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chests of recruits at entry. He gave a description oftuberculin treatment as carried out at the Royal NavalHospital, Chatham, which in suitable cases had been foundto give excellent results.-An interesting discussion followed,in which the following officers took part: Surgeon-GeneralSir James Porter, R. N. (retired), the President, Fleet-Surgeon P. Bassett-Smith, R.N., Fleet-Surgeon A. Gaskell,R.N., Lieutenant-Colonel C. Birt, R.A.M.C., and SurgeonR. Connell, R.N.-The passing of a hearty vote of thanks,proposed by the President, to Surgeon Ross for his mostcomplete and valuable paper concluded the proceedings.

ÆSCULAPIAN SOCIETY.-A meeting of thissociety was held on Nov. 21st, Dr. David Ross, the Presi-dent, being in the chair.-Dr. Leonard Williams showed aboy, aged 16, who had ascites due to Tuberculous Peritonitisof four weeks’ standing on admission. He was treated withcalcium chloride and made a good recovery. The abdomendecreased from ;52’3 cm. to 43’3 cm.-Dr. P. Hamillshowed : (1) A woman the subject of Acromegaly with deepvoice, typical facies and hands ; also a skiagram of the skulland hands ; (2) a man, aged 23, with Enlarged Upper Jaw,who may be the subject of acromegaly.-Mr. P. MaynardHeath : (1) A baby, six weeks old, who had a CongenitalAngioma under the right hallux not involving the skin;(2) a boy, six years old, who had the sternal end of theclavicle dislocated forwards by the wheel of a van passingover the shoulder without fracturing anything. Fixation ofthe arm had not prevented the continuance of the luxation.

Reviews and Notices of Books.The State Provision of Sanatoriums.By S. V. PEARSON, M.D. Cantab., M.R.C.P. Lond.Cambridge: at the University Press. 1913. Pp. 80.Price 3s.

THE problem of the control and prevention oftuberculosis is ever before us, and the literature onthe subject is growing apace. Nevertheless, in spiteof all attempts to consolidate the efforts being madeto solve the problem, chaos still persists. Someobservers still maintain that the sanatorium isthe essential element in treatment-prophylacticand curative; others, that tuberculin is the onlyrational remedy that can be employed ; others thatthe dispensary, in its capacity of a remedial andeducational centre, is the institution absolutelynecessary for the success of any measures that maybe taken against the disease. The truth willprobably be found in a judicious combination ofthese methods; reliance on one alone will, weconsider, lead to failure.

Dr. Pearson is an enthusiastic believer in thevalue of the sanatorium, and in the work now beforeus he sets forth his views as to the State provisionof sanatoriums. He gives a short outline of whatvarious countries are doing in a similar direction,and advocates the principle that tuberculosis shouldbe treated separately when any scheme of sicknessbenefit or State insurance against sickness comesto be considered.

In the chapter on How to Raise the Funds and . Control the Efliciency of State Sanatoriums varioussuggestions are made as to how the necessaryexpenditure might be met. The author mentions fivesources, one or more of which might be drawn upon:(1) Voluntary charitable contributions from privateindividuals, generally the wealthy; (2) direct con-tributions from employers of labour to ensure thebetter efficiency of their employees ; (3) local rates;(4) the pooled contributions of the working classesthrough invalidity and sickness societies or otheragencies; or (5) taxes-through the NationalExchequer, He comments on these sources, but

does not advance mattors much further by argu-ment, recognising, no doubt, the dit1iculties. Hethen proceeds to show that the history of the.

gradual adoption by civilised states of the State.provision of relief for the destitute and for the sickexhibits certain well-defirred tendencies, of whichperhaps the most promising is the recognition ofthe advisability of having, for purposes of economyand efficiency, an overseeing central authority withadequate powers of inspection and control over thelocal authorities, who, as a rule, have originally hadthe sole responsibility of looking after the destituteand sick.In discussing the management of a sanatorium

Dr. Pearson says that when large numbers of

patients are being arranged for and economydemands a good deal of grouping, probably the-best plan is to have two slightly different classesof sanatoriums. One should be within reach ofpopulated centres, with a somewhat larger staff of £nurses, ward-men, or ward-maids, and so on, thanthe other type possesses; to this all patients shouldat first be sent. The other, situated in the moreremote country, is to be utilised by drafting thoseconvalescents into it who are able to take plentifulexercise or graduated labour. While agreeing withthis plan, we e doubt whether it is wise thatboth these institutions should be called sana-

toriums ; the first class of institution he mentionspartakes of the character of a hospital, whilstthe second is more what a sanatorium oughtto be.

Dr. Pearson’s observations are valuable as sug-gestions rather than as an answer to the greatproblem at issue; but he has collected together-a number of useful facts and has based uponthem certain proposals which are worthy ofconsideration.

Preventive Medicine and Hygiene.By MILTON J. RosENAU, Professor of Preventive Medicineand Hygiene, Harvard ; formerly Director of the Hygienic-Laboratory, U.S. Public Health Service. London andNew York: D. Appleton and Co. 1913. Pp. 1074, withnumerous illustrations. Price 25s. net.

Professor Rosenau has planned this work onbroad lines, with a catholic appreciation of the

subjects which form the foundation of scientificpublic health work, and of the necessity of exactknowledge in fundamentals, if preventive medicineis to be written about and practised in the waymost conducive to learning and practical progress.His personal experience in epidemiological investi-gations in America and in public health labora-tories in different parts of the world, as well as theindustry with which he has collected and studiedthe work of others, would in any case give im-portance to his presentment of modern preven-tive medicine, and no reader of this volumecan fail to appreciate the ability and soundjudgment with which the task has been carriedout.The order of the book illustrates the enlargement

which has for some time been taking place in theconception of preventive medicine. Questions of" environmental" hygiene, especially the sanitary

requirements of communities as represented bypublic works and local administration, are at leastas important and necessary as they always havebeen, and remarkable progress is being made yearby year in their efficiency. But they are, in thepresent stage of sanitary science, being over.

°

shadowed by the progress made in detecting the

1551

methods of transmission of disease, and iu devising means for protecting the healtlxy individual from (

the particular infections or for destroying living.carriers of infection. Professor Rosenau’s book l

plunges the reader at once into the prevention : of communicable diseases - a subject which 1

occupies the first third of the volume; thefollowing and a most valuable section deals with immunity, heredity, and eugenics ; whilethe remaining half of the work comprises chapterson foods, air, soil, water, sewage and refuse dis-

posal ; industrial hygiene; vital statistics, and

hygiene of schools. This latter part, it should besaid, gives evidence of much care in preparationand a considerable knowledge of practical sanitarywork in this country and on the continent, as wellas of the United States methods, which naturallysupply the principal text. The chapter on sewagedisposal has been contributed by Professor Whipple,of Harvard, and that on vital statistics by Mr. C. L.Wilbur, the chief statistician of the U.S. CensusBureau.

Reverting to the first part of the volume, it willbe found that Professor Rosenau has convenientlyclassified communicable diseases into (1) thosehaving specific or special prophylactic measures-small-pox, rabies, venereal diseases, prevent-able blindness, and tetanus ; (2) those spreadlargely through alvine discharges; (3) those

spread largely through discharges from themouth and nose ; (4) insect-borne diseases; andfinally (5) miscellaneous diseases, as yet notclassified. The chapter on the latter includes auseful treatise by Dr. Thomas Salmon on mentaldiseases. A perusal of any of these accounts of

n i..._ "’-"1 _ .o u r, n r

ainerent cuseases Will snow tnau rroiessor nosenali

has taken great pains to set out all salient facts andto form a well-balanced judgment of the variouscauses which affect the prevalence of each diseaseand the relative importance of different means ofprophylaxis. This is well illustrated by the chapterson tuberculosis, in concluding which the authorpoints out that its prevention is now less a medicalthan a sociological problem. The results of theenthusiastic attack on tuberculosis are encourag-ing, but its eradication, in the author’s opinion,must take a long time. " We should be satisfied," hesays with useful moderation, " if we diminish theamount of tuberculosis appreciably in a generation.The momentum thus gained will increase rapidly.The time will come when the comparatively fewcases left may be treated by compulsory isolation orother aggressive measures. Persistence along thelines now understood will in time control thedisease, which will be the crowning achievement inpreventive medicine." The observations on theprevention of small-pox and the value of vaccina-tion show similar breadth, though their value wouldbe increased for English readers if the author haddrawn upon the data afforded by English small-poxhospitals, both in regard to vaccination and theireffect in spreading the disease when they have beensituated in populous neighbourhoods. Carrierinfection in typhoid fever is fully described, butcare is taken to emphasise the necessity of givingfirst attention to removing conditions in whicheither a typhoid patient or a typhoid carrier couldcause an epidemic by wholesale infection of wateror food. The prevention of syphilis is fully dis-cussed, partly as a matter of early treatment of theindividual case and partly from the standpoints ofpersonal prophylaxis and continence. This subjectmay be expected in future to take a more prominent

place in text-books of hygiene than is at present thecase.

In conclusion, we may congratulate ProfessorRosenau on an admirable piece of work, which issure to receive careful attention from hygienists inthis country.

Treatment by Hypnotism ccncl Suggestion, or Psychotherapeutics. ,

By C. LLOYD TUCKEY, M.D. Aberd., First President of thePsycho-Medical Society. Sixth edition, revised and en-larged. London: Baillière, Tindall, and Cox. 1913.Pp. 431. Price 10s. 6d. net.

THE fifth edition of this book was reviewed atlength in THE LANCET of August 10th, 1907, p. 372,and we then took occasion to commend its lucidand pleasant style, its scientific and carefulcharacter, and the candour and adherence to factwhich are characteristic of the genuine searcherafter truth. There are considerable additions,particularly in Chapter VII., which deals with thesphere of action of hypnotic treatment. The

chapter still breaks the continuity of the theme ofChapters VI., VIII., and IX., which are concernedwith the scientific explanation of hypnotism, insteadof being transposed so as either to precede or tofollow them. We are glad to note that the authornowrelies on his own experience only in the chapter ofillustrative cases-which are not, however, greatlyincreased in number-and has omitted the recitalof cases reported by other medical men. There isalso a new note in the appendix on Spiritual andMental Healing, and reference is made to the" Emmanuel method " in America.

Dr. Constance Long contributes a chapter on

Professor Freud’s Theories and Treatment byPsycho-analysis, which is intended to serve merelyas an introduction for the uninitiated; for, as sheobserves, it is no easy task to give a true pictureof Freud’s psychology and psychotherapy in a shortessay, partly because much of it is still in a fluidstate.The book still suffers from the very annoying

defect to which we called attention in reviewingthe previous edition-viz., the absence of pageheadlines descriptive of the subject matter of thechapters. The monotonous repetition of the title ofthe book at the top of every page is as irritating tothose in search of a particular subject as it isentirely devoid of utility. Far better dispense witha headline altogether.The book is an excellent introduction to the

study of hypnotism.

Die Untersuchung dei- Nieneo und der Harnwegemit X Strahlen.

Von Dr. BELA ALEXANDER. Berlin : Oscar Coblentz.Pp. 59. Price 16 marks.

THIS volume is a monograph on the radiographyof the kidneys and urinary tract, and is mainlydevoted to discussions of cases illustrated in over 40large plates, which are the chief feature of thework, and are models of clearness and accuracy.Only one, however, is an actual reproduction of theoriginal plate, or

"

positive "

as the author insiststhat it shall be called, the others being mostlyoutline sketches reduced to two-thirds.The book begins with a historical sketch of the

evolution of the radiography of the kidneys fromthe first demonstration in 1896 of a stone byMacintyre, who used -,t Roentgen tube without

I accessories-undoubtedly the ideal procedure, but

1552

inapplicable in many cases. In 1897 Garrigouexhibited to the Paris Academy his so-called"

condenser," which gave more detail in theplates and reduced the time of exposure. Thiswas the precursor of the compression cylinderof Albers-Schonberg, of which the author uses

Rosenthal’s modification. We learn that the longestexposure employed is 10 seconds, but the authorgives hardly any details of his technique, an unfor-tunate fact, as its excellence is abundantly shownin the plates, some of which exhibit details notoften seen-e.g., the outlines of the spleen and ’

suprarenal capsules.Much stress is rightly laid on the importance of

aiming at a representation of the actual kidney onthe plate, but the author is not satisfied withmerely an outline, but in favourable cases succeedsin obtaining a perspective or " plastic " effect thatis certainly very remarkable. Fig. IV. shows suchdelicate shading that the kidney seems to stand outas a solid body, and the clearness of its relation toother structures, especially bones, almost remindsone of a dissection. A good plate should show thekidney, its size, contour, and position, the vertebralcolumn, and two lowest ribs, the psoas and quad-ratus lumborum. These structures are portrayedin their natural size, as measurements of kidneysand calculi removed by operation have proved.

After a description of the normal appearances aseries of plates is devoted to renal and uretericcalculi, and tubercle of the kidney, while conditionsthat may cause erroneous diagnoses are also shown—e.g., calcification of the cartilage at the tip of thetwelfth rib. One plate shows several calcifiednodules which are diagnosed as being situated notin the kidneys but in the perinephric fat. Lastly, achapter is devoted to the radiography of the lowerurinary tract with several illustrative cases workedout in detail with characteristic thoroughness.The volume will be found most useful as an atlas

of urinary radiography.

Trachoma and its Complications in Egypt, By A. F. MACOALLAN, M.D. Cantab., F.R.C.S. Eng.,Director of Ophthalmic Hospitals, Egypt. Cambridge : atthe University Press. 1913. Pp. 74. Price 7s. 6d. net.

No one is better qualified than the Director ofthe Egyptian Ophthalmic Hospitals to instruct us ontrachoma and its management. He has been inde-fatigable in his efforts to cope with this devastatingdisease where it is most rife, and he has brought tothe work just those qualities which are most essen-tial, though seldom combined in the same individual.With a thorough knowledge of ophthalmology anda sound judgment he combines exceptional admin-istrative- ability, and his efforts are being crownedwith the success they deserve.The book is founded upon the experience of more

than eight years in Egypt. There will soon be 14

hospitals under the director’s control, besides anumber of travelling hospitals. During the year1912, 341,211 attendances at the various hospitalswere made by 28,029 patients, and 21,315 opera-tions were performed. It is no exaggeration tosaythat nearly if not quite all these patients sufferedfrom trachoma.

Dr. MacCallan reviews the history, climatic andracial variations,mode of infection, clinical features,and pathology of the disease. He has introduced,avery useful classification of its stages : I., Incipient;ILa, follicular; H.b, follicular associated with

papillary hypertrophy; III.,early cicatricial; and

IV., completely cicatrised. Stress is laid uponthe varieties of acute conjunctivitis complicatingtrachoma. We read nothing of " acute trachoma,"and our opinion, founded upon smaller experience,that the cases thus described are really ordinarytrachoma complicated by an acute conjunctivitis, igconfirmed. Part III. is devoted to treatment, andshould be carefully studied by all who have to deal,with these troublesome cases. In Part IV. thedifferential diagnosis, prognosis, influence oftrachoma on ophthalmic operations, prophylaxis,causes of blindness in Egypt, and statistics are;

discussed.Within the limits of 70 pages Dr. MacCallan has.

given us the quintessence of the subject, and we.congratulate him upon the result.

lllaladies du Coit.

Par JOSEPH ARROU, PIERRE FREI)ET, et ERNESTDESMAREST, Chirurgiens des Hôpitaux de Paris. Avec41 figures dans le text. Paris : J. B. Baillière et Fils,1913. Pp. 166. Price, paper, 4 francs; bound, 5.50 francs.THIS is a section of the large and important,

" System of Surgery," edited by Professor Le Dentuand Professor Delbet. It is written with the

thoroughness which has characterised all the partsof the work hitherto published. Injuries of theneck, abscesses, and inflammations are consideredin turn. The subject of enlarged glands is treatedfully, and the authors draw attention to the dis.proportion which often exists between the smallsize of a malignant growth of the pharynx oroesophagus and the great enlargement of thecorresponding glands. They also point out howoften the supraclavicular glands are enlargedin malignant disease of such distant organs as;

the kidney, ovary, and testis; but the stomach.and uterus are far more frequently the sites of.the primary growth than are the other organs,mentioned. An interesting section is that devotedto the study of the congenital cysts of the neck and.the tumours arising from them.. The volume:contains also a chapter on torticollis.

Fortschritte der Naturwissenschaftlichen ForschungHerausgegeben von Professor Dr. EMIL ABDERHALDEN,,Direktor des Physiologischen Institutes der Universitat-Halle a.S. IX. Band. Mit 102 Textabbildangen und’2 Tafeln. Berlin und Wien : Urban und Schwarzenberg..1913. Pp. 280. Price, paper, 15 marks; bound, 17 marks.

OF the four articles which constitute the text ofthis volume, two-viz., the Present Position of

Investigations in Regard to Lakes, and more espe-cially of their temperature, by Professor W:

Halbfuss, of Jena, and the Houses and Structureof the Habitations of Freshwater Insects, by Dr. C.Wesenberg-Lund, of Hillerod, Denmark-are ofgeneral interest, but the other two-the one on.

Diving, by Dr. Robert Stigler, of Vienna, and theother on the Significance of the Thymus Gland for-the Organism, by Dr. Arno Ed. Lampe, of Halle a.S..-are of special interestto medical men.Diving is considered from a physiological point

of view in three groups : (1) Naked diving-i.e., with arrested respiration and no technical aid; ;:(2) where the diver under water breathes through’a tube which opens free to the air-that is, breathes.the air at atmospheric pressure; (3) where the*diver breathes compressed air, which either he’takes with him in a closed vessel or is suppliedto him from above. Full justice is done to thework of Dr. J. S. Haldane and to. the well-known

1553

investigations of Dr. Leonard Hill in this country. a

The physiological actions of water pressure are "

considered on the respiratory movements and sthe circulation. A large number of the author’s fown observations are included in the text. It is E

proposed in a second communication to give an (

account of the chemistry of respiration during (

diving or prolonged submersion. lFor medical men, however, the chief interest

attaches to the article on the thymus gland. After

dealing with the phylogeny, ontogeny, anatomy, morphology, and involution of the gland, its physio-logy is next passed in review. From the historical

point of view much may be left unread, as the earlymethods of excision (1845 onwards) were too crudeto allow of conclusions of any value to be arrivedat. With improved surgical technique the effects ofits removal resulted in the establishment of thefact by Basch in 1902 of the intimate relationshipbetween the gland and ossification-the changes inthe bones being most profound, a result confirmedby Klose and Vogt. A description is given of thephenomena manifested by dogs after removal of thegland as observed by Klose and Vogt. Its removalalso affects the nervous system, leading to a condi-tion which has been called idiotia thymopriva, andto a remarkable change in the relation of the

peripheral nerves to electrical stimulation. It isnot a gland concerned in blood formation, but ratheran organ with an internal secretion which may acton blood-forming glands. It is stated that in everycase of Graves’s disease there is an abnormality ofthis gland, and it is maintained that there is adysfunction not only of the thyroid but of thethymus as well. Short references are included asto its relation to the organs of reproduction.

The Microscopist’s Vade-Mecum: A Handbook of theMethods of Microscopic Anatomy.

By ARTHUR BOLLES LEE. Seventh edition. London :J. and A. Churchill. 1913. Pp. 526. Price 15s. net.

THE last edition of this book was- reviewed in THE LANCET of Oct. 28th, 1905. Since then very con- j siderable strides have been made in microscopical technique, and so far aswe can judge from a judicious perusal of the 929 distinct subjects dealt with, the author has brought this vade mecum well up todate. It is much more than a mere compendiumgiving methods useful to the human microscopist.It takes practically all animated nature for its

province, so that students of vertebrate as well asinvertebrate structure will find a plethora ofmethods to choose from. Indeed, for an inexperi-enced person there is almost too much. In thisedition something like 700 new entries have beenmade, but owing to judicious pruning the size ofthe book has not been increased.The general arrangement remains as before, with

few illustrations, but an endless number of formulaewith references to the sources from which they aretaken. In Part I., which occupies about one-half ofthe text (pp. 1-253), general methods are dealt with.The methods of Gibson for the use of media formounting, which do not call for essential’oils orother clearing reagents, have been introduced(paragraph 449, p. 247). Objects can be mounteddirect from alcohol, whereby unstained or insuffi-ciently stained elements acquire the right degree ofvisibility, thus enabling the observer to see detailswhich are invisible in the usual mounting media.The media consist of solutions of gum sandarac in" camsal " and other solvents.

" Camsal" is a liquid

formed by the mutual solution of two solids-salol

and camphor. One of these media is called

’euparal," a mixture of camsal, sandarac, eucalyptol,and paraldehyde. The new media can be obtainedfrom Griibler and Hollborn, of Leipzig. In Part II.special methods with examples are given. In viewof the importance of unicellular organisms as thecause of many diseases, the cytological methodshave been carefully overhauled, while the sectionsrelating to blood and blood parasites have beenlargely rewritten. The advances in the techniqueof the nervous system have also demanded manychanges and the incorporation of new matter.The evidence of the importance of the neuro-fibrillar structure of nerve fibres and cells has ledthe author to incorporate the new methods fortheir demonstration, while the section on neuro-fibrils has been almost entirely rewritten. Formerlythe silver staining methods of the nervous tissueswere often most capricious in their results. Themore certain and precise methods of Cajal are

given at length from the original sources.The typography is excellent, with sufficient space

between the sections, while the titles in blacklettering enable the reader quickly to pick outwhat he desires to find. A compendium like thiscannot be made all at once; it must grow byjudicious additions and deliberate excisions, and wethink that in both these directions the author hasexercised a wise choice. The result is a reliableand up-to-date companion in the intricacies of

modern histological technique.Clinical Surgical Diagnosis for Students and

Practitioners.By F. DE QUERVAIN, Professor of Surgery and Direct01of the Surgical Clinic at the University of Basle. With510 illustrations and 4 plates. Translated from thefourth edition by J. SNOWMAN, M.D. Brux. London:John Bale, Sons, and Danielsson, Limited. 1913.Pp. 779. Price 25s. net.

IN our notice of the original of this work werecognised that it was above the average, both iniesign and execution, and we are pleased to see itin an English version. In each case which theauthor puts forward for study and elucidation hestarts from the symptoms of which the patientcomplains, and so works up to the cause of the

symptoms. Little more than a glance is requiredto show the reader that the book is the product ofan extensive knowledge of teaching the subjectand an intimate acquaintance with the needs of thestudent. There are more than 500 illustrations,and these have been chosen with care; the coloured

plates also are clear. Some represent the areas

of the skin corresponding to the different nerveroots; another excellent plate shows diagrammatic-ally the various forms of tuberculous disease of theknee, and in similar way, where it is necessary,the help of illustrations is drawn upon. The transla-tion has been well done, and only occasionally dowe meet with expressions which are not used inthis country, as, for instance, "Fibro-adenoma phyl.lodes " and " cellular emphysema."

Die Serodiagnose (ler Syphilis und ihre Bedeutungfiir Diagnose, Therapie und Prognose.

Von RUDOLPH MÜLLER, Assistent der Klinik fur Syphilo-logie und Dermatologie in Wien. Berlin und Wien : Urbanund Schwarzenberg. 1913. Pp. 171. Price, paper,7 marks; bound, 8.59 marks.

-

THE importance of the presence of a positiveWassermann reaction on the diagnosis and pro-gnosis of syphilis can hardly be over-estimated, and

1554

therefore this reaction deserves to be carefullystudied. It cannot be said that we have yetobtained the best method of applying the test, andany modification which will simplify it with-out impairing its trustworthiness would be a

decided gain. Dr. Rudolph Muller’s work is a

thorough study of all the features of the subject.The various modifications are first given, and thenthe best form of the test, according to the author’sopinion, is described in detail. The second portionof the book deals with the clinical aspect, and theauthor discusses the presence of a positive reactionin certain other diseases; next the value of thetest in the different stages of syphilis; then theeffect on the test of antisyphilitic treatment; andlastly, the use of the reaction in the treatment. A short bibliography of the papers contributed by theauthor on the subject is appended.

LIBRARY TABLE.

Lip-reading. By EDWARD B. NITCHIE. London :Methuen and Co. 1913. Pp.324. Price 5s. net.-Thisis a valuable little book, inasmuch as the authorgives in it much personal experience from adouble point of view-he speaks both as an

expert lip-reader and as a teacher of that difficultaccomplishment. The qualifications do not oftenrun together. The book is divided into two parts.In the opening chapters of the first part will befound a very clear statement of the difficultiesand shortcomings of deaf people, while the failureof the general public to be sympathetic towards thedisabilities of the deaf is shrewdly noticed. Thefailure to help the deaf over some of the hard

places of their lives is very common among us, andMr. Nitchie’s appeal loses none of its force becausehe is brave enough to be humorous where thesituation he describes is often pathetic. Tothe deaf his advice is equally salutary. In a

moderate yet forcible way he urges those whocannot hear to strive against the results of theirdeprivation, while he shows the public with whatlittle inconvenience to themselves and with whatlittle change in their usual social habits they canbring helpful intercourse to those bereft of one ofthe most important senses. Chapters IV. to XI.,inclusive, deal with a general view of themethod of teaching lip-reading and each of thelines that a teacher or pupil should work along con-temporaneously. It is interesting to note how Mr.Nitchie dwells upon the training of the pupil’smind to follow thought as being equally importantas that of training his eye to read words, or perhapsmore so. It is not of necessity the possessionof a pair of sharp eyes that helps to make a goodlip-reader; an alert and receptive mind is wanted,and be it observed such receptiveness can only becultivated by sympathetic instruction. Another

important point on which the writer insists is thenature and speed of the speech which shouldbe used to the lip-reading deaf; there mustbe’ no mouthing and no excessively slow speech,but distinct utterance. This is a hint that will beof great value to deaf people if it is taken by thosein their environment. The second part of thebook gives outlines of lessons and sections oflessons for use by both teachers and pupils. Itincludes stories and conversations, and sentence,word, and sound exercises. All such systematicinstruction can be made of great use to adults whohave lost their hearing and are studying lip-reading, as well as, to a large extent, to teachers.Doubtless the classification of sounds will present

a new view to many, and indeed it gives room fordiscussion, but it is interesting as well as practical,for it has been arranged from the point of view ofan experienced lip-reader. As a rule, we obtain ourschematic information from teachers, not them-selves dependent upon lip-reading for communica-ting with their fellow men. The series of lessonscontains many useful points which could scarcelyhave been made by anyone who had not passedthrough the ordeal of losing one sense and learntto substitute another for it. The book will beuseful to teachers of the deaf, for they willunderstand better from it the difficulties oftheir pupils. The pupils will find in it much

help and encouragement. And medical men mightwell recommend its perusal to those members ofthe public interested in social work. If people ingeneral would read and apply the hints containedin the opening chapters, the everyday hardships ofthe deaf would be considerably alleviated. Howreal those hardships are is little a,ppreciated, andas little is the valuable bond between the deaf andthe world at large which is furnished by lip-reading.

Lippincott’s New Medical Dictionary. A Vocabti-lary of the Terms used in Medicine and the AlliedSciences, with their Pronunciation, Etymology, andSignification. By HENRY W. CATTELL, A.M. (Laf.),M.D. (U. of P.). Third edition. London and

Philadelphia: J. B. Lippincott Company. 1913.Pp. 1108. Price 21s. net.-In reviewing the firstedition of this work in THE LANCET of Feb. 18th,1911, we expressed our satisfaction that thisdictionary, unlike most of the other Americanmedical dictionaries, had made no attempt tointroduce innovations in orthography, but on

the contrary tended towards conservatism. Weare very glad to find this feature continued. Inthis edition alterations and additions have beenmade on 312 pages, and the definitions have been

improved in many cases. The illustrations are not

very satisfactory. On p. 862 a figure of schistosomahaematobiumis given and ascribed to Braun, which isidentical with, but much inferior to, the figure givenin Webster’s "Diagnostic Methods" (p. 562), whereit is ascribed to Tyson, after Looss. The portraitof Professor Welch, moreover, is hardly flattering.It is indeed a question whether such pictures asthose of generalised favus (p. 342), abrachia in anamelus (p. 5), Babylonian clay model of a sheep’sliver (p. 513), pellagra (p. 701), a quack salver froman old print (p. 802), the portraits, and many otherscompensate for the waste of precious space theyoccasion, space which such pains have been other-wise taken to economise. Notwithstanding thesecriticisms the dictionary is a good one, and it wouldhardly be matter for wonder if in virtue of its

orthography alone it secured a decided preferenceamong English readers. It is interesting to notethat under the word " Doctor," reference is madeto an article in THE LANCET of July 16th, 1910, on" The Title of Doctor in Many (55) Tongues."Die Arbitestätte des Chirurgieen und Orthopäden

(mit Winken fiir Einrichtung von Privatkliniken).Von Dr. OSCAR LANGEMAK, Spezialarzt fur Chirurgieund Orthopadie in Erfurt. Mit 45 Abbildungen.Jena: Gustav Fischer. 1912. Pp. 189. Price,paper, 5 marks; bound, 6 marks.-This is a verypractical guide to the fitting-up of the consulting-room of a surgeon. Suggestions are given as to thefurnishing of the waiting-room, and though in theirentirety they are not quite applicable to this

country they contain much that is valuable. Theaim of.the author is to give such directions for the