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thing appeared to him to be certain, and it was thatAmerica had no intention of solving its psychiatricproblems by bricks and mortar alone. Child guidanceand welfare work of all kinds organised for theprevention and early treatment of mental disorders ;eugenic measures and parental education were to have ethe drive of the State dollars for the future-hencethe reluctance to increase the State hospital accom-modation. America had also lessons for us in theimportance it attached to the psychiatric education ofmedical men, social workers, occupational therapists,and others in the field of public welfare. Researchwork, too, was more widely developed andreceived greater support and encouragement bothfrom the State and private citizens than in thiscountry.Touching on legal matters, Dr. Lord said that as
regards the mental services (and certainly not ifthe Mental Treatment Bill became law) America hadlittle or nothing to teach us except perhaps in respectof recent enactments in one or two of the moreprogressive States, and also in the way in whichpatients are allowed out on leave or discharged.Although many State hospitals and municipalclinics could admit voluntary patients (the stateof mind qualifying for such seemed to him almost toexclude any aberration) this departure did notreceive much encouragement from the hospitalauthorities judging by conversations he had hadwith many superintendents from all over the States.The modern practice was admission on two medicalcertificates sworn before a judge or magistrate.This is thought to be the wisest course in non-litigious cases, to avoid future complications. Insome of the States patients, litigious or not, could be ’,detained for from 5 to 30 days on two medicalcertificates, unsworn or, if a court order was requiredand did not accompany the patient, on notification,the judge or magistrate issued a temporary com-mitment order and fixed a date for the " hearing."If the patient or his friends demanded it they couldbe present at a " hearing " ; if no such demand weremade the judge confirmed the order. The " hearing "
might be within 5 to 30 days if, in the meantime, thepatient had not been discharged or been classified asa voluntary patient. Such court orders were
always necessary in litigious cases after 5-30 days,but not always before this time. Objectionableforms of judicial intervention still existed, butAmerica did not seem to mind. A period of tem-porary treatment for 12 months without any judicialintervention as proposed under our Mental TreatmentBill was, generally speaking, unthinkable in America,Only in Maryland had the law on commitmentsbeen much relaxed. As in England it was thehospital in America comparable with our registeredhospital which received a majority of voluntaryadmissions. He hoped that our experience underthe Mental Treatment Bill would not, as regardsvoluntary admissions to public hospitals, be thesame as in America. He felt sure- it would not ifClauses I.-IV. were properly administered by thelocal authorities.
Other speakers followed, mainly seeking explana-tions or further information.
A RADIOLOGICAL INSTALLATION.-At the quarterlycourt of governors of the London Hospital last week,Lord Knutsford reported that about iô5000 is beingspent upon the installation of new apparatus for radio-graphy and for treatment by rays of very short wave-length.
HULL ROYAL INFIRMARY.——The work of thisinstitution last year constituted a record. There were4227 in-patients, 15,801 out-patients, and 23,938 casualties-a total of 15,000 more than were treated as recently as 1919.The average in-patient stay was 20-66 days, compared with22-04 in 1928. The annexe at Sutton is expected to becompleted before the end of the year.
Reviews and Notices of Books.DISEASES OF THE SKIN.
Treatment in Detail. By NOXON TOOMEY, -II.D.,late Instructor in Dermatology, University ofSt. Louis. St. Louis, U.S.A. : Lister MedicalPress. 1930. Pp. 512.$7.50.THIS is the third volume of a series of which
Pathology and Diagnosis form the other sections.It will doubtless make a wide appeal, for in thetreatment of diseases of the skin there is moredivergence of method and less tendency towardsstandardisation than in any other branch of medicine.The experienced dermatologist will approve theclassification and general plan of the book, the casualreader its simple, almost colloquial style. Thereare no tiresome introductory sections on thetheoretical principles concerned either with internalmedication or local applications. These are
adequately discussed under the various diseaseswhere necessary, and the author proceeds directly tohis purpose from his first section which is on eczema.The briefest study of this section makes it apparent thatthe author is a master of technique in therapy, andhas personally supervised every detail of the measuresadvocated under the various headings. As hehimself remarks, " there is no cutaneous disease inwhich therapeutic skill is better brought out than ineczema." All the formulae given are easily memorisedand have the support of years of universal experience ’behind them. The author wisely abstains fromoffering too many alternatives. He names no
sources of information, and in this respect, too, he iswise, for it is obviously gathered directly or indirectlyfrom the records of all nations. A word of cautionseems necessary. The book is not an elementarytreatise on the therapeutics of skin diseases, and canonly be used with advantage when a wide experiencein diagnosis and pathology has been gained. Withso much that is modern and universally accepted,it is disturbing to find that the author still advocatesthe use of X rays in certainstages of the treatmentof lupus vulgaris ; the appalling sequelae which manydermatologists in this country and abroad are
frequently called upon to treat have led to an almostcomplete abandonment of radiotherapy for lupusin expert European circles, where reliance is placedupon actinic and certain caustic applications. Thetreatment of dermatitis repens, which has been knownin this country since the days of Radcliffe Crocker,is considered in a new and interesting light, and themethod advocated seems applicable to other derma-toses of a chronic and resistant character. There isa good index, and the paper and printing are ofexcellent quality.The book is likely to find its way into all dermato-
logical libraries both public and private. It makesgood reading, and is compact with stimulatinginformation.
MODERN SUNLIGHT.By LEONARD V. DODDS. London : John Murray.1930. Pp. 322. 7s. 6d.As Sir Oliver Lodge states in his preface, this book
deals fully with medical opinions on the subject, andis put together in simple and readable form. Techni-calities are avoided since the book is written for thegeneral reader, but, on the whole, the informationoffered is remarkably accurate. There are a fewstatements which the medical reader will criticise.For example, we doubt whether the earlier detectiono f a scarlet fever rash by the use of daylight lamps infnver hospitals would be a valuable asset in savinglife, but it might certainly play a part in limitingspread of infection. It is unfortunate that in a bookmeant for the lay reader the impression should begiven that helio- and actino-therapy have rendered anyform of surgical interference unnecessary in surgicaltuberculosis. The book is of interest in the support
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it gives to the value of actinotherapy, which has beenseriously questioned or alternatively attributed topsychological effects. Abstracts of recent veterinarywork show that breeders and trainers give lighttreatment regularly to both horses and greyhounds,and the opinion is expressed that such treatment hasintroduced a new factor in the calculation of racing-odds. The experience is quoted of workers at theRowett Research Institute, who found that irradiationof cows increases the period of maximum yield andsafeguards the health of the animals. The directorof the institute of cattle-breeding of KÖIligsberg reportsthat farmers are recommended to procure quartzlamps to prevent the occurrence of rickets in cowsand valuable breeding bulls. Bees are the latestrecruits to ultra-violet light treatment. We are
informed that the hive hums contentedly, comes outas if the sun were shining, and manifests its well-beingby building more cells and hatching the larvae inshorter time. Among the less reputable uses towhich ultra-violet light has been put is, we are told,the " making of antiques " by darkening and bleachingmodern furniture and the making of " vintage "wines. This small manual will attract both medicaland lay readers, for it contains interesting informationand is written in a pleasant unassuming style.
1/AN.aESTHaiB LOCALE EN OTO-RMNO-LARYNGOLOGM.Par G. CANUYT, Professeur de clinique d’oto-rhino-laryngologie ; et J. JOUBLOT, Chef declinique, a. la Faculte de Medecine de Strasbourg.Paris : Masson et Cie. 1930. Pp. 231. Fr.40.
Prof. Canuyt, who is well known for his work onlocal anaesthesia, has given us here, in collaborationwith Dr. Joublot, a straightforward account of hismethods in the department of oto-rhino-laryngology.Their technique is simple ; the only solutions em-ployed are 5 per cent. cocaine for surface applicationto mucous membranes, and 1 per cent. novocainwith 0-2 per cent. of potassium sulphate as a synergistboth for infiltratioIl and nerve-blocking by injection ;one drop of 1 in 1000 adrenalin is added to eachc.cm. of either solution just before use. The authorsdeny that the use of adrenalin is followed by vaso- Idilatation ; on the contrary, they maintain that itfavours coagulation and hsemostasis. Syntheticpreparations of adrenalin are not mentioned, and theexperimental proof of the advantages of ephedrineis not held to be complete enough to warrant itssubstitution over adrenalin. Of cocaine substi-tutes, butyn, or butelline as it is called in France,was found satisfactory for surface application, butis not recommended for injection ; for this purposenovocain is exclusively employed. The authorsstate that the anaesthetic power of novocain is insuffi-cient for the method of imbibition, or surface applica-tion ; but in a later chapter, on the subject of removalof adenoids in children, they say that they are
accustomed simply to paint the nasopharynx witha weak solution of novocain because " this localanaesthesia is safer than a general anaesthetic andsatisfies the parents who thus know that their childwill be operated on without pain." The confidenceof parents in this respect does not seem justified bythe facts. General anaesthesia is condemned forthe removal of adenoids because of the danger ofdeath from a general anaesthetic of any kind ;similarly for tonsillectomy, general anaesthesia issaid to be contra-indicated in all circumstances as
being dangerous and predisposing to haemorrhage and,especially, to broncho-pulmonary complications.
In this country, where general anaesthetics are
largely given by men who have specialised in thesubject, and where our students are instructed inadministration by such specialists, few laryngologistswill support so sweeping a statement, which takes noaccount of the injury inflicted on the nervous systemof a sensitive child. In aural surgery the authors areless opposed to general anaesthesia, which they recom-mend for the mastoid operation unless contraindi-
cated by the condition of the patient. For the radicalmastoid operation, it has hitherto been difficult tosecure adequate local anaesthesia of the tympaniccavity ; this the authors secure by direct applicationof Bonain’s liquid, which, however, is not likely tobe successful unless there is a large perforation of themembrane. Local anaesthesia is advised for laryn-gectomy, but Prof. Canuyt, rather surprisingly,prefers laryngostomy to this operation for the treat-ment of cancer. The greater part of the book istaken up by careful and minute directions for theproduction of anaesthesia for every kind of inter-vention in the nose, throat, and ear, including thelower jaw but excluding dentistry. These directionsare practical and simple, well illustrated by diagrams,and as here drawn together, constitute a useful bookof reference for all workers in these regions.
TEXT-BOOK OF PATHOLOGY.Second edition. By D. N. BANERJEE, M.D.,Demonstrator of Pathology, Carmichael MedicalCollege. Calcutta : .Medical Bureau. 1929. With305 illustrations and 9 coloured plates. Pp. 646.Rs.12.
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JUDGING by the prevailing standard of Europeanpathology, one would be bound to say that thisis a bad book. It teaches practically nothing ofgeneral principles and is by no means free frominaccuracies of commission and omission. It includesbacteriology, animal parasitology, laboratory methodsand laboratory diagnosis, and starts from cases in thewards rather than from bodies in the post-mortemroom. It would be plainly absurd to concentrate theteaching of pathology in India round the same topics asare used in England ; to give it any reality to medicalstudents pathology must deal as far as is possiblewith the diseases which happen to be common. Andlooking at Dr. Banerjee’s book from this point ofview and considering the conditions under whichit is intended to be used, we can imagine that itwill continue to serve a very useful purpose. It isremarkably cheap.
THE PROGRESS OF LIFE.
By A. MEEK, D.Sc., Professor of Zoology in theUniversity of Durham. London : Edward Arnoldand Co. 1930. Pp. 193. 10s. 6d.
LI]KE many biologists who spend a good deal of theirtime in actual contact with live animals in theirnatural haunts, Prof. Meek is altogether unsatisfiedwith natural selection and Mendelian heredity asadequate explanations of the world about him. Hecannot get away from the conviction that the environ-ment impresses itself on the organism which reacts toit and that such changes are or may be inherited.It is indeed a little difficult to see why anyone shouldwant to get away from such a point of view except outof respect for convention. Prof. Meek’s interpretationis Lamarckism with the addition of the " memory
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conception urged by Cope, Samuel Butler, and Semon ;hence he calls it " psychogenetic evolution." Equallyhe condemns all theories of particulate inheritance,especially the modern doctrine in which the gene isall-important. Here he is perhaps rather too sweeping.It may be that there are many mechanisms ofinheritance, and that the same end is achieved by avariety of routes, the organism being relativelyindifferent which it takes. Reproduction among thehigher animals is usually sexual but parthenogenesisand budding and splitting of eggs also occur ; the factof reproduction is evidently controlled by the endwhich is attained, not by the mechanism which happensto be used. And so, too, perhaps it is by various meansthat the product of reproduction resembles its parents.
SLOUGH MATERNITY HoMB.—Viscountess Astor,M.P., recently laid the foundation-stone of a maternityhome which is being erected at Slough by public subscrip-tion. It is the first institution of the kind in Buckingham-shire.
