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LIVERPOOL MEDICAL INSTITUTION.

THE last ordinary meeting of the session was held on IApril 28th, Dr. J. E. GEMMELL, the President, in the chair. IDr. FRANK H. BARENDT read a note on the Antiquity

of Syphilis.Dr. ISAAC HARRIS read a paper on the

Value of the Electro-cardiograph in Diagnosis andProgno8Í8.

Whilst the electro-cardiograph had its limitations, therewere, he said, a great number of affections of the myo-cardium which could only be diagnosed by means of it.The practical significance was indicated of an inverted T inthe second lead, of abnormal Q.R.S. complexes and othercardiographic aberrations. A case of auricular fibrillationcomplicated by degeneration of the heart muscle was givenas an illustration of the value of electro-cardiography asguide in treatment. Digitalis was to be avoided in such acase which could not be diagnosed without the cardiograph.In regard to the Adams-Stokes syndrome, Dr. Harris pointedout that in his experience heart-block, partial or complete,uncomplicated by degeneration of heart muscle, never gaverise to the syndrome, while whenever it appeared degenera-tion of the muscle was found. Hence Mackenzie’s con-tention that the svndrome was due to a sudden transitionfrom normal to ventricular rhythm was considereduntenable. The prognosis of these cases was, as a matter offact, much worse than that of ordinary block.Dr. JOHN HAY said that it was essential to understand

what an electro-cardiogram represented. It gave in graphicform the variation in electric potential associated with eachsystole of the heart and nothing more. If for any cause anyportion of the heart beats abnormally there was a change inthe curve. Fibrillation, flutter, extrasystoles, heart-block,relative hypertrophy of either ventricle all presented theircharacteristic electro-cardiogram because some portion ofthe heart was contracting in an abnormal manner. A

recognition of these variations made diagnosis certain,and brought some accuracy into prognosis. Variationsin the ventricular complex were significant of myo-cardial damage-i.e., arborisation-block. Data were beingcollected of patients presenting bizarre forms of Q.R.S.complex. At the Royal Infirmary cases of auricular fibrilla-tion in which this unusual form of electro-cardiogram waspresent were being observed in regard to the course ofthe disease. In patients suffering from fibrillation therewas a small percentage in whom ectopic beats occurred;the prognostic import of this abnormality was not yetsettyed, though it was considered to indicate a seriousoutlook.

. Mr. FRANK JEANS read a note on the Uses and Limita-tions of the Cystoscope, with special reference to con-

ditions in which the cystoscope was the sole method ofdiagnosis.Mr. G. P. NEWBOLT described a case of Cyst of the Brain

occurring in a youth aged 17. ICorrection.-In a report of a paper read by Dr. Jane

Walker before the London Association of the MedicalWomen’s Federation on Tuberculosis in Children of SchoolAge, which appeared in THE LANCET of April 23rd (p. 862),the following sentence occurs: " From 1914 to 1919 at theEast Anglian Sanatorium 62 per cent. of the 807 childrenhad T.B. in the sputum and of these 56-4 per cent. died."This should read : "From 1914 to 1919 at the East AnglianSanatorium 68, or 6" per cent., had T.B. in the sputum andof these 35, or 56’4 per cent., died."

’i’HE SOUTHERN UNIVERSITIES OF IRELAND AND THEELECTIONS.—Our Dublin Correspondent writes : "It issymptomatic of the lack of interest shown by the Irishpublic in the elections to the Southern Ireland Parliamentthat, writing only a few days before the nominations, onecannot discern with any certainty what candidates arelikely to present themselves in the two university con-stituencies. Dublin University and the National Uni-versity are each entitled to elect four members. Inregard to the former, three or four names havebeen mentioned in the press, of whom some at leastcould hardly be regarded as serious candidates if theelection were a serious affair. Among them no medicalname occurs, nor have I heard of any medical man con-templating candidature. In the National University it isunderstood that Professor John McNeill, the presentmember for the University, will be a candidate, but it is notknown who his colleagues will be, or whether there will bea contest. The likelihood of a contest is much diminishedby the decision of Mr. Dillon not to encourage Nationaliststo seek election at present, but there may be someindependent candidates."

Reviews and Notices of Books.DISEASES OF THE SKIN.

By J. M. H. MACLEOD, M.D., F.R.C.P. London’:H. K. Lewis and Co., Ltd. 1920. Pp. 1307. f:310s.

Dr. MacLeod has dedicated his book to his colleaguesin dermatology, and the appreciation with which itwill surely be received by them should compensatehim for the infinite pains he has bestowed upon it.We think it may rank among the most authoritativetext-books of dermatology that has yet appeared inthe English language ; it is certainly the most readableEnglish modern work. It is unlikely that the charmand the vivid word-pictures which characterise Darier’s" Precis de Dermatologie" will ever be reproduced; thisstands alone and hardly admits of comparison. But Dr.MacLeod’s book resembles the Precis in this respect-while:his descriptions are admirably succinct, theyare not written in the text-book style which makesconsecutive reading almost an impossibility. Theauthor admits that he has been compelled to omita good deal of the historical side of the subject, andto restrict the bibliographies; at the same time he hasgiven us an excellent short account of the history ofleprosy. The bibliographies, if not complete, are at

any rate very useful, and, as a rule, the most importantreferences to the literature of the various diseases aregiven. Curiously enough, soft sore is not dealt with

except in the discussion on the diagnosis of genitalchancres, but this is not a very serious omission.No text-book can be quite up to date, but this volume

can be little criticised in this respect. A few importantsections might have been modernised. For example,in that dealing with oriental sore the treatmentis said to be "unsatisfactory," and, while Low’smethod of applying an ointment of tartar emeticis given, administration of antimony by intravenousinjection is not mentioned, although Ferra, of Brazil,used this method successfully several years ago.Again, in the description of xanthoma, which isincluded in the chapter on "Pseudo-neoplasms ofthe Skin," no reference is made to the work ofPinkus and Pick, and of Chauffard and his assistantson cholesterinæmia, nor is the fact mentioned thatin xanthoma multiplex, at any rate, the amountof cholesterin in the blood is greatly in excess.

Describing herpes zoster, Dr. MacLeod says : " Shouldsuppuration occur, the neighbouring lymphatic glandsgenerally become enlarged-a feature which has beennoted even in cases in which the lesions were un-contaminated by pyogenic micro-organisms;" and Dr.Henry Head, in a classical article on zoster, states that" in most cases the contents of the clear vesicles becometurbid. Possibly it is in connection with this pusformation that the lymphatic glands that drain theaffected tract of skin are in the majority of cases

enlarged." It is curious that these two accurateobservers should apparently not have noticed that theadenitis associated with herpes is such an earlysymptom that it certainly sometimes, if not always,precedes the appearance of the eruption.We are surprised, too, to find in the section on pruritus

ani that Murray’s view that the actual pruritus is due toinfection of the skin with the Streptococcias fœcaliswhereas local disorders of the rectum, threadworms,&c., are only predisposing factors, is summarily dis-missed as untenable, and treatment by vaccines asunreasonable. Bassler entirely supports Murray’swork, and considers that autogenous vaccine treatmentis the most valuable method in cases in which thepruritus persists after any local abnormality has beencorrected by operation or otherwise, and, according tohim, failure with vaccines is usually due to ignoranceof the technique and of the dosage required. The lastchapter is devoted to tropical diseases of the skin, uponwhich the author is a recognised authority, and it isto be noted that, in discussing the aetiology of pellagra,he seems rather to favour the views of Sambon, which,in the light of Boyd’s work among Turkish prisoners of

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war, to which no reference is given, and of the observa-tions of American workers on the subject, can hardlynow be seriously considered.

But, in criticising such minor points as these, we dobut emphasise the general excellence of Dr. MacLeod’swork; his clinical and histological descriptions are

clear, his discussions of the aetiology of diseases ofdoubtful causation are eminently fair, and the sectionson treatment are unusually detailed and helpful.We were particularly impressed by the sections onsyphilis and leprosy. The illustrations have been care-fully selected, and are almost uniformly good, and wegather that the publishers have spared no pains toassist Dr. MacLeod in the great task which he has sosuccessfully accomplished.

FEEBLENESS OF GROWTH AND CONGENITALDWARFISM.

By MURK JANSEN, O.B.E. London: Henry Frowdeand Hodder and Stoughton. 1921. Pp. 82. 12s. 6d.

Dr. Murk Jansen’s writings are suggestive, evenwhen we do not quite see our way to full agree-ment In this book he has endeavoured to show thecausative relations between several conditions, manyof them ill-defined, and all of them obscure, and to linkthese together as examples of the injurious effects ofnoxious influences acting on the growing body underdifferent circumstances and at different periods. Inthe first part, dealing with "feebleness of growth,"the author points out that this result may follow fromany injurious agent acting on the developing body, andthat it is proportional, not only to the intensity of thisagent, but to the rapidity of growth both of theindividual and of his various parts. Dealing mainlywith the skeleton, he goes into physiological details ofbone formation, and shows how these functions may beaffected. We do not think that there will be seriousobjection to the general " laws" which Dr. Jansen haslaid down to explain the affections with which he is deal-ing, and which enable him to bring them together as aseries in harmonious conjunction. The few paragraphsdevoted to growth feebleness in the soft parts mightprove of suggestive value to clinicians other than theorthopaedic surgeon.In the second part of this short treatise (Congenital

Dwarfism), however, we must join issue with theauthor on some of his suppositions. We have no

desire to lay stress on what are probably inaccuratedates in organogeny, for these are easily adjusted, butwe cannot help feeling that the author is mistaken inhis views when he refers the physical abnormalitiesin achondroplasia, anencephaly, &c., to the mechanicalaction of an imaginary small amnion. The amnionhas always been liable to indictment for all sortsof offences, and amniotic bands are a regular refugefor many aetiologists in their search for causes. Itcannot be denied that such bands occur, but theyare rare, and any connexion with deformities hasnot, we believe, yet been shown. In many casesan " amniotic band " is credited with an effect it couldnot possibly produce, even if it were present, andthe presence of an efficient cause of both the band andthe abnormal development, such as uterine disease, isoverlooked. Dr. Jansen, however, does not depend onsuch accessory structures in his aetiological conceptions,but postulates a shortness or want of growth of theamnion, probably only temporary in nature, to accountfor the interference with nutrition which he recognisesin his cases. We do not believe that any practicalhuman embryologist would admit for a moment thatthe embryonic amnion with which he is acquaintedcould, under any circumstances, oppose a barrier to thegrowing power of the embryo, or interfere with its

blood-supply, in the way imagined by Dr. Jansen. It

may be pointed out that one of the commonest andearliest signs of a pathological ovum or embryo is

enlargement of the amniotic sac, and diminution in itssize has not, so far as we know, been recorded. On theother hand, although it may not bear directly on the ques-tion, it is of interest to recall that in some of the lowervertebrates, the embryos develop under the pressure of a

’thick resistant zona, so that they are flattened out anddeformed by being pressed down to one side ; yet whenthe membrane gives way they are found unaffectedand pursue their course, straight, but otherwise asbefore. We do not see the necessity for the postulate.Surely the noxious agents which can be held responsiblefor upsetting normal nutrition may be thought potentenough to cause local emphasis, if periodicity is granted,without calling in the aid of probably impossible factors.

Dr. Jansen works in his theories most ingeniouslywith the facts, but, as we consider that the explana-tions are based on a wrong assumption, we cannotallow our admiration to alter our belief that theembryological evidence is against him. Nevertheless,we have no hesitation in recommending all those whoare interested in thoughtful contributions to the patho-logy of deformities to read this book. When they havefinished it they will probably have a better grasp of thesubject-matter of the work, whatever views they mayhold about the cast-iron potentialities of the amnion.

RADIOGRAPHIC TECHNIQUE.By T. THORNE BAKER, A.bT.LE. E. London: Con-stable and Co., Ltd. 1921. Pp. 196. 15s.THIS is a small volume devoted almost entirely to the

photographic side of radiography, and is evidentlywritten by one who is thoroughly conversant with allthe necessary photographic processes that go to makethe perfect radiograph. The author’s assertion thatthe photographic knowledge of many operators islamentably deficient is probably true, and it is to meetthis difficulty that the present volume is written. Apreliminary chapter is given on the installation itself,to aid the user to locate faults, but the main object isto explain and instruct the operator in carrying outthe dark-room processes, the proper management ofintensifier screens, and such other details as help tomake a radiograph pleasing to the eye as well as

valuable in diagnosis. The two concluding chaptersdeal with industrial applications of radiography, whichopen up a new field to this branch of science.

MANSON’S TROPICAL DISEASES.Seventh edition. Edited by PHILIP H. MANSON-BAHR, D.S.O., M.D. Camb., M.R.C.P. Lond. London :Cassell and Co. 1921. Pp. 960. 31s. 6d.

THE publication of the seventh edition of " Manson’s

Tropical Diseases," under the editorship of Dr. P.

Manson-Bahr, provides a most comprehensive and up-to-date study of the vast field of tropical medicine.The subject-matter of the new edition is divided intoeight sections and three appendices. Section I. embracesthe wide range of tropical fevers and occupies approxi-mately one-third of the whole volume.The subject of malaria is elaborately dealt with.

The whole question of quinine treatment and of themethods of administration is placed before the readerin a convincing and unbiassed manner. Due weight isgiven to quinine prophylaxis, but the importanceattached thereto previous to the war appears tohave been excessive. Certain points connected withthe epidemiology and endemiology of malaria are

emphasised as requiring further elucidation andexplanation, in particular " the exemption of certainislands from malaria, even though in the midst of anarchipelago of malaria-haunted islands " ; also theexistence of malaria-free districts surrounded by highlymalarious country and abounding in Anophelinse. Itis suggested that hyper-parasitism or the destructionof the plasmodium by some other kind of parasite, suchas the " black spores " described by Ross, may accountfor such anomalies. A lucid and interesting account isgiven of blackwater fever, the aetiology of which muststill be regarded as unsettled. New work on trypano-somiasis is included. The question of the identity ofT. rhodesiense and T. brucei is still much in dispute, asalso is the question of the harbourage of T. rhodesienseby big game. This point is important as it has beenraised in connexion with the desirability of gameextermination, as a means of prophylaxis in addition to

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the clearing of areas infested by Glossina palpalisand morsitans in the regions respectively affected byT. gambicnse and T. rhodesiense. It is curious thatantimony tartrate and atoxyl, though advocated in thetreatment of T. gambiense infections, are relativelypowerless against T. rhodesiense. The forms of leish-maniasis, kala-azar, oriental sore, and L. americanaare fully described with coloured drawings of the

parasites concerned. Remarkable results appear tohave followed the adoption of intravenous antimonytartrate treatment.In connexion with yellow fever the recent work of

Noguchi and the discovery of the leptospira conveyedby Stegonyicc fczsciceta promises to prove of the highestimportance. Recent researches into Rocky Mountainfever and typhus fever-in the case 6f the former byRicketts, and the latter by Arkwright, Bacot, andothers-are described, and lend much hope to the dis-covery of the real causes. In Rocky Mountain or

spotted fever the so-called Rickettsia bodies are the

supposed virus of the disease, conveyed by and foundin the tick Dermacentor venustus. In typhus fever andtrench fever similar bodies are met with ; and termedRickettsia prowazekii they are found in lice infected withtyphus blood. A full account is given of relapsing fever.The chief transmitting agent of the North African andEuropean forms of the disease, from the most recentevidence, is in all probability the louse (Pecliczclzcshumanus), whereas in Central Africa and Persia theticks Ornithodorus 2)tozibata and -4rgaspersicits are con-cerned as carriers. Considerable space is devoted tothe subjects of plague, Malta fever, and the entericgroup of fevers. The Marris atropine test receives afull description, and is noted as " the most importantcontribution made during the war to the diagnosis ofenteric fevers." Section I. concludes with a valuable

summary of the diagnosis of fevers in the tropics.Under Section II. are included " General Diseases of

Undetermined Nature"—i.e.,beri-beri, epidemic dropsy(war oedema), pellagra, and scurvy in the tropics. Thefood-deficiency and other ætiological theories are fullydiscussed. Under Section III. are described AbdominalDiseases. A graphic account of cholera and its treat-ment by Rogers’s intravenous injection of hypertonicsaline solution combined with injections of atropine, andalso by Cox’s method of slow intravenous injections ofisotonic saline fluid is given. The dysenteries, bothbacillary and amoebic, are considered in a full andadmirable account. Under Section IV. are describedthe infective granulomatous diseases, including, in

particular, leprosy and yaws, both of which are

graphically dealt with. In the treatment of leprosyprominence is given to the value of chaulmoogra oil, ofthe gynocardate and morrhuate of soda advocated byRogers and Muir, while the more recent soya bean oil,which is still on trial, is noticed. Section V. includesthe important group of animal parasites and associateddiseases. In the treatment of schistosome infesta-tions the value of intravenous injections of tartaremetic is mentioned as having been placed on a soundbasis by Christopherson. The important subject offilariasis is even more comprehensively dealt withthan in the previous edition. The succeeding chaptersof the helminthological section deal fully with fluke

parasites of the lung and liver in paragonimiasis andclonorchiasis and the many forms of infection by intes-tinal parasites, in particular ankylostomiasis. SectionVI.is devoted to diseases due to poisons, including thevarious forms of snake-bite, and an account is given ofthe vomiting sickness of Jamaica, the cause of which,long obscure, has been clearly determined by the ablework of Harold Scott to be due to ackee poisoning. Inthe two concluding sections are described tropical skindiseases and local diseases of uncertain nature, suchas craw-craw, chappa, climatic bubo, goundou, andainhum.The value of the new edition is much enhanced by

the important and practical information contained inthe three appendices occupying the last 200 pagesunder the headings of Medical Protozoology, largely thework of Dobell; Medical Helminthology, Entomology,&c., and a very complete account of laboratory methods

as applied to clinical medicine in the tropics. The lastwill undoubtedly prove of the greatest use not only tothose engaged in practice in the tropics and in theColonial Medical Service, but also to the student oftropical medicine at home.

, The outstanding merits of this edition, retaining, asit does, the lucidity of expression and charm of styleof previous editions, will ensure it a large circle ofreaders both at home and in the tropics. The type andgeneral arrangement of th6 various subjects are excel-lent, and the numerous coloured plates are beautifullyexecuted.

_______________

AIDS TO DENTAL SURGERY.Third Edition. By DOUGLAS GABELL. London :Bailliere, Tindall, and Cox. 1921. Pp. 132. 3s. 6d.

’ THE student will find this little book of some value ifhe will use it as an aid to revising his work andnot rely upon it for the purpose of cramming forexamination. The author might have added to theusefulness of the book by bringing it thoroughly up todate and extending certain sections-for example, thatdealing with the relation of dental sepsis to other

pathological problems. In the introduction attentionis directed to the necessity of ascertaining all the factsof a case by systematic examination, and a clearaccount is given of the way in which this examinationshould be conducted. There is a useful section on thehygiene and care of the teeth and mouth. Haemophiliais not mentioned-probably an oversight.

AN ATLAS OF NORMAL LABOUR.

WithanAppendix showing Sylvester’s and Schultze’sMethods of Artificial Respiration. By G. DRUMMONDROBINSON, M.D., B.S. Lond., F.R.C.P., ObstetricPhysician to the Westminster and West LondonHospitals. London : William Heinemann, Ltd. 1921.Pp. 104. 25s.

THIS Atlas consists of a number of photographs madefrom kinematograph films demonstrating the processesof normal labour in the living subject, and fromdrawings which the author had prepared for teachingpurposes. It is obvious that it is only possible toemploy the kinematograph to a very limited extent inshowing the various processes of parturition, and thatsuch photographs can only be obtained of the latterpart of the second stage and of some part of thethird stage of labour. The great majority of theplates, therefore, represent photographs of drawings ofwhat the author, no doubt quite correctly, conceives tobe taking place during labour. The actual kinemato-

graphic photographs of the stages of labour which it ispossible to represent in this way are very interestingand valuable, but the question must arise as to whetherthe results are worth the trouble and expense entailed.Nothing can be photographed in a case of labour whichcannot be equally well seen, and observation at thebedside must always be much more valuable than anyseries of drawings or photographs. The Atlas is, how-ever, an interesting production, obviously compiled onlyat the expense of much care and trouble.

THE EXTRA PHARMACOPŒIA.Sixteenth edition. Vol. II. By W. H. MARTINDALE,Ph.D., and W. WYNN WESTCOTT, M.B., D.P.H.London : H. K. Lewis and Co. 1921. Pp. 688. 17s. 6d.

THE second volume of Martindale and Westcottfollows rapidly on the first ; it has grown largely inbulk and usefulness since the last edition five yearsago. The scope of the volume is difficult to expressin a few words. Primarily it consists of analyticaladdenda to the materia medica described in the firstvolume. These are almost indispensable to anyonewho dispenses his own physic, but they should beappreciated, too, by all who desire to prescribe quickly,pleasantly, and effectively. A knowledge of the mannersand habits of drugs greatly enhances the range of

intelligent medicamentation. In this section appear in

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the present edition interesting notes on aspirin, cinchona,and digitalis. Around this primary nucleus has grownup layer by layer a number of sections on animalorganotherapy, on physiological methods of assay,on radio-active substances, and on the antisepticpower of disinfectants. The information may be avail-able elsewhere but only by stress and toil ; here it is accessible, precise, and properly documented. Notes on !the analysis of water, milk, butter, and the like, makethe book welcome in any laboratory, large or small. ! Bacteriological and clinical notes on special diseasesappeal to practitioners of medicine whose informationon, say, leprosy or leishmaniasis is not quite recent andmethodical. There is a large but not quite exhaustivelist of proprietary medicines and a glossary of foreignwords used in pharmacy, which contains the onlypiece of careless proof-reading in the whole work. Anindex is now added to include both volumes of theExtra Pharmacopoeia. It is not easy to commend thisbook to anyone unacquainted with it without appearingto exaggerate. Martindale and Westcott picks upmany of the fringes of medicine and makes them neatand tidy. Lacking it, the practitioner can hardly feelprofessionally quite well-groomed. The price has risenfrom 7s. to 17s. 6d., but value is offered for the extrahalf-guinea. _______________

JOURNALS.Journal of Laryngology and Otology. March and April, 1921.

Vol. XXXVI., Nos. 3 and 4.-In the March number ProfessorRoss Hall Skillern, of Philadelphia, discusses the operativetreatment of ethmoidal suppuration. He finds that patientsare frequently made worse by indiscriminate ablation ofethmoidal cells, and that in most cases the best results areto be obtained by preliminary removal of the middle turbmal,and then, after healing has occurred, by carefully following fthe pus to its ource; good stereoscopic skiagraphs are of material assistance.-Mr. James Harper describes a methodof partial thyroidectomy by which the gland is shelled out

‘

of its capsule with the finger; he claims that there is noshock nor risk of post-operative haemorrhage or of injury tothe recurrent nerve, and that it ’is never necessary to liga- Iture an artery.—Mr. Andrew Campbell describes Bezold’s

method of treating chronic suppuration of the middleear by intratympanic syringing, inflation, drying, andthe insufflation of boric acid.-The April number containsa description of four cases of thrombosis of the cavernoussinus, by Dr. Ritchie Rodger.-Mr. Layton reports a deathafter tonsillectomy in a man aged 32 years ; he had had thefauces anaesthetised two and a half hours before by injection

i of novocaine and adrenalin, and the pillars were sutured atthe close of the operation on account of persistent oozing,but bleeding recurred and was finally arrested about 11 P.M.,and the patient died at 4.30 on the following morning; it isdoubtful whether death was due entirely to haemorrhageas there was some post-mortem evidence of pulmonaryembolism.-Dr. J. N. Roy, of Montreal, describes thesuccessful removal by cesophagotomy of a foreign bodywhich had remained in the gullet for nearly 14 months.-Mr.W. M. Mollison contributes a study of the tonsil as a focusof infection in chronic arthritis.

Archires of Radiology and Electrology (January, February,and March). - Recent issues present many ’ subjects ofinterest. In the January number Dr. A. E. Barclay points outa danger attending the use of the Coolidge tube for screenexaminations, while some studies in gastro-intestinaldiagnosis are contributed by Dr. R. Knox.-Sir JamesCantlie describes an X ray motor ambulance for use at homeand in tropical countries that is likely to be of greatvalue. The question of pastilles and their colour measure-ment is dealt with by Messrs. Donnithorne and Baker, andemphasises the conditions in which these should be usedif reliable results are to be obtained.—In the Februarynumber Dr. Gosta Forssell, of Stockholm, contributes avaluable paper on the Differential Diagnosis of Tuber-culosis in Bones and Joints, which is admirably illustratedwith a series of splendid radiographs.-A sketch ofthe History of Electrotherapy by Dr. Hector A. Colwellis evidence of much painstaking research, and is accom-panied by many illustrations of persons, appliances, andmethods that have made the history of this interestingsubject.-Dr. Forssell’s paper on Tuberculosis is continuedin the March number, and Dr. J. Neil Leitch refers to someuses of the infrequently interrupted faradic current, whichseems to have a special value in cases of incontinence.-Theprinciple of the Bucky Diaphragm for radiography of thethicker parts of the body is described by Dr. H. E. Potter.-The usual sections are devoted to reviews, notes, andabstracts.

New Inventions.URETHRO-VESICAL MEDICATION.

(1) An Improved Irrigator Handle.THE advantage of the irrigator handle herewith illus-

trated is that by means of a special stopcock insertedin the stem the flow can be regulated from a drop to aforce sufficient to allow the fluid to enter the bladder,only one hand being required for this manipulation. Itthus does away with the necessity for any clip upon the

rubber tubing. A dome 41 in. in diameter, sufficient to protect from splashing, is soldered on to the stem at a Idistance from the rubber tubing, to permit of theinstrument being supported on the palm of the handand the flow controlled by compressing the rubbertubing between the thumb and index finger, as someoperators desire, yet the stream can immediately beshut off by closing the stopcock with the thumb of thesame hand. The stem projects from the dome a distancesufficient to give a good view to the operator when the

nozzle is inserted. The nozzles, metal or rubber, aremade in three sizes to suit a small, medium, or largemeatus. They block the meatus but do not enter theurethra. They are easily sterilised and extremelydurable.

The handle is made by Messrs. Allen and Hanburys,Ltd., 48, Wigmore-street, London, W.

(2) A New Syringe for the Treatment of the PosteriorUrethra.

In the treatment of chronic posterior urethritis or thesexual neuroses one often wishes to instil a medica-ment into the posterior urethra, and Ultzmann’s syringeis used for that purpose. All operators are aware ofthe difficulty of localising the instillation to the spotdesired, and unless considerable skill is used the fluid is

either injected into the bladder or into the anteriorurethra with unsatisfactory results. I have had madea solid ended catheter, 8 inches in length, with auniversal holder to fit an ordinary 20-minim recordsyringe. Down the centre of the instrument passesa fine bore which opens into a hollow notch, 1 inch inlength, placed on the convex side of the catheter curve.When the instrument is in situ the verumontanumprojects into this concavity and so can be treated; onslightly withdrawing the instrument the remainder ofthe posterior urethra can be dealt with.The instrument is made by the Holborn Surgical

Instrument Co., Ltd., Thavies Inn, London, E.C.

M. W. BROWDY, M.B., Ch.B.