945REVIEWS AND NOTICES OF BOOKS.

with othtr patients. Two months after the commence-ment of treatment at this ho-pital he went back to

duty in good health, his weight having increased 7lb.When the dysentery was cured this weak-n.inded man lackedthe initiative to tackle ordinary f(10d: he was drawn along thepath of the régime of a hospital, but at that stage a smallamount of individual attention would have obviated much ofthe subsequent state. So long as he was treated as aninvalid he remained such. A neurasthenic was usuallyreasonable, and much good resulted from making his

thoughts run along new lines. A somewhat similar casewas that of a soldier who had been in nine hospitalsbefore coming under Captain McDowall’s care. Anyemotion in his case caused vomiting, but a good resultwas obtained by psychical methods. He (the speaker)had not met with any cases of neurotic vomiting inwhich the symptoms were such as to endanger life, butin one case such a danger might have been possible, andthis was described in detail. A good result here. also,was anticipated. The exact mechanism of the productionof the symptoms was not clear, and how much was due tovagal stimulation was uncertain, The vagus c(,uld influencenot only the secretions, but the state of motility ofthe stomach muscle. Vagal stimulation performed ex-

perimentally, could produce turbulent gastric peristalsis,which might readily change into retrograde peristalsis, andvomiting might ensue The practical point was that thevomiting was due to emotional stress, and the treatment shouldbe directed to the offending emotional tone This couldbe done by givirg the patient a true insight into his

symptoms, removing any worrying element, and graduallyrestoring to him the sen-confidence which he had lost. Eachcase must be dealt with individually and on its own meri’s.

Dr. R. H. STEEN commented on the fact that many of thepatients whose cases Captain McDowall narrated showed ahereditary predisposition to the condition described andto nervous instahility. With regard to the strong influencewhich the emotions exerted on the bodily state, it had beenshown that this influence made itself felt, not only on thegastro intestinal tract, but also upon the adr na] glands. Hecould understand vomiting following a definite emotion,but he was anxious to know the views of Captain McDowallas to why the vomiting persisted.

Dr. R. ARMSTRONG- JONES thought, the thesis had supportedWilliam James’s theory, that the emotion was not the causeof the vomiting, but the vomiting produced the emotion.He asked whether the vomiting was accompanied by anyelev;4’ui,,i3 of temperature ; that was so in some cases ofshell shock he had seen in whom vomiting was present. A

strong emotion would often raise the temperature. Neuras-thenic" were very imitative, and it was bad policy to

place such cases in wards with patients who had fits. Heraised the question whether such men as Captain McDowallhad described were fit to be sent back to the fighting line.Mr J. NOEL SERGEANT expressed the view. from intimate

personal experience, that the victims of shell shock whovomited did not realise that the vomiting was due to theshock, but attributed it to some organic lesion. Theycontinued to vomit because their dread acted as a continualmental irritant.

Dr. C. F. FOTHERGILL said his custom was to show the

patients that the case was sympathetically understood, andthen feed them well. If they vomited a meal another shouldbe ready to give them. That had a very beneficial effect.

Dr. T. DRAPES (Enniscorthy) did not agree with Dr.Armstrong-Jones that the vomiting produced the emotion,especially as when the emotional state was abolished thevomiting ceased. These cases retained a condition ofcerebral irritability, and therefore of susceptibility to allinfluences.The PRESIDENT had found vomiting in cases of shell

shock comparatively rarely, but the cases which CaptainMcDowall saw were sent to a special institution.

ERRATUM.-In the report of the meeting of theMedical Society of London held on Nov. 13th, published inTBE LANCET of Nov. 18th, p. 864, we stated that LieutenantDunn, R.A.M.C., lecounted his clinical experience ofnephritis in France in the casualty clearing station zone.The initials of Lieutenant Dunn were given as W. H., but itwas Lieutenant John Shaw Dunn, R.A.M.C., director ofthe Clinical Laboratory, Western Infirmary, Glasgow, whocontributed to the debate.

Reviews and Notices of Books.C1’Owley’s Hygiene of School Life.By C. W. HUTT. London : Methuen and Co. 1916. Pp. 428.Price 3s. 6d.

Newsholme’s School Hygiene.By JAMES KERR. M D Cautab. Eleventh edition. With49 illustrations. London: George Allen and Unwin,Limited. 1916. Pp. 352. Price 4s. 6d.IT so happens that the two best English works dealing

with school hygiene were written by authors who were sub-sequently transferred to app’ intments under Governmentdepartments. We refer to , - Newsbo me’s School Hygiene"and " Crowley’s Hygiene of School Life " The advances inthis important section of preventive medicine and the altera-tions brought about by legislative enactments in recent yearsmade it imperative that both works should be rewritten ifthey were to retain their usefulness. The authors by reason of1 heir official position were debarred from performing this duty.During this year, therefore, we have had the coincidence of theissue of both books in a new form entirely rewritten by newauthors. It is no light task, and one from which manywould flinch, for a new author to rewrite a standard work ;and this is particularly so under the special circumstaJ cesin the case of these two books. We have therefore to

congratulate both Dr. James Kerr, who was responsible forthe rewriting of "Newshotme’s School Hygiene," and Dr.C. W. Hutt, to whom has fallen the same task in relation toI- Crowley’s Hygiene of School Life," upon the conspicuoussuccess which has crowned their labours. Under thecircumstances we have detailed it is inevitable that the onebook should seem to challenge conpatison with the other,and the doubt naturally arises whether one is not redundant.This fear is dispelled immediately upon a comparison of thebooks, which differ so greatly in content and in the treat.ment of the subject matter that no question of rivalry oreven of overlapping arises.

11 Newsbolme’s School Hygiene " has long been the familiarpossession of all those inteJested in the health of schoolchildren, but at the time of its first appearance in the year1887 under the signature of it original author, Dr. ArthurNewi-boime, the subject of school hygiene was little morethan a patthwo’k of h3gienic commonplaces applied to thespecial requirements of the school. To-day the subject hasassumed vast proportions, and it is not saying too muchwhen we claim that the very existence of a satisfactorystandard of physical health among the adult population, andconsequently of future generations. depends on the intelligentapplication of the principles of health in the interests of ourschool children at the present moment. The modest pro-pcrtions of 1, Newshoime’s School Hygiene," as presented byits early editions towards be end of the last century. wereimplicit in the existing conditions, but even then it alwayscontrived to keep a little in advance of the times and tolead rather than to follow. It. still remains true totradition, and in its new appearance there is no fallingaway from the high standards established. It is no exaggera-tion to say that as far as England is concerned we owe muchof the modern conceptions of school ygiene to Dr. JamesKerr, the author of tbl,.; new edition. A substantial portion ofthe research work which has been carried out in connexionwith improvements in the health and nutrition of schoolchildren has been pursued under his direction in theschools which are administered by the Education Com-mittee of the London County Council. In a sense thisnew volume is a memorial of the liberality and enterprise ofLondon’s edul ational authority, and of the zeal and hardwork of the large staff who have worked under their dis.

tinguished chief. As at present constituted, "Newsholme’sSchool Hygiene " is not only an authoritative text-book of allthat is soundest in the subject, but it also contains a greatdeal of original matter which heretofore has only beenindeper.dently published or has previously appeared in" School Hygiene " and other journals. The most superficialreadmg of the chapters on speech, eyesight, the care ofabnormal children, and deafness will convince the reader ofthe enormous progress which has been made in the subjectssince the publication of the last edition, and it is most

gratifying to us Englishmen to realise that most of these

946 REVIEWS AND NOTICES OF BOOKS. -NEW INVENTIONS.

advances are due to the work and enterprise of our owncountrymen. We feel convinced that for its size and scopetlaere is no more complete and valuable work on school

hygiene than Dr. Kerr’s new edition of Dr. Newsholme’swell-known volume.

Dr. Hutt’s standpoint is that of the administrator seekingto work out conscientiously the problems involved in the

practical application of such enactments as the Education(Provision of Meals) Act, 1906, the Education (Administra-tive Provisions) Act, 1907 the Education (Choice of E rnploy-ment) Act, 1910, or the Education (Defective and EpilepticChildren) Act, 1914. His book therefore deals with theactual world in which at the present moment the schoolmedical administrator finds himself and with the problemswhich immediately torment him, while Dr. Kerr’s bookis written from the point of view of the independent-investigator, untrammelled by the toils of administra-1tion. Dr. Kerr is original, stimulating, and provoking.His basis is the physiology of the child and his needs,and he does not concern himself with the practicaldifficulties of the administrator ; where his book touches

upon the limitations of the law it- is unconcernedor frankly critical. It enters a vast field of research,into which Dr. Hutt, working under the limitationsof legality, does not venture a foot. The great subject ofeducational hygiene, including the absorbing problems ofover-pressure, of curriculum, of the physiology of writingand of reading, fully treated by Dr. Kerr, is entirely ignoredby Dr. Hutt. This serves to emphasise what an importantsection of his work the busy school doctor has beenvirtually excluded from by the limiting effects of legislativeenactments. On the other hand, the administrator will lookin vain to Dr. Kerr’s. book for help or guidance on suchimportant questions as, for instance, the equipment of aschool clinic or *he administration of the Acts dealing withthe employment of children or the provision of school meals.For these he must have recourse to Dr. Hutt’s book.The books are thus complementary one to the other, and it is

a pity that the titles of the two works were not so framed asbetter to guide the student with regard to their respectivesubject matters. One does not expect, for instance, in a book

on the Hygiene of School Life" to find no reference to thesubjects of fatigue or of clothing. Dr. Hutt’s task has beenthat of discriminating selection from a vast amount of materialto be found in official reports. This he has performed withalmost unerring judgment, and his conclusions are in everycase eminently sound and convincing. We have detectedonly one error of judgment in the whole of the work, andthat is the useless reproduction on a reduced scale ofSnellen’s types for vision testing. Particularly admirableis his treatment of the infant and the infants’ school,including the lower age-limit of school attendance, daynurseries and schools for mothers, of the equipment ofthe school clinic and of the measures, including disinfection,to be taken for prevention of spread of infectious diseases.There is one practical difficulty constantly present to themedical administrator which has not received adequateconsideration at the hands of Dr. Hutt-we refer to the

freeing of the scholars in our public elementary schools fromthe infestation of parasitic vermin. The problem is urgentan clamant.With this one exception Dr. Hutt’s survey of the adminis-

tration of the Acts and official regulations in regard to schoolmedical work is complete, and it easily takes the foremostpiace amongst works dealing with this aspect of schoolhygiene. The excellence of the print and of the diagramsand illustrations is a little astonishing, considering theprice at which it is published. Together with Dr. Kerr’swork, it covers the whole field of modern school hygiene,and it may confidently be expected that these two bookswill long remain our best standard works upon this subject.

Th,e Making of Mieky Me Ghee, and Other Stories in Verse.By R. W. OAMPBELL. Illustrated by H. K. ELCOCK.London: George Alien and Unwin, Limited. 1916.Pp. 100. Price 3s. 6d. net.THE author claims nothing more for his stories than that

they are simply soldier rhymes, and he dedicates them to thegentlemen of the ranks with whom he has spent happy days.The rhymes are realistic and convey something of the

spirit as well as of the language of the trenches. Mr.Elcock’s drawings cleverly hit off the situations.

New Inventions.AN AMBULATORY EXTENSION SPLINT FOR THE

LOWER LIMB.

THE splint figured in the accompanying illustration wasdevised by us for the treatment of tuberculous disease ofthe hip, but can be used in many other cases in whichextension of the lower limb is desired. It does not claimto be superior to those extension splints already on themarket, but satisfies all the necessary requirements at a verymoderate cost, and thus falls within the reach of manyhospital patients who would otherwise have had to becontent with a

-

Thomas splint,patten, andcrutches. Thevarious parts ofthe splint are

well shown inthe illustration,and it is there-fore not neces-

sary to describethem, except tomention t h a tthe thigh-, leg-,and foot-piecesare made of pexuloid. The figure shows a lower limb withthe splint in position before extension has been made.After extension has been applied the knee-joint is lockedand the patient is ready to walk.

It will be seen that the splint is built in two sections, inthe upper of which is incorporated the pelvis and in thelower the foot, so in order to put the limb under tension itis only necessary to force the two sections firmly apart. Tomake extension the bars are drawn forwards in front of theknee, swinging on their pivots (A, B), and are fastenedtogether by fitting the pegs into appropriate holes; several

trials may be required to determine which hole shall be used.In this position the extension bars form a low trianglestanding on the limb as base, and since any two sides ofa triangle are together greater than the third, it follows thatwhen the bars have been pushed back into alignment thebase of the triangle will have become stretched to a lengthequal to the combined lengths of its other two sides, andthis effect will be more or less pronounced in proportion tothe height of the triangle. Powerful extension may thusbe obtained, and it is well to begin by using the highest pairof holes, since these are often found to give all the extensionneeded ; but later on, through loosening of the thigh-piece,stretching of the anklet, and such causes, lower pairs ofholes will be required. When the bars have been lockedtogether in alignment by the running lock (E) they are

screwea nrmiydown to steelstrips on thesides of thethigh- and leg-pieces at c, D,in order to givegreater rigidityto the splint.As thus des-

cribed, the

splint is seen inits fundamentalform in which itis admirable for

hip disease. When used for the treatment of other condi.tions involving contracture of joints the addition of certainaccessories may be required; thus it is a simple matter toadd an elastic toe-elevator for foot-drop or an anterior steelor elastic accumulator for the straightening of a flexedknee. The splint has been made for us by Longmates Limited, of

Weymouth-street, London, and has proved to be eminentlysatisfactory.

R. 0. WINGFIELD.St. Thomas’s Hospital, S.E. S. H. ROUQUETTE.

R. C. WINGFIELD.S. H. ROUQUETTE.