and the typhoidfever epidemic of 1892 was thus clearly established, andthe inhabitants of the town of Lynn had these factsset before them in a masterly manner by Dr. Bruce

Low, who reported on the subject to the Local