1357REVIEWS AND NOTICES OF BOOKS

ing of the ruptured surface and absorption of extra-vasated air resulted in recovery within three weeks.

REFERENCES

1. McCready, P. B.: Arch. of Otolaryng., 1935, xxii., 331.2. Selby, H.: Brit. Med. Jour., 1932, ii., 734.3. Hobbs, F. B.: Ibid., 1930, i., 950.4. Berkeley, H. B., and Coffen, T. H.: Jour. Amer. Med.

Assoc., 1919, lxxii., 535.5. Davidson, F. C.: THE LANCET, 1935, i., 547.6. Tilley, J. B. : Newcastle Med. Jour., 1930, xi., 88.7. Fishberg, M.: Pulmonary Tuberculosis, Philadelphia, 1932,

vol. ii., p. 171.8. Chifoliau, P.: Progrès méd., 1919, xxxiv., 140.9. Pick, E.: Wien. klin. Woch., 1925, xxxvii., 508.

10. Meade, R. H., and Stafford, F. B.: Amer. Rev. Tuberc.,1930, xxi., 579.

11. Dobbie, D. N.: THE LANCET, Feb. 15th, 1936, p. 365.

TORSION OF THE VERMIFORM APPENDIX

ASSOCIATED WITH PREGNANCY

BY GERALD FLATLEY, M.B. Belf.RESIDENT MEDICAL OFFICER IN THE MATERNITY DEPARTMENT,

MILE END HOSPITAL, LONDON

ON mechanical grounds alone, from its positionand structure, the vermiform appendix appears tolend itself to torsion. The condition is, however,exceedingly rare, and a careful search reveals onlya single case reported in English-that described byMcFadden in 1926. In neither English nor con-tinental medical literature have I been able to traceits occurrence during pregnancy. In view of this,the following case-note may be of interest.A primigravida, aged 22, was admitted to Mile End

Hospital on Feb. Ilth, 1936, with the history that shehad been awakened 38 hours before by very severe peri-umbilical pain. She had vomited several times withoutrelief. The pain was still present, had not radiated, and

1McFadden, G. D. F.: Brit. Med. Jour., 1926, ii., 1223.

at the time of admission was but slightly less severe thanat onset.

Examination.-Well-nourished young adult. Pulse-rate100. Temperature 100° F. Blood pressure 128/80 mm. Hg.Slight malar flush. Tongue very furred and dry. Nothingabnormal noted in thorax.Abdomen : uterus 26 weeks’ size-i.e., corresponding

to the period of amenorrhoea. Left occipito-anteriorpresentation ; head not fixed. Fcetal heart heard, therate being 130. Great tenderness on either side of theumbilicus, right rather more than left, and associatedwith some rigidity of the right rectus.

Diagnosis appeared to rest between acute appendicitisand red degeneration in a small intramural fibroid.A blood count by the Mile End Group Laboratory just

before operation gave a white cell count of 18,000 perc.cm., of which 91-5 per cent. were polymorphonuclears,6-5 per cent. lymphocytes, 1-5 per cent. monocytes, and1’5 per cent. basophils. The Schilling haemogram gave atoxic index of 0-7.

Operation.-Abdominal section was decided upon, andafter premedication with morphine sulphate gr. andhyoscine hydrobromide gr. 1/100, a right lower para-median incision was made under spinal aneasthesia (per-caine 14.2 c.cm.). The uterus was normal. The csecumwas brought into the wound and the appendix, pre-ilealin position, was found to have become twisted throughtwo and a half turns about a point half an inch from theproximal end. The distal portion of the appendix, 3 in.long, was gangrenous. The appendix then proceeded tounwind itself slowly without mechanical aid. Appendi-cectomy was performed and the abdomen closed.

Microscopical investigation of the appendix by theL.C.C. Central Histological Laboratory showed " purulentperitonitis over a dilated, necrosed, and engorged appendix. "

Despite intensive medication with sedatives, labourbegan and the patient delivered herself of a 27 weeks’miscarriage eleven days after operation. Convalescencethereafter was quite uneventful.

I am indebted to Dr. Alan Randle, superintendent ofMile End Hospital, for permission to publish this case.

REVIEWS AND NOTICES OF BOOKS

Treatment of Venereal Disease in GeneralPractice .

By THOMAS ANWYL-DAVIES, M.D., B.S., M.R.C.P.Lond., Director, L.C.C. Whitechapel Clinic ; Con-sulting Venereologist to the L.C.C. ; Lecturer inVenereal Diseases to London Hospital Medical

College. London : John Bale, Sons and DanielssonLtd. Pp. 202. 7s. 6d.

ONE of the disadvantages of increasing specialisa-tion in medicine is the danger that the general practi-tioner may lose touch with modern methods of treat-ment in certain highly specialised branches, especiallywhen, as in the case of venereal diseases, referencesto these subjects in current medical periodicals arerelatively infrequent. This small and readablemanual from an authoritative source should do muchto counteract this tendency in relation to thetreatment of these infections.

Dr. Anwyl-Davies has succeeded in compressinga remarkable amount of important matter into a

limited space, and has presented facts in a clearand interesting way. The chapters dealing with thetreatment of syphilis are particularly good. Thevarious remedies are enumerated and discussed, andthe methods of administration described. Principlesof treatment, dangers, and precautions are well setout ; and practical schemes of treatment adaptedto the individual needs of patients and to the differentstages of the disease are suggested. On the more

controversial subject of gonorrhoea description iswisely confined to the methods which the authorhimself favours, but in respect of these practicaldetail is not spared. The treatment of less commonvenereal infections is briefly summarised.

Certain blemishes detract from the general excel-lence of the work ; among them is a tendency tothe use of a loose terminology, especially in referenceto pathological and metabolic processes.

"

Paralysisof the liver " is not a scientific or even an accurate

description of the toxic effects of the arsenobenzenesupon the liver cells ; and the statement that " alcohol... reduces the antigenic properties of the blood,"even if it were correct, is hardly relevant to itscontext. Occasionally, too, the author’s enthusiasmfor some particular form of treatment outruns hisdiscretion in recommending this treatment forgeneral use. For example, however good may bethe results obtained by experts, the practice of treat-ing acute gonococcal cervicitis and salpingitis bythe intra-uterine instillation of glycerin would bedangerous in unskilled hands. The statement thatthe dosage of non-detoxicated gonococcal vaccinesvaries from 5000 million organisms to a maximum of80,000 millions is probably the result of a printer’serror, but it might lead to unfortunate results if

accepted and applied by the practitioner. Apartfrom such errors, which are very few in number, thisbook is a most welcome addition to the small numberof practical manuals on this subject.

1358 REVIEWS AND NOTICES OF BOOKS

Poverty and HealthBy G. C. M. M’GOXIGLE, M.D., D.Hy., D.P.H.,and J. KIRBY, M.R.S.I. With a foreword bySir F. GOWLAND HOPKINS, O.M. London : VictorGollancz Ltd. 1936. Pp. 278. 6s.

IT is right and necessary that medical men workingin the distressed areas should make known theirviews on unemployment. Dr. M’Gonigle is medicalofficer for Stockton-on-Tees, and his book, writtenin collaboration with Mr. J. Kirby, is intended to

bring the problem of malnutrition more urgentlybefore profession and public. After pointing to theunsound physical condition of the population, as

indicated by the unfitness of recruits to the Services,the authors turn to the state of the children andprovide an interesting chapter on the examinationof child welfare records. The essential part of thebook, however, is based on Dr. M’Gonigle’s well-known observations on a population removed froma slum area to a new housing estate. By this transla-tion the rents of the families were increased by4s. 4d. per week, thus reducing the margin availablefor food. To malnutrition is attributed the sub-

sequent increase in the crude death-rate from 18-75to 26-71, and " approximately a four-fold increaseon a normal expected death-rate." The objectionto this argument is that the findings are based ontoo small a sample. The population at risk was

only 710, on which population the crude rates quotedshow 13 and 19 actual deaths-figures which are

insufficient for valid deductions. Incidentally theactual causes of death might well have been set out sothat their relation to nutrition might be considered.

This reliance on small samples affects also otherof the conclusions drawn. Thus comparisons are

made of death-rates of employed and unemployedbased on populations of 1564 and 1572. There areshown crude death-rates of 25-47 for unemployedand 17-1 for employed, and standardised rates of29-29 and 21-01, and these latter are compared withexpected rates of 8-75 and 8-53. Dr. M’Gonigle andMr. Kirby may well refer to the figures as startling;but are they justified ? For any validity the calcula-tion needs to be made from a much wider basis.The conclusions have to be set against such a state-ment as the following, from the Registrar-General’sDecennial Supplement England and Wales, 1931

(Part I.)." The following comparative figures (Table P) indicate

the relation of the recent experience in these sections tothat disclosed by the 1921 investigation. It will be seenthat in the Northumberland and Durham County Boroughsthere has been a substantial improvement at all the agesshown in the table except at age 20 in the case of females.This is a matter of high importance as proving that thedeath-rates in the worst years of the economic depressionand in an area ranking among those most severely hitby that depression exhibit no increase. On the contrarythe mortality experience in this section is lighter thanthat disclosed by the previous decennial investigation,and on the analogy of the national experience there isreason to believe that if research were carried backsufficiently far it would be found that in the years 1930-32the mortality experience of the County Boroughs ofNorthumberland and Durham was lighter than that of thisarea in any corresponding period in the present century."

Table 50 of the book sets out various income scalesand corresponding death-rates as means of a four-year period. The figures show a variation of crudedeath-rate from 30-96 at 25s. to 35s. per week to9-00 at 75s. or over per week, and a variation ofstandardised rates from 25-96 to 11-52. The popula-tions in the five groups vary from 1187 to 132. The

population in the highest grade is 140, and the crudedeath-rate is 9-00, which represents 1’26 deaths

per annum. We do not doubt the accuracy of thesedata, but it seems to us that, with so small a popula-tion observed over so short a time, it cannot beconcluded that the observed numerical differences

represent real differences in the mortality of thecontrasted categories. The figures are suggestive,but the deductions must be tentative.

Less controversial are the chapters devoted to foodand family budgets and expenditure. These showan intimate knowledge of social conditions and thedetailed analysis of expenditure merits carefulperusal. They are a revelation of how the poorlive. The various necessary items of expenditureapart from food are given, and Tables 46 and 47show food expenditure in ingredient value and inquantity. The main point brought out, and whichhas been elsewhere emphasised, is the shortage ofprotein, and no one can doubt the importance oflaying stress on this, especially in relation to the

growing organism. It may be noted, for example,that the weekly amount of fresh milk purchased perman-value in the lowest income group was only0-55 pints ; this may be related to C. M. Burns’sinvestigation of the consumption of milk by 1000families in County Durham which showed " thefigures for whole milk purchased are appallingly low,ranging from 0.25 pints to 0-005 pints per head perday."As we have said, the conditions of the distressed

areas must somehow be brought home to the mindand conscience of the more favoured population.Too many of us have still a quite inadequate apprecia-tion of the circumstances ; Jarrow and Oxford-street are in different worlds. It is not surprisingthat the authors of this book, confronted by theproblems presented in a district of heavy and con-tinued unemployment, should be oppressed by theirurgency ; probably they could say with the Psalmist" The zeal of thine house hath eaten me up." Buttheir deductions seem to us incompletely justified bytheir data. The book therefore should be read, butit should be read critically.

The Operations of SurgeryBy R. P. ROWLANDS, M.S., F.R.C.S., late Surgeonto Guy’s Hospital ; and PHILIP TURNER, B.Sc.,M.S., F.R.C.S., Consulting Surgeon to the Hos-pital. Eighth edition. Vol. I. London : J. and A.Churchill Ltd. 1936. Pp. 1045. 36s.

HowEVER skilful he may be the young surgeonmust often be conscious of his lack of experience;not so much when performing an operation for thefirst time as in selecting the cases suitable for surgicaltreatment and avoiding the " wrong ’uns." It is inthis respect that the advice of a senior colleaguemay be so helpful, and the most valuable attributeof " Rowlands and Turner " is that it provides awritten substitute for the wise counsellor. In thefinal production of this volume Mr. Philip Turnerhas been deprived of the collaboration of Mr.R. P. Rowlands, who died while this eighth editionof the work was in course of preparation. Hehas been fortunate in obtaining the assistance ofMr. W. H. Ogilvie and Mr. Grant Massie, who haveundertaken the revision of the chapters on thevertebral column and the lower extremity, and adetermined effort has been made to maintain the

high reputation so justly enjoyed by the earliereditions of " Jacobson." The sections of the book

1359REVIEWS AND NOTICES OF BOOKS

which deal with the surgery of the limbs requiredvery little revision, and the new matter added byMr. Grant Massie on the lower extremity has beenclearly set out, though it might have been an advan-tage to include rather more detail about the indica-tions for the orthopaedic operations, and fuller

descriptions of those for various forms of talipes.When bringing out another edition of a well-

established text-book it must be hard to decide howmuch to keep of the old and how much to add ofthe new in surgery. For the most part Mr. Turner’sdecisions have been wise, and adequate accountsare given of plastic operations, recent experienceof the use of radium in carcinoma of the tongue andof the breast, cervico-thoracic ganglionectomy, andthe recognition and removal of tumours of the para-thyroid gland. On the other hand, commonly acceptedinnovations in the surgery of cervical rib, anky-losis of the jaw, thyroglossal cysts, and the thyroidgland are omitted ; the chapters on the brainand on the thorax are lamentably out of date; andit is high time that longitudinal incisions in the neckshould be condemned in any but the most exceptionalcircumstances. Criticism must also be directed atthe references to the literature which supply volumeand page but no date. A large number of thesereferences are very old, and it is essential that thereader should be able to distinguish them from themore recent ones. The book has been to so manysurgeons a wise and trusted friend that those whoare entrusted with maintaining its fine traditionshave a special responsibility.

A Manual of PhysicsFourth edition. By J. A. CROWTHER, Sc.D.,F.Inst. P., Sometime Fellow of St. John’s College,Cambridge ; Professor of Physics in the Universityof Reading. London : Humphrey Milford, OxfordUniversity Press. 1936. Pp. 585. 14s.

THIS manual, now in its fourth edition, has an estab-lished place in the presentation of elementary physics.The new features now incorporated lie for the mostpart in the electrical section where good accountsare given of methods of production of X rays andtheir physical properties, and of natural and artificialradio-activity. Prof. Crowther has found it necessaryto enlarge the section on alternating current, andthe result is a very readable and instructive accountof electro-magnetic induction and the practicalapplications which have led to the devising of sucha variety of different instruments. The book canbe recommended without qualification ; it is attrac-

tively written, comprehensive, and accurate.

Introduction to Human ParasitologyFifth edition. By ASA C. CHANDLER, M.S., Ph.D.,Professor of Biology, Rice Institute, Houston,Texas. New York : John Wiley and Sons, Inc. ;London : Chapman and Hall Ltd. 1936. Pp. 661.25s.

THE scope of this book is wider than that of mostworks on human parasitology. The subject has beendivided into three main sections, dealing respectivelywith protozoa, helminths, and arthropods. Withinthese sections the chapters have been arranged ina systematic manner, either from the standpoint ofzoological classification or from that of effects onthe host. While it has obviously not been theauthor’s intention to give a complete account of

all the parasites dealt with, detailed descriptions andfigures have been supplied where two importantspecies have to be differentiated-e.g., betweenE. histolytica and E. coli, T. solium and T. saginata,and X. cheopis and X. astia. Additions made duringthe last few years to our knowledge of human parasi-tology have been numerous and important. Particu-larly extensive changes have been required in manychapters of this book, notably those dealing withspirochsetes, amcebse, malaria, rickettsias, flukes,strongyloides, filariae, and myiasis; and in manyplaces complete rewriting and rearrangement havebeen necessary in order to give an adequate andwell-coordinated presentation. Throughout the bookspecial emphasis has been laid on the biologicalaspects of the subjects. Considerable space is devotedto life-cycles, epidemiological factors, and inter-relations of parasite and host. Specific and detaileddirections for the treatment of the parasitic diseaseshave been excluded, but the underlying principlesof treatment and prevention are discussed. Sinceit is difficult to go very far into such a vast subjectas parasitology within the limits of one book, Prof.Chandler has included a list of the leading journalsand standard works which cover the field. Hisenthusiastic outlook is refreshing. The book is wellproduced and clearly printed with numerous effectivediagrams.

Psychology and ReligionBy DAVID FORSYTH, M.D., D.Sc.Lond., F.R.C.P.,President of the Section of Psychiatry, RoyalSociety of Medicine; Consulting Physician to

Charing Cross Hospital. London : Watts and Co.Pp. 221. 7s. 6d.

THE discussion of the conflict between science andreligion has moved far since the days of Huxley.The earlier concentration on the historicity of theBible, the testimony of the rocks as against thecosmology of Genesis has more or less ceased, atleast outside fundamentalist circles. But with thechallenge of anthropology and psycho-analysis theproblem has assumed a new and more cultural guise.Religion could stand up to the theory of the evolutionof the species, but the real test is whether it canstand firm when psychology and anthropologyallege that man’s moral and social nature evolvesfrom lower to higher forms. The theory that manpasses from a religious to an artistic-philosophicand thence to a scientific level of enlightenment wasthe view of Auguste Comte. But he did not have aTylor and Frazer, a Westermarck and a Freud togive chapter, verse, and punctuation to support hisviews.

In this book Dr. Forsyth builds almost entirelyon Freud’s theories of the development of the childmind and his theory of social origins. No one willdeny that Freud’s oedipus complex has illuminatedthe dynamics of the mind and incidentally the originof society and its usages. But while the Cyclopeanfamily is even to Freud a speculative concept, it isnot easy to accept the corollaries of this idea, as

applied to human society and its institutions. More-over, it is not logically sound to equate the imagina-tive ideas of simpler peoples with the illusory. Reli-

gious ideas and folk practices were the ways in whichthe simpler peoples dealt with the world and theirown relations; it was in short their social science.It must be agreed, however, that the abundant useof magic and of some forms of religion is no longerserviceable to humanity and can be positively harm-ful ; for example, its extension into patriotism can

1360 REVIEWS AND NOTICES OF BOOKS

have devastating international effects. Furthermore,Dr. Forsyth is not always up to date in his psycho-analytic data, and perhaps on this account he makesa simple process of what is now known to be a verycomplex one even in the child mind-i.e., magicalthinking and its fructifying effects. Religion is

shedding and will doubtless contrive to shed manyof its primitive notions, and its anthropomorphisms.But there are some who will for epochs to comecontinue to feel awed by nature and moved by that" oceanic feeling " which Freud claims he has neverfelt.

_____________

Cystoscopy and UrographySecond edition. By JAS. B. MACALPINE, F.R.C.S.,Hon. Surgeon and Surgeon in charge of the

Genito-urinary Department, Salford Royal Hos-

pital, Manchester. Bristol: John Wright and Sons,Ltd; London: Simpkin Marshall Ltd. 1936.

Pp. 478. 30s.

NINE years have elapsed since the first appearanceof this book, and nine years is a long period in thehistory of urology. Many new methods of examina-tion have been introduced, the most notable beingexcretion urography. These advances have neces-sitated the inclusion of three entirely new chaptersdealing with excretion urography, pyeloscopy, andpelvic resorption. Of these the first is the most

important, pelvic resorption being mainly of scientificinterest, and pyeloscopy a method of examinationwhich, though excellent in principle, is difficult in

practice. As the author points out, the presence ofa foreign body (the opaque fluid) in the ureter excitesefforts at expulsion, and the appearance of the

pelvis and calyces under these artificial conditionscannot be regarded as physiological. Moreover, fewclinicians have the time or the experience necessaryto interpret the constantly and quickly changingshadows seen on the fluorescent screen.

Mr. Macalpine writes clearly, and does not over-load his text with theories or quotations from otherauthorities. His book is eminently practical, andwith its help those who have limited experience ofcystoscopy and cystoscopic methods will be able toimprove their technique and increase their knowledgeof cystoscopic conditions. The coloured plates areof a high order, so also are the reproductions ofpyelograms illustrating the section on pyelographyand excretion urography.

Disease in Childhood: The First YearA ClinicaZ Study. By ROBERT S. FREW, M.D.Edin., F.R.C.P. Lond., Physician to the Hospitalfor Sick Children, Great Ormond-street. London :Macmillan and Co., Ltd. 1936. Pp. 669. 30s.

THE age-incidence of disease is a study which hashardly received the attention it deserves, and in

reading the preface to Dr. Frew’s work one is struckby the good fortune of a physician privileged tosee all out-patients in age order for a period of seven-teen years. Unfortunately, however, it soon becomesobvious that when the first year of life is subdividedinto three age-periods even statistics based on

8823 consecutive cases under 12 years of age, providea quite inadequate basis for discussion of any exceptthe commonest disorders of childhood. Dr. Frewhas not, in this book, supplemented his own experi-ence to any considerable extent by quotations fromrecent medical literature. This is the more unfortu-

nate because his own views on paediatric pathologyare unconventional. He attributes many of thedisorders of childhood, with the exception of tuber.culous meningitis, to a condition which he calls"

hyperphlebaemia." It would be wearisome toenumerate all the diseases, from laryngismus stri-dulus to early pulmonary fibrosis, and from cretinismto ceeliac disease, which he finds due directly orindirectly to this cause. " A bewildering array ofclinical manifestations " seems, under the circum.stances, a cautious understatement. With sledge-hammer logic the author proceeds to apply an Alice-in-Wonderland system of pathology to treatment,with results such as the following : "If, when thebaby is born, ... he is suffering from white asphyxia,’the cord should be severed without ligaturing andbleeding promoted by every available means "

(p. 144). Similarly after concluding that a failureof the ductus venosus to close at birth is the mostlikely explanation of " status lymphaticus " (withthe cautious proviso that when the opportunityarises, this point will naturally be investigated withgreat interest), he says : "If this be the aetiologyof the disease, then in cases where a thymic shadowis found, I imagine it will not be beyond the skill ofthe surgeon to ligature the ductus venosus underlocal anaesthesia before a general anaesthetic isadministered " (p. 564). It is difficult under thecircumstances to appreciate the few jewels that

undoubtedly exist in a somewhat fantastic setting.The book is well printed and contains a number ofexcellent illustrations.

Treatment of Fractures in General PracticePocket Monographs on Practical Medicine. Secondedition. By W. H. OGILVIE, M.D., M.Ch.,F.R.C.S. London: John Bale, Sons and Danielsson.1936. Pp. 180. In two volumes. 2s. 6d. eachvolume.

WE welcome the second edition of these twosmall green volumes on fractures. It is an achieve.ment to have compressed so much information intosmall compass and yet to have produced a text easyand pleasant to read. The first part of the work,which covers the 58 pages of Vol. I., is devoted tothe general principles of fracture treatment. Theenumeration of the headings and subheadings frompage 21 onwards still seems to us somewhat unsatis-factory ; in all other respects the meaning is clearand the description of methods of treatment conciseand easy to follow. From the practitioner’s pointof view it is an advantage that Mr. Ogilvie describesonly methods of proven value, the apparatus forwhich is readily available. For fractures of the

upper limb, for example, the moulded plaster-of-Paris splint is described and illustrated. Skeletaltraction is recommended in fractures of the lowerlimb, but methods of skin traction are also described,and the practitioner is advised to use these wherethe case is being nursed under less ideal conditions.It is interesting to find an account of a serviceablemethod of treatment by continuous traction offractures of the neck of the femur ; this is recom-mended for use in very feeble patients. The operationdescribed for this fracture is by the Watson Jonesmodification of the Smith-Petersen’s pin fixation.In general, however, open operation for fractures isproperly relegated to a secondary position.

This excellent monograph is worthy of a place inthe surgery of every practitioner and in the pocketof every student.

1361CARE FOR THE DEAF

CARE FOR THE DEAF

THE LANCETLONDON: SATURDAY, JUNE 13, 1936

ON Thursday the National Institute for theDeaf celebrated its silver jubilee with the openingby H.R.H. the Duke of YORK of new headquartersat 105, Gower-street, London, W.C.I. An appealis being made by Lord CHARNWOOD, the presidentof the Institute, for larger support of a movementwhich during its 25 years of existence has provedthe necessity of the objects for which it exists andjustified the energy with which the officiate haslaboured to overcome great difficulties. The firstof those difficulties is the general apathy, due tolack of information, displayed by the public inregard to the position of the deaf in the com-

munity. Year by year at annual meetings of theInstitute the case of the deaf has been broughtforward with the intention to show how vastlythe deaf can help themselves, if only they meetwith help from their more fortunate brethren, andto illustrate how large is the range of activitiesalong which the deaf can prove themselves valu-

. able citizens, when the courtesy and patiencenecessary to bring about normal intercourse areextended to them. Reasoned advocacy alongthese lines has produced during the existence ofthe Institute practical results. Associations made

up of representatives of deaf societies and of

public authorities have been established in manyareas, covering indeed England and Scotland, andsimilar centres it is to be hoped will soon be estab-lished in Wales and Northern Ireland. Such

public and private movements have producedmany beneficial results, among others the vitalone of the placing of many deaf in employment.But the aims of the Institute cannot be fullyrealised till adequate provision is made for the

training of the adolescent deaf, for their re-trainingwhen necessary, and also for the replacing in suit-able work of adults who have become deaf throughdisease or accident. Lord CHARNWOOD, an untiringpublic servant, points out in his jubilee appealthat these developments will entail the strengthen-ing of voluntary societies to fit them for largerresponsibilities, while districts in which the interestsof the deaf are still unrepresented by any societymust be stimulated to play their part.No special legislation exists to protect the

interests of the deaf, apart from that which entitlesdeaf children to suitable education. Their causehas been the concern of the National Institute,a voluntary body, and of its affiliated associationsand voluntary local societies. The Institute main-tains three organisations for deaf women and

working deaf boys, and acts as a clearing housefor the work of the county associations. Its scopeis largely administrative and will be found wellset out in its publication " All About the Deaf." 1

1 London: The National Institute for the Deaf, 105, Gower-street, W.C.1. 1934. Pp. 122. 3s. 3d.

Here will be seen how the deaf are helped andhow they may help themselves. And in this

publication Lord CHARNWOOD draws the valuable ifself-evident distinction between the case of thosedeafened through injury or disease and thoseborn deaf, in whom the prevention of deafnesshas not to be considered. The only State inquiryinto the conditions of the deaf made during thelast 50 years was summarised in a report by thelate Dr. EicHHOLZ in 1930. But this document,though embodying the result of the first investiga-tion of the State into the needs of the deaf overschool age, paid little attention to the needs ofthe deafened, who form a much larger classthan the born deaf. The Institute desires tosee the compulsory school age lowered to fiveyears for children born deaf ; for their investi-

gations prove that, if speech is to be acquired bydeaf-mutes in a way to fit them for playing theirpart in national life, it must be acquired young.Relegation of education until the age of seven isextremely unfortunate. Further an extension ofsuitable educational opportunities for school leaversis needed, while another just reform among theobjects of the Institute is the granting of earlierold-age pensions to those who through deafnessare unable to support themselves by their ownlabours. This would bring the treatment of thedeaf into line with that of the blind, and to bedeaf is as much a deprivation as to be blind. Thesad case of the blind is spectacular ; that of thedeaf must go without public notice.

Other aims of the Institute, emphasised byLord CHABNWOOD in his appeal, are, first, the main-tenance for both sexes of hostels for the adolescentdeaf similar to those for homeless deaf boys suc-cessfully established at Highbury; and, secondly,the establishment of homes to receive the adult deafon the lines of the Institute’s homes at Barrowfordin Lancashire and Poolemead in Somerset. Inthese places the inmates are made happy throughbeing able to communicate with one another andwith the trained staffs; while to lessen the hard-

ship of isolation-the heaviest burden which thedeaf subject has to bear-the Institute has startedlip-reading classes at its headquarters for thedeafened generally. In these and other ways the

headquarters of the Institute has become a clearinghouse for all matters connected with the deaf. Inclose touch with the principal deaf societies

throughout the world, it has established with thema systematic exchange of the latest results ofresearch into deaf problems of all kinds. Througha skilled staff and a medical committee of distin-

guished aurists ; an executive committee on whichare represented the regional associations, theLondon County Council, the associations of countycouncils, many municipal corporations and educa-tion committees, various local deaf societies, theNational College of Teachers of the Deaf, andindividual members of both Houses of Parliament,the Institute is in close touch with the Ministriesof Education, Health, and Labour. It is thus ableto combine research and organisation on a nationalscale with individual help to the deaf in all partsof the United Kingdom.