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to bear upon the life of the mental hospitals by meansof hospital visitors and social workers.

"Truly a mental hospital is a house of comedy andtragedy. Reasoning and argument have no practical valuetherein. Only sympathy, kindness, and true friendliness areof any avail.... How are the insane kept in a mentalhospital ? P If they decided to go home, home they would go.Our light hospital buildings and the proportionately fewnurses would not keep them a moment; yet escapes fromasylums are perhaps fewer than from prisons.... Bars towindows, physical restraint, &c., are practically unknownnowadays in mental hospitals. The chains are there,however, although not forged from iron or steel. They aremuch stronger and more effective, being links of kindness andpersuasion, the artificer being the doctor and the nurse.So it is not that the ground is barren for the exercise of thesevirtues."

Every mental hospital ward or group of wards, then,should have its social visitors-level-headed, discreet, Iand kindly men and women with some idea of mentaldisorders, who would pay particular attention tofriendless patients, and would act as a connecting linkbetween those patients who had homes and theirrelatives. The onset of mental disorder which leads to’a patient’s removal from home is often sudden, and theeffects upon family affairs catastrophic ; here there isobviously a useful avenue of work for the social visitor.Moreover, the visitor would gather valuable infor-mation concerning the patient’s home environment,which would help the medical officer in his treatmentand disposal of the patient. Dr. Lord speaks of thegreat difficulty of arriving at the truth in cases ofmental disorder, the relatives being frequentlyunwilling to disclose information ; here the socialvisitor’s evidence would materially assist the case.

Dr. Lord quotes the successful experiment begun atHorton Mental Hospital, Epsom, in June, 1922, whenMiss E. M. Dale was appointed as hospital visitor.Although this lady has limited her activities largely torecently admitted patients and to acute cases, she hasalso followed up cases sent to the main building, andlately has also been investigating the condition ofpatients prior to admission. The results have been sosuccessful that the hospital management are keenlydesirous of extending such work to the whole building,and for this purpose more helpers are required. Thisis a beginning. The strength of the movement will befounded on the fact that such visitors will not beofficials, and will, therefore, be free from the suspicionwith which all official asylum workers are regarded.Dr. Lord closes his remarks with a reference to thealready extensive social work of this nature carried onin connexion with State mental hospitals in America,and with the expression of a certainty that before longno mental hospital administration will be consideredcomplete without its hospital visitors and associatedworkers.

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ACETYLENE AND ETHYLENE AS ANÆSTHETICS.

RECENT contributions, both on the continent andin Canada and America, have amplified our knowledgeof the anaesthetic action of ethylene and of acetylene.The number of cases so far reported is not great butsuffices to show that both these gases are capable ofproducing complete muscular relaxation in some

subjects and can be safely extended over periods oftime long enough for most major operations. Bothgases are, of course, highly inflammable, and ethyleneprovides with air an explosive mixture if it reachesthe proportion of 4 per cent. Acetylene and ethyleneare used from cylinders like those employed fornitrous oxide, and are given together with oxygen.Acetylene is administered in the proportion of 60 percent. to start with. This is generally increased to 70for producing full anaesthesia and can afterwards belowered even to 20 or 30 per cent. in the course of along operation. The inhalation is said to produce nodisturbance of pulse, respiration, or blood pressure.Recovery is described as being remarkably rapid andthe proportion of subjects suffering from post-anaesthetic nausea or vomiting small. In the case ofethylene there were 14 instances of vomiting after 92

inhalations. Gauss and Wieland have used acetylenein 220 cases. They precede the inhalation by one ormore injections of morphia and scopolamine. Theanaesthesia produced by both ethylene and acetyleneappears to be comparable with that obtained fromnitrous oxide. Wieland believes that this is essen-tially different physiologically from the anaesthesiaof ether and chloroform and the other lipoid-solventanaesthetics. His argument, however, comprises thedisproved supposition that nitrous oxide and oxygencannot produce anaesthesia unless administered underpressure. This was, of course, Paul Rert’s belief,but it has been fully shown to be erroneous.

DANGEROUS DRUGS.

IN pursuance of Section 7 of the Dangerous DrugsAct, 1920 (10 & 11 Geo. 5, cap. 46) a regulation-the Dangerous Drugs (No. 3) Regulation-amendingthe Dangerous Drugs Regulations, 1921, has beenmade. Regulation 15 of the Dangerous DrugsRegulations, 1921,1 will take effect after August 1st,as if at the end of the regulation were inserted thefollowing words :-

" If a foreign ship in any port in Great Britain requires toobtain a supply of any of the drugs in order to complete thenecessary equipment of the ship, the master of the ship isauthorised to purchase and be in possession of such quantityof any of the drugs as may be certified by the medical officerof health of the port where the ship is (or in his absence bythe assistant medical officer of health of the port) to benecessary for the purpose, the quantity not to exceed whatis required for the use of the ship until it next reaches itshome port. The certificate given by the medical officer orassistant medical officer of health of the port shall bemarked by the supplier with the date of the supply and shallbe retained by him and kept available for inspection."

THE TREATMENT OF NERVOUS POLLAKIURIA.

A COMPARATIVELY rare manifestation of a psycho-pathic constitution is frequency of micturition forwhich no organic cause can be found. A report byDr. Chavigny in Paris M6dical for June 30th dealswith two such cases, which show how easy it is to goastray in the treatment of this condition, and how, byappropriate treatment, a complete cure can be effected.The first patient was a man, aged 21, whose fatherhad suffered from incontinence of urine, and whosemother and sister were extremely neurotic. Thepatient had never been seriously ill, and there was norecord of nocturnal enuresis beyond the normal limitsof infancy. For several years frequency of micturi-tion had become progressively worse, and he had toget up at night five or six times to pass water. Therewas also pollakiuria by day, and when he could not atonce respond to the desire to micturate he experiencedsevere pain in the lower abdomen, and there wasspasmodic retention of urine for some little time.Examination in hospital failed to show any localpathological condition to account for his symptoms,and the history he gave of the treatment he hadhitherto received was as instructive as it was full ofmistakes. His first medical adviser, consulted in 1921,had diagnosed gravel, and had prescribed the treat-ment supposed to match this disease. The resultswere entirely negative. The next practitioner madea rectal examination and diagnosed prostatitis. This,of course, required massage of the prostate, but againno benefit was obtained. The third practitionerconsulted decided that the urinary tract was intact,and that the condition requiring treatment was amuco-membranous enteritis. A fourth practitionerfound a little cystitis, but was not inclined to prescribeintensive local treatment, regarding the pollakiuria asa concomitant of disordered intestinal functions. Dr.Chavigny, being unable to find any organic diseasesuch as tuberculous cystitis, decided, more or less by aprocess of exclusion, that the irritability of the bladderwas of psychic origin. His first therapeutic essay wasa complete failure. For 24 hours the supply of fluids

1 S.R. and O., 1921, No. 865.

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was greatly reduced ; the highly concentrated urineirritated the bladder, adding severe pain on micturi-tion to the patient’s other urinary troubles. Thepollakiuria was not one whit the better for thistreatment, which was promptly abandoned. Thetreatment which was then adopted, and which provedhighly successful in both cases, consisted of repeateddistension of the anaesthetised bladder by increasingquantities of fluid. First an intravesical injection ofcocaine was given, and then 150 g. of fluid wereintroduced. This treatment was repeated at firstevery other day, and later every day, the amount ofthe injected fluid being ultimately raised to 500 g.,and the patient being trained to retain this fluidfor increasing periods. This re-education of thebladder was completed in 15 days, and the patientwas able to leave hospital after a month, by whichtime he no longer had to get up at night, and requiredto pass water only four or five times during the day.The record of the second case was also one of rapidand complete recovery. In neither of these cases wasthere any nocturnal enuresis, and on the rare occasionswhen enuresis occurred by day it was more or less avoluntary act, prompted by the semi-consciousdecision to let the urine escape into the clothing ratherthan, by waiting for a suitable opportunity tomicturate, to excite an attack of pain and spasmodicretention. Whatever the incidence of psychic pollaki-uria may be, it is obvious that before this condition isdiagnosed, and the treatment described is instituted,all the other possible causes of pollakiuria must beeliminated by a thorough examination. I

EXTRAPLEURAL THORACOPLASTY IN

PULMONARY TUBERCULOSIS.

A SHORT monograph has recently been publishedby Prof. H. C. Jacobaeus and Dr. Einar Key! on thetreatment of pulmonary tuberculosis by extrapleuralthoracoplasty. The authors deal with 60 cases, in 15of which fitness for work, and in 19 definite improve-ment, were achieved. In 44 of their cases there hadbeen an observation period of at least a year and ahalf since the operation, and among these 44 patientsthere were 12 who were restored to fitness for workand freedom from symptoms, and 8 who were

definitely improved. It may therefore be calculatedthat this operation may restore approximately 27 percent. to comparatively good health, and may effectconsiderable improvement in 18 per cent. By them-selves these figures may not seem very cheerful, butthe results achieved well deserve the description" remarkable " when it is remembered that thepatients submitted to this treatment had been com-pletely invalided by their disease for several years.Some interesting and rather curious facts emergefrom a study of these cases. The average durationof the disease in the cases which benefited from thetreatment was 5.15 years, whereas it was only 4-27years for the unsuccessful cases. This suggests thatthe acute case does not respond well to this treatment.In 38 cases the left side of the chest was operated on,and among the 22 right-sided cases there were only6 which responded satisfactorily to the operation.Among the left-sided cases there were, however, asmany as 18 successes. Why this should be so is notclear, but the authors note that the late Prof. Saugmanand Prof. Sauerbruch’s assistant, Dr. Brunner, havealso found that thoracoplasty is more often successfulon the left than on the right side. Again, there wereonly 24 male to 36 female patients, and this disparityappears in the statistics of other operators. Thereason for this is still a matter for conjecture. One ofthe most important matters concerned with the selec-tion of cases for this treatment is the standard bywhich the efficiency of the healthier lung is to bejudged. Some surgeons insist on an immaculaterecord from the healthier lung, or they may make a

1 Weitere Erfahrungen über Thorakoplastik bei Lungen-tuberkulose. Supplement III. to Acta Chirurgica Scandinavica,1923. Pp. 88.

concession only to such hilum disease as radiologistsalone and a few talented percussionists can demon-strate. The authors were less nice in this matter;only in 14 of their cases did the healthier lung appearto be perfectly normal or the seat of only slight hilumchanges. In the remaining 46 cases the X rays or thephysical examination or both betrayed involvementof the parenchyma of the healthier lung, which in 28cases was shown to be diseased by both methods ofexamination. Their experience has taught the authorsthat it is not so much the extent and localisationof the disease in the healthier lung that mattersas its character. If the disease is arrested in this lung,even half the lung may be involved and yet thoraco-plasty on the opposite side may be justified.

A SURVEY OF DISEASES OF THE LUNGS

AND PLEURÆ.

THE writers of text-books, and even of text-bookswhich have much merit, may go wrong in two ways :they may set up their own views to the exclusion ofall others but without bringing forward the necessaryjustification, or they may act as impersonal compilersbut discharge their task without due judgment. Manywriters of the latter class abstract without discrimina-tion, allotting each author the same space with animpartiality which does their powers of criticismno credit. In a recent comprehensive survey 1of the subject of diseases of the lung and pleursethe authors have chosen the happy mean betweenthese two extremes, and they have fused theirgreat experiences with those of the most reliableof their fellow-workers. This survey is published asNo. 12 of the series of 22 volumes of the System ofMedicine, edited by G. H. Roger, Fernand Widal,P. J. Teissier, and M. Garnier. With regard to therelative importance of heredity and infection, theyhave no doubts ; hereditary immunity has never, intheir opinion, been proven, and they regard as negli-gible the part played by heredity in the outbreak oftuberculosis. Their survey of the problem of tuber-culosis complicated by pregnancy shows how differentis the attitude of the French from that of the Germanmedical profession. In France, the induction ofabortion in tuberculous women is regarded withlittle favour, and it is considered warrantable only invery exceptional cases. The short chapter on therelation of tuberculosis to influenza shows howdivergent are the opinions of various writers ; whethera physician considers influenza a perfectly harmlessor a most sinister complication of pulmonary tuber-culosis, he will find himself in excellent company.The authors’ discussion of specific treatment revealsthe same diversity of opinions, and their own lackof faith in it is betrayed by their comment that theadvocates of specific treatments commonly reservethem carefully for slight cases and those which showa definite tendency to spontaneous recovery. Theprinciple, according to this view, is that of rushing tothe aid of the victor. The chapters dealing withdiseases of the pleurae are short but full of valuableinformation, and it is interesting to note that theopinion, formed by Landouzy as early as 1881, thatpleurisy a frigore is merely a misleading synonymfor tuberculous pleurisy has subsequently beenjustified. Primary rheumatic pleurisy, unassociatedwith any articular manifestation of

" rheumatism,"is also regarded by the authors as a figment of theimagination, and nothing but a euphemism cloakingtuberculosis.

WE regret to announce the death on July 28th,following an operation, of Dr. Flora Murray, who wasfor long officer-in-charge of the Endell-street MilitaryHospital.

1 Nouveau traité de médecine, pathologie de l’appareilrespiratoire. By Dr. M. Letulle, Dr. P. Halbron, Dr. P.Harvier, Dr. M. Pinard, and Dr. L. Ribadeau-Dumas. Paris:Masson et Cie. 1923. Pp. 596. Fr.40.