522

the 41 cases treated by thyroidectomy were alsonot particularly cheering unless account be takenof the seriousness of the pre-operative condition ofmany of these patients. In 28 cases there was noevidence of thyrotoxicosis, but only five or six ofthese 28 were wholly rid of their symptoms, and couldbe considered as cured; the remainder had variouspsychoneurotic symptoms. Further, 7 patients stillshowed signs of thyrotoxicosis, and 6 suffered frompermanent hypothyroidism or myxoedema. Tetanywas observed in 2 cases, and paralysis of the recurrrentlaryngeal nerve in 4. Permanent hoarseness andasthma had developed as a sequel to the paralysisof the recurrent laryngeal nerve in one case. Therewere also minor troubles such as discomfort on swallow-ing due to adhesions in the field of operation. To

lighten this gloomy picture it should be noted that26 of these patients were fit for work, though manyof them had not achieved full working capacity tilla year or two after operation. The radiologicallytreated group was comparatively small. Of the 10patients thus treated 8 showed no signs of thyro-toxicosis on re-examination, but most of them stillsuffered from the psychoneurotic symptoms, and acomplete cure could be claimed in only two or threecases. Dr. Rasmussen’s discussion of the com-

parative merits of operative and radiological treat-ment betrays no strong bias either way, and all whoare interested in this subject would do well to readthe judicious summing-up in his paper which is

published in English.

THE DEVELOPMENT AND STRUCTURE OF

THE SKELETON

EXPERIMENTAL morphology is fairly new, and itsexponents are mostly those who have actually takensome part in its development: especially duringthe last few years many excellent monographson the subject have made their appearance. Thelatest 1 is a critical summary by Dr. P. D. F. Murray,and though it consists mainly of a review of recentwork it includes a certain amount of unpublishedresearch done by Dr. Murray himself and other workersat the Strangeways Laboratory. The most importantdevelopmental fact which emerges from the welterof diverse opinions and results is the fundamentaldistinction between the primary cartilaginous skeletalelement and the bone which replaces it. The firstis determined by forces inherent in the organism,but the second, taking the general shape given toit by the structure it replaces, is yet but the materialemployed in the play of many and varied externalforces, which seem to be solely responsible for itsfinal form and constitution.Now and then one is struck by the crudity-we

had almost said childishness--of some of the hypo-theses advanced by the experimenters in this field(and not in this field alone) to explain their results.They seem in a hurry to bring forward purely physicalexplanations of the simplest sort in matters whichare plainly organismic. A survey of the stores ofrelated facts garnered by the older morphologistswould surely be of value to the experimenter, enlarg-ing and modifying his outlook considerably ; the oldmorphology and the new must meet and agree ifprogress is to ensue, and the sooner the better. Theproblem of the appearance of the cranial membranebones for example illustrates clearly this need forcorrelation. Some at least of the hypotheses brought

1 Bones : A Study of the Development and Structure of theVertebrate Skeleton. By P. D. F. Murray, M.A., D.Sc.Cambridge: The University Press. 1936. Pp. 203. 8s. 6d.

forward to account for the existence and limitations.of these bones would have been suppressed if theirauthors had considered a wider morphology. The

ingenuity displayed in explaining the appearanceof these bones in situ in the human head wouldhave been recognised as misplaced had the bones.been followed back into reptilian classes or even

lower, and such notions as pressure from the brainwould not have been suggested as one of the factorsof determination. Among the observations recordedby Dr. Murray on this subject two seem to us ofgreat interest, and apparently not in opposition-notably the views of Kokott and of Troitsky. These-hypotheses still lack the embryological evidence inthe vertebrate classes which would lift them to the-level of reasonable theory, but doubtless this will besupplied in the future. Dr. Murray has put togetherin an engaging shape records of experimental worknot only on bones but on the form of joints andfalse joints ; this work will certainly modify the viewsof those concerned with the pathology of these-structures.

WATER BALANCE AND THE MENSTRUALCYCLE

THE minor ailments and dislocations of physio-logical equilibrium that often attend menstruationoffer a rich source of material for both clinical scientist.and physiologist, and there are signs that recentdiscoveries in endocrinology are leading to its investi-gation. One of the commonest, though not the most.distressing of these abnormalities, is a rather abruptretention of fluid which sets in during the last few-days of the cycle, reaches a peak at or about the onset.of menstruation, and disappears rapidly as the flow-is established. As a rule the symptoms are trivial.Slight thirst, a sharp rise in body-weight, and afeeling that clothes are too tight, may be all that is.noticed, but direct evidence of waterlogging, in theshape of pitting cedema of the legs, is not rare. Whatrelation, if any, this menstrual oedema bears to thewaterlogging of pregnancy and the gross oedema ofpre-eclampsia is not clear, but it is permissible to-

suspect that the three may have something incommon.

’

These facts lend particular interest to the observa-tions of P. L. Krohn and S. Zuckerman 1 on cyclicalobservations in the water balance of Old World monkeys..The monkey is endowed (or cursed) with a sexualcycle which resembles that of woman in the appear-ance of menstruation at intervals of about 30 days.The simian cycle, however, is distinguished by an,additional set of phenomena which reach a climax inovulation about midway between successive men-

strual episodes. These additional changes seem to.

correspond to cestrus in the lower mammals andcomprise gross swelling of the genital region, appa-rently composed of fluid, but not, like simple oedema,displaceable by pressure. Krohn and Zuckermannoticed that the ebb and flow of the swelling was.accompanied by a considerable and parallel rise and-fall in body-weight, and they decided to find outwhether the latter could be attributed to gain andloss of body fluid. Adopting principles familiar tostudents of metabolism, they accordingly madedaily measurements of the various fractions of fluidintake and output and so obtained estimates ofthe total water exchange. Such estimates are neces-sarily approximate, but the fluctuations describedseem well outside the limits of experimental error..

1 J. Physiol. 1937, 88, 369.