69MATERNITY AND CHILD WELFARE CONFERENCE.

oedema.. Another cause for the appearance of papill.oedema after head injury was the collection of cerebro.spinal fluid, often mixed with blood, in the subdura’space. When papilloedema was present the patientshould have operative treatment, even though atthe time he might be relatively free from symptoms,A well-planned decompression would give the patienta much better chance of avoiding the chronic ill-health which otherwise so often followed head injury.Lateral deviation of the head and eyes towards theinjured side was very important as indicating the sideof the main lesion. Great reliance could also be

placed on dilatation and fixity of one pupil as indicat-ing that the major cerebral lesion was on the same sideof the body. This sign was particularly valuablewhen other neurological evidence seemed to indicatethat the lesion was on the opposite side. The wholesubject of pupillary reactions in head injuries was verycomplicated, and was worthy of close investigation.Mydriatics and morphia should never be used incases of head injury.Mr. Cairns went on to deal with injuries to the

geniculo-calcarine pathway, remarking that theoccipital lobe was frequently damaged in headinjuries. Except in perforating injuries, however,the damage was superficial and tended to be limited tothe occipital pole and the outer aspect of the occipitalpole, thus sparing the greater part of the visual area.This might, he suggested, explain the fact thathomonymous defects of the visual fields were onlyrarely observed in head injuries in civil practice.Inability to read words and letters and to recogniseobjects, though visual acuity was good, was observednot infrequently in association with intracranialtumours, and in vascular disease and penetratinginjuries of the brain. Injuries of the fibre-tracts andnuclei which controlled movements of the eyesseemed to be rare, at least in cases of head injurywhich recovered from the immediate effects of theinjury.

Finally, the speaker dealt with disturbances ofvision in persistent cerebral contusion. Some patients,after a blow on the head, perhaps only of slight degree,suffered from persistent headache and attacks ofdizziness, these attacks being brought on or aggra-vated by exertion. As neurological examination wasnegative, there was a tendency to regard the con-dition as functional. He suggested, however, thatthe basis was an unresolved cerebral contusion.Most of these patients had subjective visual disturb-ance, with an ache behind the eyes, sometimes withphotophobia.

Mr. CHARLES GOULDEN dealt with the subject fromthe ophthalmological aspect. He began by referringto Mr. Bathe Rawling’s Hunterian Lectures of 1904on Fracture of the Skull, which shed valuable light,he said, on several problems, and laid down principlesof diagnosis whereby the probable course of fracturecould be predicted if the site of the blow was known.60 to 70 per cent. of cases of fracture of the basewere shown to be due to direct violence applied tothe neighbourhood of the base of the skull, whereas30 to 40 per cent. of basal fractures were due toradiation from fractures of the vault. The pathwhich a fracture of the base might take was largelydetermined by the various fissures and foramina ofthe base. Rawling had shown that a fracture involv-ing the optic canal might occur in any fracture of theskull, and such a fracture was more probable whenthe injury to the head was in the neighbourhood ofthe orbit. In a certain number the result was partialor total primary optic atrophy, the lesion being innearly all cases unilateral. After a blow on the head,usually near the orbit-perhaps not sufficiently severeto cause unconsciousness-the eye on the side of theinjury was blind. The pupil was dilated and inactive,there was no perception of light, and the ophthal-moscope revealed no pathological signs. After aninterval of two to six weeks the appearance of primaryoptic atrophy was found with normal blood-vessels.In fracture of the middle fossa there might be injuryto the optic chiasma, due to laceration by a fragment

of bone, crushing or compression, and the optic tractswere exposed to some similar injury. Such injurieswould lead to defects in the visual fields ; and caseshad been reported of bitemporal hemianopia,presumably due to laceration of the chiasma in itsinner part. There might be total blindness in oneeye and temporal hemianopia in the other.Mr. Goulden drew attention to the value of the

pupillary reactions in cases of injury to the opticnerve in fracture of the skull. Reflex iridoplegia hadbeen observed after injury to the skull. The othernerves liable to injury in fracture of the base were theoculomotor, the trochlear, the trigeminal, the abdu-cens, and the facial. The nerve most commonlyinvolved was the abducens, with consequent paralysisof the external rectus. The oculomotor nerve wasonly rarely affected. In fractures involving thesphenoidal fissure there might be a complete internaland external ophthalmoplegia, but in that event therewas usually an involvement of the other nerves whichpassed along the cavernous sinus and through thesphenoidal fissure. The fifth nerve was rarely affectedin fractures of the base of the skull. The facial wasthat most involved in these accidents ; Boehm foundit involved in 22 per cent. of cases of fractured base.The internal carotid artery was most liable to injuryat the point where it crossed the line of fracture fromone middle fossa to the other.

A number of other papers were read during theCongress, and an exhibition of ophthalmic instrumentsand other exhibits was held.

MATERNITY AND CHILD WELFARE.

FIFTH ENGLISH-SPEAKING CONFERENCE.

LONDON, JULY 2ND-4TH, 1929.

A CONFERENCE organised on behalf of the NationalCouncil for Maternity and Child Welfare by theNational Association for the Prevention of InfantMortality in cooperation with the M. & C.W.Group of the Society of Medical Officers of Healthwas held last week at Friends House, Euston-road,London, N.W. Brief notice has already been givento the opening session which dealt with the welfareof the child between 1 and 5 years.

PRESIDENTIAL ADDRESS.

In his encouraging and inspiring presidentialaddress, unavoidably postponed until the third dayof the conference, the Minister of Health, Mr. ARTHURGREENWOOD, welcomed the overseas visitors andexpressed his good wishes for the success of DameJanet Campbell’s forthcoming visit to Australia.He went on to refer to the progress made in thereduction of infant mortality and to the great possi-bilities of further progress. There were still blackspots and we did not get a hundred per cent. valuefrom existing regulations. We must look backward tothe mother and forward to the school-child. Maternalmortality was a most obstinate problem and for itsdefeat a new holy war in a real crusading spirit wasneeded. Education would gradually overcome reluct-ance to attend antenatal centres. They must havewidespread vision and a long distance and compre-hensive programme. It was futile to leave the childalone when a half-finished product and, withoutbeing grandmotherly or grandfatherly, they neededto exercise constant watching care from birth todeath to ensure the best citizenship. Most childrenwere born normal, and the problem was how to keepthem so. He hoped to be able to do something toimprove the status of the midwife and to leave hismark on the public health service. He had thehighest regard for voluntary workers. There was notenough of such work. Enthusiasm was reborn atevery such conference as theirs.

70 MATERNITY AND CHILD WELFARE CONFERENCE.

MATERNAL MORBIDITY.A whole day was devoted to the consideration of

various aspects of this subject, the morning sessionbeing presided over by Prof. A. Louise McIlroy,D.B.E., and the afternoon by Surgeon J. S. Boggess,representing the U.S.A. Government.

Maternity Nursing.This discussion brought out unanimity among the

speakers and the auditors that every woman shouldbe attended at her confinement by a well-trainedmidwife and that such midwives should have animproved status and a higher remuneration, so thatbetter educated women may be attracted to theprofession and that those who adopt it may be in aposition to devote a greater knowledge and moretime to each case. It follows that in many or mostcases the midwives will have to be subsidised, or thematernity benefit will need to be increased and morecarefully allocated; and that the handy womanwill have to disappear as a midwifery attendant butmay join the ranks of the home helpers.

Several speakers referred to the higher status ofmidwives in Sweden, where they have been recognisedsince 1700. In Sweden the maternal mortality isonly half what it is in this country, and the Swedishmidwives undergo a much more complete training,including a course in paediatrics.Dame JANET CAMPBELL pointed out that only an

adequately trained woman was able to note in theinterests of both mother and child the slightestdeparture from the normal, and that the visitingmidwife can do much to avert disaster if she is ableto devote more knowledge and time to her cases.The best way, she said, of getting rid of the handywoman is to make the services of a midwife easilyobtainable by all patients needing maternity nursing.The problem was mainly an economic one. Byencouraging the midwife we could get better nursingand relegate the untrained woman to her properfunction as a home help.

Dr. J. S. FAlBBAiBN agreed that nursing attendanceon confinements should be restricted to certificatedmidwives and emphasised the points that the experi-enced midwife of the right type was successful inobtaining a maximum of normal deliveries and normallactations and in securing surgical cleanliness duringthe puerperium, and was in a position to makereliable reports to the doctor as to the progress ofboth mother and baby. Till every mother, Dr.Fairbairn concluded, had a certified midwife tonurse her and the handy woman and all inferiorlytrained nurses were wiped out, puerperal morbiditywould continue more rife than it should be.

Miss E. DOUBLEDAY (College of Nursing), inapproaching the subject from the nursing point ofview, was in entire agreement with the two previousspeakers, and gave in some detail a description of themany functions and duties of a midwife which calledfor expert knowledge. The medical profession, shesaid, must insist that maternity nursing be onlydone by certified midwives. She concluded with aplea for the education of the public as to the needfor improved maternity nursing both for those whocan and for those who cannot pay.

Other points made in the discussion were-that at30s. a case a midwife cannot earn an adequateincome, that hospital extern departments are reluctantto undertake the nursing of abortions, and that thereis a real danger to the patient if the midwiferyattendants suffer from catarrhal symptoms, especiallyin times of epidemics.In replying on the discussion, Miss DouBLEDAY

said that the local authority had power to pay forthe services of a maternity nurse and she expressedher opinion that extern cases should be nursed bythe hospital staff and that the payment of a separatefee for antenatal work would be a retrograde step.-Dame JANET agreed that the nursing of mis-carriages was neglected. She also stressed the point

that the working-class woman cannot pay an adequatefee, and that greater facility for the provision oftrained maternity nurses is a more effective methodof getting rid of the handy woman than penalisation.

Home Helps.In addition to doctor and midwife someone is

needed to look after the domestic comfort of thehousehold if the mother is to enjoy the physical restand peace of mind which she requires. Miss F. E.WRIGHT, assistant superintendent of health visitors,described the Birmingham scheme for supplyinghome helps at charges diminishing in proportion tothe family income ; and at the same time deploredthe small use made of this service up to the present.Forty home helps were employed in the city andattended 404 cases during 1928, whilst the number ofbirths was 17,222. The payment made to the homehelps was 5s. a day (from 8 A.M. to about 6 P.M.)and she is expected to provide her own food.

Dr. S. G. MooRE said that Huddersfield providedfree home helps and Dr. FRANK ROBINSON couldnot understand why they received so few applica-tions for home helps under their Cambridgeshirescheme.

Mrs. BLAKE (Crewkerne) said her authority onlycontributed towards a home help if a maternitynurse had been engaged.

The Question of Abortion.In this discussion there was general recognition of

the fact that criminal abortion is very largely on theincrease in most countries, and that it is a verycommon cause of fatal puerperal sepsis. There areno statistics available in this country but appallingstatistics are available from Germany. As it isagreed that spontaneous abortion does not usuallylead to sepsis or a fatal result, and as therapeuticinduced labour in skilled hands only exceptionallygives rise to fatalities, it may be inferred that,practically speaking, every case of sepsis or deathfollowing abortion is due to criminal abortion.

Dr. COMYNS BERKELEY, in opening the discussion,said there had been no improvement in the death-ratefrom childbirth or puerperal sepsis in the last 20 years.He described the essentials for an improved medicalservice: better educated doctors and midwives;more hospital beds; antenatal centres linked upwith a consulting antenatal centre preferably at ahospital, &c. ; and he laid especial stress on the needfor educating the public as to the required remedies.Midwifery was the worst paid profession in theworld. He pointed out that legitimate inductionof labour was not dangerous. Criminal abortionwas greatly on the increase and a common cause ofsepsis.

Miss SUSAN MUSSON (general secretary, NationalCouncil for the Unmarried Mother and Her Child)spoke as to the widespread prevalence of the saleof drugs as abortifacients. Her Council could speakfrom the knowledge of nearly 8000 cases in the pastten years. The death-rate from childbirth amongunmarried mothers was twice as high as amongmarried. In their case department they listened toastounding stories of the pills, powders, and potionswhich had been advised and administered. Theirmost dangerous enemy was the retail shop whichsold " pills for ladies," " female pills," or " pills toremove irregularities." Trade by correspondencewas very common, though the Advertising Associationhad recently persuaded the press to refuse suchadvertisements. Unfortunately, the firms whichsupplied abortifacients, or supposed abortifacients,also dealt largely in birth control accessories, andabortifacient drugs were supplied through advertise-ments which purported to deal only with birthcontrol. There was a loophole in the law as to thesale of lead preparations, in that lead plaster made bymachinery was excluded and she had been informedby a leading gynaecologist that a woman could buyfor a penny enough diachylon plaster to poison herself,cause abortion, and leave her a mental and physical

71MATERNITY AND CHILD WELFARE CONFERENCE.

wreck. The Home Office should be pressed to deawith this matter. Miss Musson’s conclusion was thatpublic opinion must be educated to deal less hardlywith the unmarried mother in order that she mayshun these so-called remedies, which endanger thelife of herself and her child.

Mr. F. E. SCRASE, F.R.C.S. (M.O.H., Hampstead),described the scheme for a panel of consultantgynaecologists and obstetricians which was workingsatisfactorily in his borough.

Dr. DOROTHY R. MENDENHALL (U.S. Children’sBureau) read a paper on maternal mortality in theU.S.A., and gave statistics as to the variations ofthe maternal death-rate between one State and anotherand among the white and coloured populations.The latter were largely attended by untrained mid-wives. A study by the Bureau extending over atwo-year period, not quite completed, indicated thatdeaths following abortion contributed largely tomaternal mortality and particularly that from sepsis.In the discussion it was pointed out that the recentincrease of criminal abortion was very largely amongmarried women (one speaker referred to a wife whohad performed abortion on herself seven times), andthe advocates of birth control claimed this as a

cogent reason for giving sound advice as to contra-ceptive methods.

Other points made were : that women takingdrugs will not attend antenatal centres; that thereis no hospital treatment for abortions, and conse-quently no adequate education of medical studentsin the treatment of abortion.

Special V.D. Clinics.A whole session was allotted to a discussion on

the holding of special venereal disease clinics forwomen and children in connexion with maternityand child welfare departments. The main pointsemerging were : the need for a better linking up ofall the medical services for the discovery of venerealdisease with a view to securing special treatment inwell-equipped premises with no label attached tothem, and particularly the devising of methodswhich make it easy for the pregnant woman to secureearly treatment; and also the need for combatingthe greatly exaggerated view held by both themedical profession and the public as to the risk ofcontagion.In his introductory remarks Mr. E. B. TURNER,

F.R.C.S. (Chairman of the Executive Committee,British Social Hygiene Council), voiced the anxietyof his Council to see all maternity and child welfarecentres equipped with facilities and means fordiagnosis, and the establishment of special clinicsat unlabelled premises for the treatment of marriedwomen.

Dr. DAVID LEES (V.D. Medical Officer, Edinburgh)said that 60 per cent. of these diseases were notacquired through illicit sexual intercourse. Theamount of gonorrhoea under treatment had increasedbut we were not yet treating anything like all ofit. Gynaecological hospitals, children’s hospitals,maternity hospitals, and maternity and child welfarecentres were not used as they might be in theirschemes. The last named should at least have themeans of diagnosis. The labelling of discharges inpregnancy as venereal should be avoided. Acentralised control of their schemes was very import-ant. Health visitors were not at present educatedfor following up V.D. cases. With ordinary carethere was no danger from contagion or cross-infectionin hospitals. In new general hospitals there shouldbe first-class equipment and service for dealing withvenereal diseases. There should be no labelling andthe same waiting-room should be used for differentpurposes at different hours.

Dr. VIOLET RussELL (V.D. Medical Officer, Guy’sHospital) favoured treatment for pregnant women atmaternity centres. There should be proper facilitiesfor diagnosis and a consultant available at all centres.Special difficulties arose from the attempt to transfer

pregnant women from the centres to the V.D. centresfor treatment, and, in order to secure the desiredresult, everything must be made easy and pleasantfor the pregnant woman. Children with congenitaldisease and their mothers, when not pregnant, couldbe treated at the V.D. clinics. She had met withcases of gonorrhoeal vulvitis in girls spread byunhygienic w.c. seats, and advocated the use ofseats such as those used on the Continent. As theresult of five years’ experience at the antenatalclinic, they had found 5 per cent. with a positiveWassermann reaction. Diagnosis was often difficultclinically and the patient was frequently unaware ofher complaint. The medical officer of the antenatalclinic should not wholly let his patient go but shouldcall in the V.D. officer to carry out the special treat-ment. Lock hospitals should be abolished. Theirgreat aim should be to secure the antenatal examina-tion of every pregnant woman and the early treat-ment of every syphilitic so found.

Dr. NoRAH I. WATTRE (Assistant V.D. MedicalOfficer, Glasgow) thought that antenatal supervisionin Scotland was now extended to about 50 per cent.of pregnant women. She alluded to the difficultiesin the diagnosis of gonorrhoea and advocated severalexaminations. Treatment was provided in Glasgowat the centres but cases requiring daily treatmentreceived such at the V.D. clinic, while still attendingonce a week at the centre. This compromise workedsatisfactorily.

Dr. NAYLOR BARLOw (M.O.H., Wallasey) com-plained that the Ministry had recently refused togive consent to the establishment of a first-classcomposite clinic, including V.D. in Wallasey.

Dr. D. BREWER (M.O.H., Swindon) said thatsuspects should not be sent to the V.D. clinics.He would like to see the special treatment carriedout by special officers at a general clinic as proposedat Wallasey.

Miss Mussorr advocated the treatment of expectantmothers at maternity hospitals.

Dr. P. S. BLAKER (Dudley) stated that they hadappointed a new V.D. officer to do antenatal and otherwork with facilities for immediate diagnosis at thecentres, thus linking up the V.D. with the M. & C.W.work.

In reply, Dr. LEES expressed his opinion thatgonorrhoea was not a cause of puerperal septicemiabut rather of a sapreemia arising about the tenthto the fourteenth day. Antenatal work diminishedthe risk of septicaemia. Any child born with asyphilitic rash in a maternity hospital was a reflectionon our schemes and meant failure to secure antenatalsupervision and early treatment. He spoke approv-ingly of the great increase of suspects at their clinicsin Edinburgh. Linking up well-equipped premisesfor the work, and a juster appreciation of the realrisk of contagion were both very necessary. As thesediseases were so frequently not acquired " venereally,"he preferred to call a spade a spade and to talk aboutgonorrhoea and syphilis rather than venereal disease.

WORK OF GuY’s HOSPITAL.-The annual report ofthis great institution shows that in 1928 11,000 in-patientsand 126,000 out-patients were treated at a cost of B180,000 ;out-patients made 547,000 attendances. The income fromendowments was .866,567, but the annual subscriptionsamounted only to 66,000. The downward movement ofthe rate of mortality which for three years had remainedstationary at 56 per cent., has been resumed, and last yearwas 5-2 per cent. There has been a remarkable growth ofconfidence in the venereal diseases clinic. In 1924 ,its firstyear as a whole time clinic, the attendances numbered21,706 ; in 1928 they were 61,148. The percentage of casesdischarged as cured shows a marked upward curve. A newdeparture is the allotting of four beds to cases requiringextensive or special types of dental treatment. In theState examinations Guy’s nurses were notably successful,only four out of 78 failing in the preliminary, and two outof 54 in the final. At the close of the year the total numberof available beds was 646.

72 REVIEWS AND NOTICES OF BOOKS.

Reviews and Notices of Books.A TEXT-BOOK OF PULMONARY TUBERCULOSIS FOR

STUDENTS.

By R. C. WINGFIELD, M.B. Oxf., F.R.C.P. Lond.,Medical Superintendent, Brompton Hospital Sana-torium, Frimley. London: Constable and Co.,Ltd. 1929. Pp. 401. 31s. 6d.

THIS book is clearly written and full of informationwhich will be appreciated not only by the student butalso by tuberculosis officers and others interestedin consumption. The first few chapters deal withepidemiology and the effect of the tubercle bacilluson the tissues, and here we are in the realm of debate,but the author’s arguments are well expressed, andhis summing up of the experimental work and viewsof different authors is lucid and convincing. Heemphasises the fact that tuberculosis in the adult is

practically confined to a chronic disease of the lungsand cannot be compared to tuberculosis in the infant,where the manifestations of the infection are so

different that they produce quite another type ofdisease. The decline in mortality is ascribed tourbanisation, which, though leading to a preliminaryrise in the death-rate, is followed by a fall as thesucceeding selected generation, immunised by theinfantile infection, reaches adult age. The adult isrelatively immune, but if an old lesion (not of necessityin the lung) becomes active or reinfection takes placeat a time when immunity happens to be at a low ebbthe bacilli may multiply and be carried to the lungsin sufficient numbers to cause phthisis.

There is a very full account of methods of physicalexamination, but the reader is warned that physicalsigns no longer hold the " pride of place in the equip-ment of the chest specialist " as in days gone by. Thethorax is by no means built to pattern, and, therefore,even in health, sounds heard on auscultation or per-cussion will vary, and what is normal in one may beabnormal in another. The importance of a careful andthorough physical examination is admitted, but in mostcases symptoms and other means of examination pointto a true diagnosis before the appearance of physicalsigns, and the old habit of giving a clean bill of healthbecause no signs are detected is fortunately passingaway. The author rightly emphasises the fact thatit is not enough to say " this patient is infected withtubercle bacilli," but one must also go on to saywhether the symptoms are or are not due to thatinfection. In Chapter IX., which deals with classifi-cation and assessment, it is clearly explained thatalthough pulmonary tuberculosis is one disease, yetit is a disease of many phases, each requiring differenttreatment.The last eight chapters are devoted to treatment,

and it is most refreshing to find so much space givento such an important subject. The reader is warnedto shun the extremist, and the author himself keepsan open mind. For example, he does not regardtuberculin as a really valuable method of treatment,yet he devotes a whole chapter to a fair discussionof its possibilities and limitations. The descriptionof sanatorium treatment is of special interest for thepurpose of the treatment is made clear, and one cantherefore understand why certain patients are

unsuitable and others obtain great benefit. The chiefcriticism of the sanatorium system is that it failswith advanced cases, but, after all, its main object isto prevent mild cases from becoming advanced.Many a life is thrown away by waiting for the patientto pass from the early and curable into the later andincurable stage before advising sanatorium treatment.We agree with the author that the physician whobewails the results of sanatorium treatment amonghis patients is oftentimes but bewailing his owninefficiency. The technique of the simpler laboratorymethods are described in a brief appendix, and thebook concludes with a useful index.

A text-book on tuberculosis was wanted. This onecan be thoroughly recommended to all interested intuberculosis, not only as a text-book but also as awork of reference.

HANDBOOK OF CLINICAL CHEMICAL PATHOLOGY.

By FRANK SCOTT FOWWEATHER, M.D., M.Sc.,D.P.H., F.I.C., Lecturer in Chemical Pathology,University of Leeds. With a foreword by SirBERKELEY MOYNIHAN. London: J. and A.Churchill. 1929. Pp. 216. 8-f. 6d.

IT is obvious that the study, by means of chemicalanalyses, of the fluctuations and alterations of thebody’s functions has thrown considerable light on themechanism of disease, and in this field the subject ofchemical pathology has surely still more to give to us.Its chief interest to the medical profession appears tobe on a somewhat lower plane, for the demand fornew and practical methods of diagnosis Tby means ofwhat are usually described as " laboratory tests " isinsatiable. In an age when most of us are afraid ofnot being up to date these tests are much in vogue ;and the author of this book, realising the inherentdangers of such a situation, has set out to describehow, when, and why they should be carried out. It isnot a laboratory manual, and all details of the actualmethods of analyses have therefore been avoided.The investigation of renal function, liver function,gastric function, and so on are dealt with on conven-tional lines in a simple manner which should be usefulto the student. Apart from the description anddiscussion of diagnostic tests there are other chaptersdevoted to some of the recent advances which havebeen made in medicine. In these are described thevitamins and deficiency diseases, basal metabolism,anoxoemia, acid-base balance, and the toxaemias of

pregnancy.There is no information in the book which is not

already available elsewhere, for the most part in theseries on Recent Advances issued by the same pub-lishers. But Dr. Fowweather presents it clearly andconcisely and has produced a useful guide to thesubject. The chief disappointment of the book isthat the reader is left in considerable doubt as to thevalue of some of the tests. We exclude from thiscriticism the chapters on the investigation of pancreaticand intestinal conditions where definite pronounce-ments are made on the uselessness of many tests andon the value of others. The experience of the Leedsschool, which has such a high reputation for surgery,on the value of chemical tests for the diagnosisof cancer and ulcer of the stomach, would have beeninteresting. Tests for occult blood in the faeces arehighly esteemed in some places and neglected else-where. For these very reasons, perhaps, the authorhas been content to describe some of the tests and toleave their assessment an open question.

THE TROUBLED CONSCIENCE AND THE INSANE MIND.

j By CHARLES BLONDEL, Professor of Psychologyin the University of Strasbourg. With an intro-duction by F. G. CROOKSHANK, M.D., F.R.C.P.London : Kegan Paul, Trench, Triibner and Co.,Ltd. Pp. 91. 2s. 6d.THIS little volume is one of the Psyche Miniature

Series, and will prove of very genuine interest topsychiatrists, and to the general reader with a tastefor philosophical study. It is not quite clear who isresponsible for the admirable translation fromFrench into English, but Dr. Crookshank providesan introduction in which he gives a résumé of thepsychological conceptions behind Prof. Blondel’sessay. The translation is so good that the readerwould forget that the essay was originally writtenin French but for the constant use of the term" delirium," not only in the usual English sense ofthe word, but also as a synonym for

" psychosis."The book is an attempt to explain the irrational

and dissociated behaviour and language of the insane.