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Mr. F. F. WARD said he believed his failures inthis condition had been due to the fact that he hadwashed out once only. He described one or twocases in which trouble ensued. The cannula he hadbeen using was a lacrymal duct cannula. If at theinjection of colloidal silver the patient complained ofpain, that was an indication that the substance wasactually in the vas. He would like to know whetherthe operation could be done in a fairly recent andacute case. He thought the operation was applicablefar more often to cases which suffered from gonorrhoealarthritis.

Dr. DENNIS VINRACE said it was inadvisable to tella patient with gonorrhoea that he was cured ; a saferplan was to tell him to come for a further inspection iafter an interval; and if at the further interview his z,prostate was found to be enlarged, or his vesiclesinflamed, he should be advised to have an operation.He hoped this operation would become a popular one,and that after the detailed description had beenpublished more workers in venereal diseases would

icarry it out.

I

Mr. KIDD, in reply, said his object in bringingthe communication forward was to popularise theoperation. He had now been working at the matterfor ten years, arriving at the present position afterexperiencing many difficulties. It was easy to causethe vas to slough if it were hung up ; it was a simpleprocedure to ligature it. When operating on thebladder he often ligatured the vas, and nothinghappened to the testicle. He hoped that those whoessayed the operation would perform it on chroniccases, and follow his description of the operation inevery detail. The colloidal silver he was usin g was onemade specially for him at the Crookes Laboratory, andit was the best material for the purpose. Sometimeshe used it in a 10 per cent. strength, very rarelyindeed 20 per cent. His cannulas were made byMr. J. H. Montague ; it was essential to keep the wirein, otherwise there would be leakage into the needle,blocking it. He still emphasised the fact that therewas a liability for iritis to recur after an interval ofeven years, and this was not the case with jointtrouble after it had once been disposed of.

Reviews and Notices of Books.CEREBRO-SPINAL FLUID IN HEALTH AND DISEASE. li

By ABRAHAM LEVINSON, B.S., M.D., Associatein Pediatrics, Northwestern Medical School.London : Henry gimpton. 1923. Pp.267. 25s.

Dr. Levinson’s book is already known in thiscountry. In this, the second edition, he has added agood deal of new matter and brought the whole up to idate. The result is a useful and thoroughly practicalmanual. Indeed, the author has rather tended to iomit theoretical considerations in places where theymight with advantage have been included. This is i

particularly the case when he deals with the newerdiagnostic procedures, such as the colloidal gold andmastic reactions, depending upon alterations in thephysical properties of the proteins of the cerebro-spinal

i

fluid. His descriptions of the uses and interpretationsof these tests is excellent, and his account of thetechnique quite sufficient to enable an intelligentworker to carry them out; he barely touches, how-ever, upon the much-discussed mechanism of thesephenomena.A description of the technique of cistern puncture

1

is given, and here the author might have gone moreinto detail. His advice is that no one should practiseit without frequent preliminary trials on the deadbody, and to do this avails more than the reading of Iscores of pages of instructions. No mention is made Iof the washing out of the spinal theca through needlesinserted in the cervical and lumbar regions. Certainlythe value of this procedure is doubtful, and it may bequestioned whether it is ever justifiable, but it is foradvice and information on just such points as this thatthe reader goes to books like Dr. Levinson’s.

Froin’s syndrome comes in for rather casualmention. To imply that it consists only in xantho-chromasia and increased protein and cell content of thecerebro-spinal fluid is hardly to do justice to itsoriginator. It is the presence of these phenomena inthe fluid from one portion of the theca in conjunctionwith normal or more or less normal fluid higher up thatconstitutes the full syndrome ; in practice, we admit,the presence of the normal fluid higher up is frequentlytaken for granted. The section on the anatomy ofthe ventricular systems and of the meninges is lucidand the illustrations good. The historical summary isexcellent and makes interesting reading. A good Imany of the illustrations are unnecessary. Micro-photographs of tubercle and other bacilli are not ofmuch use to the sort of readers who are likely to resortto Dr. Levinson’s pages, nor in fact to any one. It

may be taken as axiomatic that even as in the dusk allcats are grey so in microphotographs all bacilli arealike.

BACTERIOLOGICAL DIAGNOSIS.

Leitfaden fiir die klinisch-bakteriologischen K ultur-methoden. Von Dr. HUGO SCHOTTMULLEB, Pro-fessor und Direktor der medizinischen Poliklinikder Universitat Hamburg. Berlin und Wien:Urban und Schwarzenberg. 1923. Pp. 96.Tms handbook is intended as a guide to bacterio-

logical diagnosis in a well-appointed clinical laboratory.The subject-matter dealt with is therefore ratherrestricted, and the greater part of the informationwhich it contains is also to be found in more completeworks on bacteriology. The methods which are

recommended are well described, and they deriveinterest from the fact that they have been selectedby one who has had large practical experience in thesubject and has himself devised some of the technique.Sixty-eight of the 91 pages are devoted to bloodculture, and both in this section and elsewhere especialattention is given to the streptococci, as is naturalconsidering the association of Schottmuller’s namewith work on this group of bacteria. Some of thestatements are more suggestive of finality in strepto-coccal classification than will be accepted as theystand by most other bacteriologists. For the"typhoid-coli" group of organisms the methods ofdiagnosis are, in accordance with German custom,rather unnecessarily complicated, especially as regardsthe use of various whey and nutrose media, whichin this country are usually regarded as quite super-fluous for routine diagnostic work. The simple andentirely satisfactory MacConkey’s lactose bile-saltagar, on the other hand, is not mentioned. Theomission of dulcitol, which is so useful in culture-mediafor the identification of the salmonella group, seemsstrange in a book written by the original sponsor of theparatyphoid bacilli. The book is very well andclearly printed, and contains a good index but veryfew references. ____

Mikromethodik Quantitative Bestimmung der Harn-und Blutbestandteile in kleinen Mengen. ZweiteAuflage. Von Dr. med. et phil. Ludwig Pincussen,Direktor der Biochemischen Abteilung des StadtKrankenhaus am Urban zu Berlin. Leipzig:Georg Thieme. 1923. S. 125. M.18.IN this book, in the compass of 125 pages, the

author brings together many of the more recentlydescribed micro-methods for quantitative investigationof the blood and also micro-methods worked out byhimself for the estimation of the constituents of theurine. Micro-methods involving for the patient onlya prick with a needle are of obvious advantage indealing with the blood ; in the case of the urine,however, their advantages hardly appear to outweightheir disadvantages; the use of only 01 c.cm. of urinefor estimation of the nitrogen by a micro-Kjeldahlmethod and of 1 c.cm. for estimation of the chloridesby a micro-Volhard method seem rather in the nature

227

of a tour de force, when dealing with such easilyobtainable material. The disadvantages inherent inall quantitative micro-methods are by no meansminimised by the author, and all who contemplatefollowing his technique will do well to study carefullyhis " allgemeine Regeln " (p. 7). The methods of bloodinvestigation are excellently chosen; they include pro-cedures, mostly of proved value, for the estimation ofpractically all the constituents of the blood, includingthe gases, and also the method recently describedby Michaelis for the estimation of the pH of serumand other fluids. The descriptions of techniquethroughout are models of clarity and conciseness.

THE ANATOMY OF THE FEMALE PELVIS. IBy F. A. MAGUiRE, D.S.O., M.B., Ch.M. Syd.,F.R.C.S. Eng., Hon. Assistant GynaecologicalSurgeon, Royal Prince Alfred Hospital, Sydney.Sydney: Angus and Robertson, Ltd. 1922.Pp. 115. 6s.Tms little book is written by a clinician for clinicians,

though its author is also a teacher of anatomy in theUniversity. It gives the main facts of female pelvicanatomy shortly and clearly, and goes on to theexamination of the organs during life, from theanatomical point of view. Its small size and easyarrangement will render it a serviceable book ofreference for those who may find their knowledge ofthe parts at fault when dealing with some condition ofdisease in these regions.

A MANUAL OF HUMAN ANATOMY FOR DENTALSTUDENTS.

By R. BRAMBLE GREEN, M.B., B.S. Lond.,F.R.C.S. Eng. London : Benn Brothers, Ltd.1923. Pp. 263. 18s.

THIS is a very good book on descriptive anatomysuitable for students of dentistry. It is divided intotwo parts, the first giving clear accounts of generalanatomy, and of the skeleton and systems throughoutthe body in general. The second part is devoted tothe regional anatomy of the head and neck. It is nota manual of dissection, but appears to sum up. in anintelligible and short way, all that it would seemnecessary for the students to know. There is noattempt to deal with the teeth, on which there arespecial handbooks. The information contained in thebook appears to be thoroughly reliable, except thatin one place the author seems to suggest that thepalatoglossus owes its innervation to the twelfthcranial nerve, on which point some might differ fromhim. The volume is well produced and printed inclear type, with useful illustrations.

BOOKS FOR NURSES.

Surgical Nursing and After- Treatment. Secondedition. By H. C. RUTHERFORD DARMNG, M.D.,M.S. Lond., F.R.C.S. Eng., F.R.F.P.S. Glasg.,Surgeon, Coast Hospital, Sydney, N.S.W. ; Demon-

strator of Anatomy, Sydney University. London : IJ. and A. Churchill. 1923. Pp. 566. 8s. 6d.

IN this portable volume Mr. lJarlmg nas conaensedadmirably all the knowledge that a nurse is expectedto possess when called upon to undertake a surgicalcase. Given the practical experience that can onlybe obtained at the bedside, any nurse who knew allthat this book contains would be able to undertake thenursing care of any surgical patient. Each chapter ispreceded by a synopsis of its contents, which arethen presented in a lucid and readable form. Anumber of illustrations add to the attractiveness ofthe book. It is divided into sections-namely," General Surgical Nursing " and " Regional SurgicalNursing." In the first section short accounts are

given of the pathology, symptoms, and treatment ofthe general surgical conditions commonly met with,including a glimpse into bacteriology and immunity.The general principles of asepsis, the arrangement ofan operating theatre in hospital and in privatepractice, the treatment of haemorrhage, infections,

and fractures are dealt with adequately. Itmust be remembered that the book was written inAustralia for Australian nurses, and that referencesto the South as an ideal aspect for an operatingtheatre must be translated into North for our lati-tude. The second section on regional surgerydescribes the preparation of the patient, the require-ments of the surgeon, and the special after-treatmentnecessary for operations on the various organs ofthe body. A number of the modern improvementsintroduced during and since the war are included,and the book is thoroughly up to date. We hope thatthe book will meet with the success which is its due.

The Nursing of Infectious Diseases. Third edition.By F. J. WOOLLACOTT, M.A., M.D., B.Ch. Oxon.,D.P.H. London : The Scientific Press, Limited.Pp. 180. 4s.Tms book. based on a course of lectures to nurses

given by Dr. F. J. Woollacott, has been revised andbrought up to date by Dr. Dorothy C. Hare. Thechief additions relate to methods of investigation ofinfectious diseases both for diagnosis and infectivity,chapters on cerebro-spinal fever, tuberculosis, andvenereal diseases having also been included. Thesubject of infection and the prevention and generalmanagement of infectious diseases is briefly butadequately discussed in the first three chapters ofthe book, after which follows a description of thechief infectious diseases of this country. Excellentjudgment has everywhere been shown in the selectionof points for discussion, and although it is assumedthroughout that the reader has some acquaintancewith the general principles of nursing, nothingrelating specifically to the nursing of infectiousdiseases has been taken for granted. Some of theteaching given would hardly be endorsed by leadingauthorities at the present day.

In discussing the various plans adopted for pre-venting cross-infection the principles of barrier-nursing and bed isolation are described, but enoughemphasis is hardly laid upon the fact that with theslightest neglect or carelessness on the part of a

single nurse the whole system breaks down in thatparticular institution. Indeed, the experience ofmost authorities goes to show that even with theutmost care in technique bed isolation is not safe formeasles or chicken-pox, or even, in Dr. W. Goodall’sview, for severe cases of scarlet fever, diphtheria, orwhooping-cough during the acute stage of the disease.These are small points, however; the book as awhole is admirably adapted for its purpose, and thenew edition will be welcomed by nurses.

Text-book of Anatomy and Physiology. For TrainingSchools and other Educational Institutions. ByEuzABBTH R. BUNDY, M.D. Fifth edition,revised and enlarged by MARTHA TRACT, M.D.,Dr.P.H., and GRACE WATSON, R.N. London :J. and A. Churchill. 1923. Pp. 442. lls. 6d.Tms little book was written as a text-book for

those who were training for recognition as nurses,and includes an account of the human body fromanatomical and physiological standpoints. Thedifficulty of producing enough and not too much, inwriting for readers of this sort, is known to everyonewho has attempted the task, and it is easy to beover-critical when dealing with the efforts of others.We can only claim, then, to express an individualopinion when we say that such things as the treat-ment of the palate bone as a separate entity, or themention of nutrient foramina, however brief theymay be, seem to be unnecessary ; we rather thinkthat, for nurses, certain parts and functions of thebody might be treated with much more detail thanis usually afforded, while of the rest some might besketched in with broad outlines and others omittedaltogether. The writers of this book do not see

things in quite the same way, however, and the factthat the work has reached its fifth edition is perhapssufficient justification for their faith.

228

To assist the authors in preparing the sixth edition wemav note the following points. Fig. 79 has a mistakenlabel for the rectus ; the nerve supplies of buccinator,diaphragm, and one or two others would bear alittle revision ; such things as the rotating action ofthe psoas and the origin of the small pectoral musclemight also be reconsidered ; it might, moreover, bewell to harmonise the conception of the meaning ofeversion and inversion of the foot with that moreusually accepted. The work is well and clearlyprinted and produced, and is copiously illustrated,with many coloured figures.

New Inventions.NEW PATTERN OXYGEN SIGHT-FEED

VALVE.

THE illustrations show how, by means of a singlepiece of apparatus, the supply of oxygen to patientscan easily be regulated and waste obviated. Thetube and funnel method is not only wasteful but oftendefeats the object of its use, as usually the bloodbecomes saturated with oxygen, the H-ion concentra-tion is decreased, and consequently the respiratorycentre receives less stimulation than before, and thepatient breathes more shallowly than ever. Oxygenshould be given in such a way that it enriches, butdoes not displace, the air the patient breathes. Thiscan be achieved most economically by means of theapparatus described herewith, the oxygen passing

downwards into a vertical tubecovered by a small quantity ofwater. The bottom of the tube is

open, and at different distancesabove are

drilled smallholes. A smallflow of oxygenwill, by itspressure, onlydisplace asmall quan-tity of waterfrom thetube, and willbubble out ofthe first hole.A greater flowwill, of course,displace morewater andbubble out ofthe secondhole, and so on. In this way the physician can order Ithe nurse to give the patient two, three, or four Iholes of oxygen as the case may be, instead of vaguely Iordering the administration of oxygen. In order thatthe patient should get the full benefit of the smallquantity of oxygen required, a nozzle is attached tothe ’rubber tube, and by means of a spring clip inconnexion with it, the nozzle can be fastened to thebedclothes in such a position that the flow of gas isdirected towards the patient’s nostrils or mouth, andas near as may be necessary, thus achieving the desiredobject of enriching the air the patient breathes.The apparatus is supplied in two forms by Messrs.

Coxeter and Son, 171, Pancras-road, London, N.W. 1,one for use with upright cylinders and another for usewith horizontal ones. In one form the apparatus

consists of a pressure gauge and sight feed in one,ready for screwing into the cylinders, the gaugeenabling one to see at a glance how much oxygen isavailable and the control of the gas taking place atthe cylinder valve. In the second form an automaticpressure-reducing valve is provided for screwing intothe cylinder, to which is connected, by a rubber tube,the sight feed part which is hung at the head of thebed, and the flow of the gas is controlled by a fineadjustment valve attached thereto, instead of on thecvlinder.

F. P. DE CAUX, L.R.C.P. Lond., M.R.C.S.

AN APPARATUS FOR THE ADMINISTRATIONOF NITROUS OXIDE, OXYGEN,

AND ETHER.THE apparatus here illustrated consists of two

8 oz. bottles fitted with screw tops and mounted ona metal base. The N 20 inlet to the water sight feedbottle (s) is made partly of metal and partly of glass,

the metal part having a hole above the water-levelequal to the calibre of the tube itself. When theN 20 is turned on the level of the water in the glasstube is depressed, such level indicating regularity offlow. A depression of ! in. represents approximatelya flow of 120 gallons of N 20 per hour. The obliqueconstruction of the oxygen tube (o) enables thebubbles to be plainly seen, and permits at the sametime of a rapid and considerable increase in the volumeof the oxygen without the risk of water being drivenout of the bottle. Two " holes " of oxygen with adepression of ! in. in the N 20 tube represents 10 percent. of oxygen. Both gases can be easily variedaccording to the requirements of the patient, anddelivered under positive pressure if desired. Themixed gases can be diverted through ether, or C.E.mixture if preferred, by means of the two-way stop-cock (T). The bottles can be filled or emptied throughthe plugs (P) without unscrewing the tops. On theassumption that a table of some kind is usuallyavailable for the anaesthetist, an elaborate stand orcarrying case has been omitted from the design. Thecylinders are mounted with fly nuts on a horizontalmetal bar which is provided with two detachable legs.Long lever keys are used and the gas valves heatedwith a spirit lamp. Used in conjunction with aportable tracheal insufflation apparatus alreadydescribed by me in THE LANCET,1 and to which thisunit can be easily attached, N20, oxygen, chloroform,and ether can be given by inhalation or insufflationas desired.The original model of this apparatus was made for

me by Messrs. Coxeter and Co., and the improvedpattern by Messrs. Down Bros., St. Thomas’s-street,S.E. 1.

I. W. MAGILL, M.B., B.Ch., B.A.O. Belf.,Senior Anæsthetist, Queen’s Hospital, Sidcup.

1 THE LANCET, 1921, i., 918.