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affection, was reacting to injections of eserine (grain 1/100)three times a week so well that until this proved ineffectivenothing further was intended. Skiagrams of the conditionbefore and after operation were shown, also the excisedrectum, which, with contents, weighed 6 pounds.-Mr. L. B.Rawling showed: 1. A case of Tumour of the Lower Jaw withEgg-shell Crackling ; a skiagram showed the wisdom tooth(unerupted) situated at the top of the tumour. Mr. Rawlingconsidered the diagnosis lay between a dentigerous cystand a myeloid sarcoma ; he proposed to operate. 2. A

Cyst in the Shoulder presenting through the fibresof the deltoid beneath the scar of an old operationincision. It was at first considered that it mightbe a hernial protrusion of muscle, but an exploratorypuncture produced fluid containing some melon-seed bodies.He considered it was a tuberculous affection and probably aprotrusion of a pouch of synovial membrane from the jointitself ; the nature of the previous operation was unknown.- me. J. E. R. McDonagh showed several cases in whichmarked and intractable syphilis had been treated with an

injection of "606," all with surprising and almost imme-diate success.-Mr. Haldin Davies showed : (1) A case ofTuberculide ; and (2) a case of Pigmented Neevus.—Mr. S.Maynard Smith showed a case of Cirsoid Aneurysm of theScalp ; this had been quite small at birth but after a blowon the head had considerably increased in size ; he hadtreated it by multiple ligature, causing its almost. completedisappearance.-Mr. E. Laming Evans showed a case of

Congenital Upward Displacement of the Right Patella in alittle girl.-The President showed some gynaecologicalspecimens, and an interesting discussion followed.

OXFORD MEDICAL SOCIETY.- A meeting of thissociety was held on Oct. 14th at the Radcliffe Infirmary.-Dr. Tibbs related the history of a case of Lymphatic ’,,Leukxmia which had ended fatally in the infirmary. The Icourse had been very acute ; there had been high tempera-ture, a septic throat, and the blood picture ot the large-celled type. A blood culture was negative. The interest ofthe case lay in the fact that post mortem the glands and thepericardium were found to contain a Gram-negative diplo-coccus, which it had not been possible to grow in pureculture. Several preparations from the case were exhibited.The question was whether the case was one of chronicleukmia with a terminal septic infection, as three weekspreviously the patient had been in his usual health, and thepatient volunteered the statement that his glands had alwaysbeen enlarged.—Dr. W. Collier then read a paper on the

Therapeutic Use of Alcohol. Pharmacologically it was an

irritant, and its action in this respect on the stomach wasstimulant. It was doubtful whether, on the nervous system,alcohol stimulated first and depressed afterwards or depressedfrom the beginning. The essays of Crile and Gairdner hadhad a very marked effect in altering Dr. Collier’s treatment ofhis own patients and, he thought, that of many other phy-sicians. Preceding the crisis in a fever Dr. Collier thoughtthat ammonium carbonate, digitalis, and strychnine were asefficacious as alcohol. For fainting it was perhaps the mostaccessible drug, though it possessed no advantages over thepreparations of ammonia. As a hypnotic it was doubtful ifit was ever as useful as veronal and other similar drugs.As a means of warding off syncope in slight operationssuch as tapping it was a useful drug. For childrenwith diarrhoea it was a useful adjunct to other methodsof treatment, and to the aged it might be given with

impunity. In facial neuralgia two glasses of port winedaily often had a marked effect, and during convalescencegood wine in moderation more quickly restored the strengthef the patient. The present fashion of giving meat-wine waswasteful and expensive treatment, and offered in persons nottaking it under medical orders a likely means of developinga habit. The alcohol consumed in institutions had beenmarkedly lessened in the last 15 to 20 years. In the RadcliffeInfirmary in 1889, when 1399 patients had been treated, &pound; 117had been spent on malt liquors and 91 on wine and spirits ;20 years later, when 2257 patients were treated, E9 had beenspent on malt liquors and E51 on wine and spirits. The re-cords of other hospitals all showed enormous reductions in theconsumption of alcohol.-In the discussion which followed ’Mr. R. H. A. Whitelocke urged its vigorous use in all cases of ’septic poisoning.-Dr. F. G. Proudfoot doubted whether inslight operations ammonia preparations had the same effect <

I as alcohol. He mentioned its diuretic action and the vary-! ing action of different preparations of alcohol, such as

beer and whisky, in this respect. In digestion its actionI depended entirely on the individual.-Dr. W. J. Turrell

urged its value for tiding over a period of great fatigue inlong-continued muscular exercise ; for instance, towards theend of a long bicycle ride. It was a valuable drug inchildren and old people. According to Graves, it wasvaluable if the pulse and respiration remained steady. Healso thought that it was a valuable hypnotic and as a stimulantto the appetite in fatigue.-Mr. A. P. Dodds-Parker relatedthat in the records of two physicians at a certain Londonhospital the percentage mortality in the patients of the onewho gave alcohol freely was half that of another physicianwho withheld it. In septic cases he thought that it was oflittle use, and much preferred in his own practice to givelactose as a means of keeping the tissues of the body suppliedwith a minimum of food.-Dr. W. Duigan said that in hisexperience alcohol in asthenic conditions, as, for instance,bad innnenza, was a valuable drug, and in continued feverof an asthenic type.-Dr. W. A. P. Waters mentioned itsvalue in his hands after acute illnesses, especially inchildren.

Reviews and Notices of Books.Saient-ifia Memoirs by O’coers of the Medical and Sanitary

Depcartznents of the Government of .india. 11 o. 37,lnvestigativns on Bengal Dietaries, 1vith Some Obsertationson the lnjlzcenee of Dietary on the Pky.5ieal Developmentand TVeU.being of the People of Bengal. By Captain D.MCCAY, M.B. R.U.I., I.M.S , Professor of Physiology,Calcutta Medical College. Calcutta : Superintendent ofGovernment Printing. 1910. Price Rs.2.6, or 4s. 3d. -

THIS volume contains an account of a prolonged andexhaustive investigation into the composition and food valueof the dietaries that are in use in the various jails in Bengal,with some valuable observations on the physiology of alimenta-tion, and practical recommendations for improvement inexisting conditions. The scope of the inquiry was to investi-gate the suitability of the diet scales prescribed for prisonersin Bengal. Most of the work done has related to the

estimation of the nutritive value of the dietaries in use,and in particular to the determination of the digestibility, orabsorbability, of the nutritive principles contained in them.It has been laid down by recent authorities on the physiologyof nutrition (e.g., Atwater) that in foods most easy of diges-tion and absorption, such as meat, fish, and eggs, the proteinis utilised to the extent of 97 per cent. ; while with otherarticles, equally nutritious and necessary for the animal

economy, such as bread, cereal grains generally, and fruit,its digestibility coefficient is 83 to 85 per cent., and with theleguminosae about 76 per cent. The most important resultof Captain McCay’s investigation has been to prove that, asregards the protein of the dietary, the degree of its absorba-bility depends very largely on the actual quantity or

bulk of the food consumed. This question of bulkiness

is not of much moment in European and American

dietaries, but in many parts of India and the East,and particularly in Bengal, it is of the first importance ;the average weight of cooked food consumed in a day by aBengali prisoner amounts to about 140 ounces, or more than8 pounds. (It should be remembered that the Bengali injail is better fed than his friends and relations outside, butthe character of the dietary is the same.) It was found

that with this diet protein absorption was barely 55 per cent.,instead of the theoretical 76 tc. 85 per cent. Another factor

tends to reduce the net alimentary value of the Bengali’sdietary. The energy value of a dietary is the total potentialenergy of the food minus that of the corresponding fsecea andurine. With the dietaries universally in use in Bengal ex-cessive fermentative change;-, take place in the carbohydrate

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constituents while passing down the alimentary tract; sugarand starch are converted into carbon dioxide and fermenta-tion products (acetic and lactic acids, &c.) of low caloric

value, and a great deal of potential energy is lost. More-

over, intestinal troubles are extremely prevalent, leading tomalnutrition.

After an introduction giving a r6s?ttne of work that hadbeen previously done in regard to Indian jail dietaries, andof the methods employed in the present investigation, theauthor describes the dietaries at present in force and givestheir chemical composition ; also their energy value as

determined by means of the calorimetric bomb by ProfessorBenedict of Washington, an act of international scientific

courtesy that is gratefully acknowledged. Then follows a

detailed account of the experiments on the nutritive valueof the dietaries, first in Lower Bengal jails, then in those ofBehar. The Lower Bengal dietary consists of 26 ounces

rice, 6 ounces dal (pulse), 6 ounces green vegetables, andcondiments ; it contains 93 grammes protein, 693 grammescarbohydrates, and 305 grammes fat, yielding 3508 Calories,a higher value than any of the standard diets that havebeen formulated for Europeans," but the author shows that,by reason of the excess in carbohydrate (leading to excessivefermentation), the absorption of the protein is so much inter-fered with that its value is reduced to 60 or 65 grammes.This was proved by very numerous experiments. Batches of

five or ten or more men were carefully observed, their urineanalysed in five-day periods, and the metabolism calculated.In some series of observations not more than 50 per cent. ofthe nitrogen ingested was metabolised. The carbohydrateswere gradually reduced in amount and a succession of

observations made on the nitrogen excretion under the

altered conditions. It was found that when the rice rationwas 18 ounces (instead of 26 ounces) the nitrogen absorbedamounted to 8’5 grammes (instead of 7-5). "Any rice inthe dietaries in excess of 18 ounces per man daily is not onlyuseless but actually clogs the absorption of protein, so thatthe amount of nitrogen undergoing metabolism actuallyfalls. "

In the jails in Behar (which is Upper Bengal) the quantityof rice allowed is only 16 ounces, the same amount of pulse(dal) is given as in Bengal-viz , 6 ounces, and either 10 or12 ounces of ata, a flour prepared either from wheat or maize,which contains protein. The value of this diet is approxi.mately 105 grammes protein, 650 grammes carbohydrate, and38 grammes fat. The diet is less bulky than the Bengaldiet, but there is too much carbohydrate to permit of

the best use being made of the protein element. The

recommendations. made are: for Bengal jails a diet of

rice (Burma or country) 18 ounces, pulse 4 ounces, wheatata 4 ounces (or fish 4 ounces in its stead twice a week), andvegetables 6 ounces ; for Behar jails : rice 12 ounces, ata

either 10 ounces (from wheat) or 12 ounces (from maize),pulse 5 ounces, vegetables 6 ounces, and on two days a week5 ounces of fish or goat’s flesh in place of 2 ounces ata and

1 ounce dal. The general effect would be to decrease the

quantity of rice all over Bengal by 6 ounces daily, whichwould work out to a saving of 75,000 rupees (<&5000) perannum. It seems strange to read (p. 44) that "it was foundpractically impossible to get the prisoners (in the Presidencyjail, Calcutta) to consume the full diet (26 ounces) of Burmarice for more than a day or two ; " the same was found atBuxar jail (p. 102). There must have been a great accumula-tion of surplus stores in these institutions. Country rice, onthe other hand, is consumed in its full quantity.The general result of the inquiry is to demonstrate that

while in chemical value the Bengal diet contains 93 and theBahar diet 106 grammes protein, the nutritive or physio- 1logical values are only 49 and 60 grammes respectively-that

is, a little over 50 per cent. only of the protein is absorbed,the cause of this low absorption being the excessive bulkiness.of the food. By a succession of careful trials it was found

that the optimum quantity of rice was 18 (instead of 26)ounces in Bengal and 12 (instead of 16) ounces in Behar.

In the second part of the volume is a very suggestivediscussion of Chittenden’s views as to the possibility of

existing in health on a diet containing less than half theprotein content of diets ordinarily in use in Europe andAmerica. In his previous memoir Captain McCay had shownthat this is the case in Bengal, the average native reach-

ing an even lower limit of nitrogenous metabolism than anyof Chittenden’s subjects ; many students and fairly well-to-do persons exist on a metabolism of less than 40 grammesof protein daily. But when it came to jlldging of the effects.of such a dietary on physical development, capacity for

labour, and resisting power to disease and infection, it wasfound that Chittenden’s standards were not sufficient. Th&

Bengali diet is contrasted with that of the Behari ; the latter(in the jails and in the population generally) is about2 grammes per head higher in nitrogenous metabolism thanthe former. " In accordance with this we find in theBehari a much better physical development, greatercapabilities for muscular exertion, a distinctly greaterdegree of vivacity, briskness, and sprightliness of manner."His weight is 120 pounds, compared with the 110 poundsaverage of the Bengali. This results from the 10 percent. higher nitrogenous metabolism. It is also pointedout that the low nitrogenous metabolism of the Bengalidoes not secure him from renal disease, the particularcondition that Chittenden considers to be most likelyto be avoided by protein economy, for renal disease is.

much more common among the working population of Bengalthan in Europeans. A comparison is also made between thehill tribes to the s-ime effact, and the conclusion is come tothat in those races where an assimilable protein, and par-ticularly an animal protein, forms part of the ordinary diet,muscular development and good fighting qualities seem to beintimately related with the level of nitrogenous metabolismattained. "

The present memoir by the professor of physiology atCalcutta is of permanent scientific value, and second to noneof its predecessors in interest or importance.

Handbucch der hindcrkczlk2cnde. E ite3 by Professor Dr. M.PFAUNDLER and Professor Dr. A. SCHLOSSMANN. Secondedition. Four volumes, with 69 coloured plates and 515illustrations. (Fifth volume in preparation.) Leipsic =F. C. W. Vogel. 1910. Vols. I. and II. Price eachvolume, unbound, M.12.50 ; bound, M.15. Vol. I .,pp. 455 ; Vol. II., pp. 588.

IT is difficult within the limits of a review to do

justice to the many additions and improvements whichhave been introduced in this new edition of a famous text-book. Much has occurred in the domain of paediatricssince the first edition appeared in 1906, and it its

scarce exaggeration to state that no event of importanceremains unchronicled in these pages. That this vast and

comparatively expensive handbook should have been trans-lated into two languages-English (reviewed in THE LANCETof Feb. 6th, 1909) and Spanish-and yet require a newedition within four years of its first appearance, adequatelytestifies to the intrinsic merits of the work and to the positionwhich paediatrics now holds in the world of medicine.In its completed form this new edition will be enlargedby an additional volume and thus consist of five volumesand not four. as in the original issue. The new volume willbe concerned with the surgical and orthopaedic aspects of thediseases of children and will be the joint work of Professor

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F. Lange of Munich and Dr. H. Spitzy of Gratz. The

present review is, however, limited to a consideration of

Volumes 1. and II. only.The first volume deals with such general subjects as nutrition

and metabolism, diseases peculiar to definite age-periods, andwith the general pathogenesis, pathology, treatment, and

prevention of diseases in children. In only two of the

chapters which deal with these subjects is there any note-

worthy change-namely, in the one concerned with mortalityand morbidity in childhood, written by Professor Prausnitz ofGratz, and in the one on nutrition after the first year, written

by Professor Schlossmann himself in conjunction with Dr. P.Sommerfeld of Berlin. The first of these chapters is enlargedand brought up to date, but even in its present form it hardlydoes justice to the importance of the subject. The secondhas been entirely rearranged with the change in authorship.This chapter, though an important one, is not likely to

appeal to English readers. In the first and theoreticalsection the feeding of children is expressed in calorie values,a method which, despite its scientific and abstract interests,has few practical applications in the feeding of the humananimal, which has tastes, fancies, and idiosyncrasies of

digestion and metabolism, all having a way of upsettingthe most carefully laid plans. The second section of this

chapter, which is concerned only with practical dietetics,also has its limitations, for German foods and methods andtimes of feeding hardly harmonise with English ideas.The second volume shows many more important changes.

Moreover, it comprises subjects which are of greater clinicalinterest and importance. The contents of this volume are :Blood diseases, by Dr. A. Japha of Berlin ; constitutionaldiseases, by various authors ; acute infections and chronicinfections, both written by a variety of distinguishedmembers of the profession. Barlow’s disease, or infantilescurvy, if we mistake not, was included in the first editionin the chapter which was devoted to rickets ; in this editionit has conferred on it the dignity of a chapter to itself fromthe pen of Dr. W. btoeltzner of Halle. The chapter on ricketshas itself been greatly enlarged by Professor W. v. Starck ofKiel, and now provides the reader with a more comprehensive

account of the etiology and pathogenesis of the disease.

The latter elaborates the theory at which he only hinted inthe first edition, that the disease is primarily an osseous andmuscular dystrophy, and dependent on the factors of

domestication and confinement. In this connexion he makeshonourable mention of Findlay’s experimental work on

puppies. Young animals kept in confinement, and especiallyunder conditions of overfeeding, do not give full play to

their natural instincts for muscular exercise. The inactionof the muscles deprives the growing bones of their healthyand natural stimulation. Professor Starck draws attentionto the influence of internal secretions such as those by theadrenal organs, and refers to the antagonistic action betweentheir secretion and that of the pancreas.

In anew and very excellent chapter Professor Pfaundler dis-cusses the part played by diathesis in disease, and he reviewsthe claims of such conditions as neuro-arthritism, lymphaticdisease, and the exudative diathesis to be regarded as inde-pendent entities, or as merely accidental syndromes ofsymptoms. He gives full prominence to Czerny’s views on theexudative diathesis and his treatment by a restricted diet andunstimulating psychological environment. He also refers at

length to the views of Buchard and his school with referenceto the part played by a sluggish metabolism in the determination of such dyscrasias as gout, arthritis, and fattydisease (Fettsucht). The prominence given to the views ofthis French school is in marked contrast to the manner inwhich they have been heretofore ignored in Germany.Duke’s "fourth disease," which, it will be remembered, was

described in a separate chapter in the first edition, receivesfuller notice in the present volume, and additional evidenceis adduced in support of its claims to be regarded as anindependent infectious exanthem. Following on this chapteris another from the pen of Professor Pfaundler on ’’ erythemainfectiosum," an infectious exanthem 300 cases of whichhave been recorded in German literature. This diseasehas been described under various synonyms ; for instance,Plachte originally called it megalerythema epidemicum, whilePospischill gave it the name of erythema simplex variabile ;by others it has been called erythema simplex marginatum,erythema infantum febrile, and "the fifth disease." " Pro-

fessor Pfaundler declares for its independent existence as

a disease svi generi8. He describes the symptoms and

course of the disease with detailed accuracy. The import-ance of being able to diagnose this exanthem from scarletfever, or indeed from measles, lies in the fact that its

comparatively harmless character does not necessitate pro-longed isolation. The troubles of the practitioner in makinga differential diagnosis between scarlet fever, German

measles, the fourth and the fifth disease, would be greatlymitigated if it could be shown that they are due to infectionby polymorphic varieties of one and the same microbic agentpresenting different degrees, or indeed kinds, of virulence.The fact that these diseases are not mutually protective doesnot entirely dispose of this possibility.The joint editors of these volumes are to be congratulated

on the completion of a task of great magnitude. Not one ofthe least of their difficulties must have been to eliminate aconflict of opinion between the numerous and distinguishedcontributors who have taken part in this literary symposium.We notice in these two volumes greater uniformity and lessreiteration than in the former edition ; such a result impliesmost careful and painstaking editorship and a broad-mindedappreciation of the criticism of reviewers.

Mediaal Etect’l’wity and Roentgen Rays. By SINCLAIRTouSEY, AM., MD., C ",suIting Surgeon to St. Bar-tholomew’s Clinic, New York City. With 750 illustra-tions, 16 in colour. London and Philadelphia : W. B.Saunders Company. 1910. Pp. 1116. Price 30s. net.

THIS is a voluminous work whicn will form a valuable, it

ponderous, addition to the library of the specialist in medicalelectricity and radiology. The subjects are from the

beginning treated in the most exhaustive manner, and

every point is illustrated with suitable diagrams and

drawings. The first section deals with the physical problemsinvolved, and runs to nearly 300 pages. Constderi. g thatthis is a medical work we thi k that this part miht hd.vebeen very considerably curtailed. The section on electro-

physiology is distinctly good and complete. This first

portion of the book, consisting of 340 pages, might well forma volume by itself for the more convenient use of thosewho seek a useful laboratory handbook. In the chapter onelectro-pathology the author describes the effects of lightningand high- and low-ten4i m currents on the tissues and

organisms as a whole-a subject that becomes ot dailyincreasing importance with the rapidly extending use of

electricity for industrial purposes. We note that he makesno reference to the work of Jellinek of Vienna, whose con-tributions to the study of electric shock are of the first

importance. Subsequent sections deal with the subjects ofelectro-diagnosis, ionic medication, one on general tfotro-

therapeurics being strikingly brief. After a short note ence

to the effects of the eleot.ro-ma.gnet the author pat-f un tothe use of electricity in n<-rBju diseases, but leave" ."" withthe impression of a lack ot completeness, and not 4,earlyconvinced of the efficacy of the methods advised.

High-frequency currents are treated at some lenrh and

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appear to find favour with the author for many conditions.He considers such applications of decided value in cases ofpulmonary tuberculosis. On p. 558 is a radiograph of a

patient’s chest who had been treated by this method amongothers. He states that after three months the patient hadvery greatly improved ; he has omitted, however, to give aradiograph of the chest before treatment, which would havebeen valuable for comparison. The patient died about a

year later, but the author thinks the case might have beencured had the patient been able to follow up the treatment,a sanguine view which he does not support adequately.When he comes to the treatment of local conditions andskin lesions by high-frequency currents, the author is on

surer ground, and records and illustrates some definitelyvaluable resulLs, though we do not quite see the reason forillustrating a typical case of alopecia areata that is undertreatment at the time of writing, and apparently unchanged.He has had excellent results in pruritus, psoriasis, andchronic ulcers.A short chapter is given on phototherapy, and then follows

the section on the X rays which takes up the rest of thevolume except for a few pages at the end which are devotedto the consideration of radium. This X ray section has

been very carefully prepared, and we notice a novelty in theform of a cellular diaphragm with which the author claimshe can get better definition in his radiographs. It has the

effect of intercepting the stray rays to an even greater extentthan the ordinary tubular diaphragm. The methods advisedin radiography call for no special mention, except that thetechnique employed in any part of the body is fully explainedand illustrated. A short chapter is devoted to X ray treat-ment, which also calls for no special mention. We note thatthe author does not claim any higher value for the X raytreatment of malignant disease than it deserves.The book as a whole is a very valuable contribution to the

literature of the subjects treated, but we think it might havebeen condensed in many places with advantage. The work

could have been made less unwieldy by issue in two separatevolumes. The printing and illustrations are of a high orderand leave nothing to be desired.

Uric Acid in the Clinw. A Clinical Appendix to .. Uric Acidas a Factor in the Causation of Disease." By ALEXANDERHAIG, M.A., M.D. Oxon., F.R C.P. Lond., Senior Phy-sician to the Metropolitan Hospital and the RoyalHospital for Children and Women ; late CasualtyPhysician to St. Bartholomew’s Hospital ; assisted byKENNETH G. HAIG, L.R.C.P. Lond., M.R.C.S. Eng.London: J. and A. Churchill. 1910. Pp. 306. Piice58. net.

IN this book Dr. Haig gives descriptions of cases illustratinghis views regarding the pathogenic effects of uric acid. It is

to be regarded as a clinical appendix to the well-known bookin which he has enunciated his opinions ; at the same time hehas further developed them in the commentaries he gives uponthe cases described. He maintains that the diseases or condi-tions caused by uric acid fall into two groups, the first beingthe collaemio group, in which he believes that the blood is

thickened and its circulation hindered by floating particles ofcolloid uric acid ; and the second the precipitation or retentiongroup in which local retention of uric acid leads to irritationor pain. The collaemic group is subdivided into conditionsdue to simple coltasmia, such as headache, epilepsy,neurasthenia, mental depression, asthma, insomnia, andvarious other conditions and groups of symptoms. The

second subdivision is described as collasmia complicated byan organic factor, and comprises dyspepsia, chorea, Bright’sdisease, glycosuria, diabetes, high blood pressure, Graves’sdisease, Raynaud’s disease, &c. In the retention group the

ordinary gouty conditions are included, as well as arthritis,

endocarditis, catarrhs, and cutaneous manifestations. Dr.

Haig insists that these various conditions are not sharplymarked off from one another and that they are not diseases,but are in all varieties and combinations the results of food

poisoning. He discusses the effects of what he describes asa "uric-acid free " diet on these conditions. He divides

drugs into solvents and precipitants, and climates are

similarly classified. The data given in this book are for themost part simply illustrative cases, and for critical purposesmust be considered in connexion with the original work.

LIBRARY TABLE.

The Expectation of Life of the Consumptive after Sana-toiinna Treatment. By NOEL DEAN BARDSWELL, M D. Edin.,M.R.C.P. Lond., F.R S. Edin., Medical Superintendent, KingEdward VII. Sanatorium. London, Edinburgh, and Glasgow:Henry Frowde and Hodder and Stoughton. 1910. Pp. 130.Price 3s. 6d. net.-Few tasks are more difficult thanthat of appraising the value of any method of treatment in achronic disease of variable type such as pulmonary tuber-culosis. A careful study of the after-histories of cases

treated at sanatoriums is calculated to afford useful informa-tion in regard to the results of that method of treatment.Dr. Bardswell gives a careful statistical study of 241 patientswho were under his care in sanatoriums during the years 1899to 1905. He classifies his cases according to their conditionon admission into three groups-viz., incipient, moderatelyadvanced, and far advanced. He gives the results at the timethe patients left the sanatoriums and also in 1909. Of the241 patients, as many as 101, or 45 per cent., were dead in1909, while 99, or 41 per cent., were classified as "well,"and15, or 6’2per cent., as "alive "-i.e., "the patient hasto make the care of his health his chief considerationin life, possibly to the exclusion of everything else." Whenthe cases are studied in their respective classes the resultsareless gloomy, for of the 62 incipient cases, 46, or 74 per cent.,were classified as well ; 1, or 1’ 6 per cent., as alive ; and 11,or 17 6 per cent., as dead, 4 being lost sight of. Among themoderately advanced cases 36-8 per cent. had died, andamong the advanced cases 88 per cent. Dr. Bardswellexamines his statistics by various methods and gives aninteresting commentary upon the results obtained. His con-

clusions are temperate and practical and he makes no

exaggerated claims as to the value of sanatorium methods.His little book is a useful contribution to a subject which isnow widely discussed.

.11-2ms2ng in Diseases of the Eye, Ear, Nose, and Tkroat.

By the Committee on Nurses of the Manhattan Eye, Ear, andThroat Hospital. London and Philadelphia: W. B. SaundersCompany. 1910. Pp. 281. Price 6s. 6d. net.-This is a

good little book upon the nursing of sufferers from eye, ear,

nose, and throat diseases. In detailing the general dutiesof sick-nursing, as well as those called for in special diseases,its range is large, nevertheless it avoids superficiality or tire-some minuteness, and is full of invaluable hints clearly andplainly set down. In the treatment of emergencies there islittle or nothing omitted that is likely to prove of use to theattendant, and we would refer to the instructions given for thestilling of epistaxis as particularly serviceable. In the after-treatment of tracheotomy the steam tent is recommended asif it were indispensable. Doubtless climatic conditions renderit advisable in many quarters of the globe, but we believe thatin London experience has shown that tracheotomy cases doperfectly well, as a rule, when exposed to the ordinary wardatmosphere. We should have been glad of fuller details onthe important matter of the procedure and after-treatmentof the major operations on the nose and ear. As a rule,purely medical points are wisely omitted, but one amongthose included-namely, the statement that nasal septal