860

Annotations." Ne quid nimis."

ROYAL MEDICAL BENEVOLENT FUND.

THE urgent needs of benevolent fund? to relievedistress within the medical profession will occupy theattention of the annual meeting of this Fund, to be heldthis year at the Royal College of Physicians, Trafalgar-square, London, on May 7th, at 4 P.M. Sir ThomasBarlow, the President, will be supported by SirHumphry Rolleston, Sir Anthony Bowlby, and SirWilliam Hale-White, and addresses will be deliveredby the Archbishop of Canterbury and Lord Sumner.The objects of the Fund—(1) to make grants of moneyto distressed members of the medical profession,their widows, or orphans ; (2) to provide annuitiesfor such after they have reached the age of 60 yearsare well known to our readers, but the support givenis still meagre. The number of new applicants for helpin 1922 was nearly double that in previous years,and the value of the grants was also considerablylarger; the total number relieved was 483. Theincome from subscriptions during the year amountedto J33503 and the grant expenditure to 4966. Theincome from investments was 4166 and the annuityexpenditure .S4458, leaving a deficit for the year onthe two Funds of .61754. The committ,ee, facedfor the first time with a deficit, are thereforemaking a special appeal for new subscribers-anappeal which we have warmly endorsed on manyprevious occasions. The hon. treasurer is Sir ChartersSymonds, and the offices of the Fund are at

11, Chandos-street, Cavendish-square, London, A-N7. 1.

READING IN BED.

SLEEP is accepted as part of the nature of things. Iand yet we know little about it. Theories of physicalrecuperation do not explain it, for bodily rest is notsleep and cannot take its place. Sleep is a withdrawalof interest from the world, a retreat from. consciouslife, a shutting off of outer stimuli, and its onset isheralded by a stage in which coherent thought givesway to an undirected flow of ideas, a flow which mayescape notice by those happy people to whom sleepcomes as surely and regularly as night itself, but may,by a harassing union of vividness and incoherence,

1

present itself as hypnogogic hallucinations that arrestthe onset of the deeper loss of consciousness. Or theflow of ideas may be so charged with emotion thatinterest cannot withdraw from it, and the worries ofthe day become the sleep-destroying demons of thenight. The inability to sleep is a constant symptomof a condition of anxiety-whether due to currenttrouble in the outer world or arising from a psycho-pathological cause within the sufferer-and thethoughts that come crowding into the wakeful nightadd to the feelings of exhaustion and foreboding thatmar the following day. But other conditions influencesleep. The essentials of bodily comfort and a moderatedegree of mental or physical tiredness aid thatpleasant anticipation which is perhaps the surestprelude to sleep, whilst exhaustion may make its onsetirresistible. Although to the town worker exerciseand open air are wonderful soporifics, yet there is acondition of being too tired to sleep, and insomnia isnot always to be overcome by the induction of fatigue.Some time-honoured ways of wooing sleep-countingimaginary sheep is traditional-depend upon forcedattention to unemotional matters, and the somniferouseffect of some subjects, or even speakers and writers,arises from the same combination ; on the other hand,if spontaneous- interest is sufficiently aroused wakeful-ness may result.

These considerations result from the contemplationof a series of light volumes under the title of

" TheBedside Library," which has been planned for reading

1 London and Toronto : Messrs. J. M. Dent and Sons. Priceof each volume, 2s. 6d. cloth ; 3s. 6d. leather.

in bed. We need not assume that the aim of reading inbed is always to induce sleep, nor do the publisherssay in so many words that the subjects of these daintybooks are selected with that aim, but attention isdrawn to the absence of contentious subjects, to thesoothing appearance of the form of the book, and tothe facility of reading and handling it; attributes notdistasteful to him who reads in bed because he likes to,but especially attractive to those who seek in thepractice a pleasant aid to slumber. To seize and holdexpectant attention would defeat this aim ; hence weare not surprised to find that, like contentious material,the thrilling and highly emotional finds no part inthe series. The only novel is ’’ Craaford and,delightful as this classic is, the thread of the story isslender and the drowsy reader can readily break off,to renew on the morrow, his acquaintance with therestful personalities of Mrs. Gaskell’s creation. " TheGolden Book of St. Augustine" follows, too, thegolden mean of moderate interest and in its diction isfar enough removed from modernity to call for thateffort which, not sufficient to perturb, yet suffices toinduce relaxation of effort when other conditionsfavour sleep. The range of subjects in the series iswide enough for most of those who may seek byreading in bed to induce a flow of mildly toned ideasas a stage towards the night’s repose.

ANÆSTHESIA FOR REMOVAL OF TONSILS.

THERE are few operations about which so muchdifference of opinion has been expressed as has beenuttered with regard to the removal of the tonsils.No little part of this divergency of opinion centres onthe questions of what is the best anaesthetic to useand how it should be given. In this country there isno large support for the use of local anaesthetics atthis operation, and controversy has mainly beenwaged around the respective merits of chloroformand ether and of a deep or a light state of narcosis.At the present time we believe the consensus of expertopinion is for a deep ether anaesthesia in all but theshortest operations. In America, however, the positionis different, because local analgesics have been widelyused and recommended for tonsillectomy. In a

symposium on the question recently instituted bythe Therapeutic Gazette, of Detroit, we are able to seethat opinion among the contributors to the discussionis pretty evenly divided between those who preferlocal and those who prefer general methods. Neverthe-less, there are several statements made that will, wethink, go far to corroborate in their opinion thoseoperators who employ almost entirely general anaes-thetics for the operation of removal of the tonsils.For example, it is pointed out that the danger ofpneumonia and abscess of the lung is by no meansnegligible when local anesthetics are employed. Weknow of no statistics showing the rate of occurrenceof this complication after removal of tonsils duringgeneral anaesthesia, but a wide experience assures

us that it must be of the greatest rarity. Similarly,deep cervical infection, a very rare sequel to theoperation performed here, appears to be not so unusual._1’4.._., .t-1-...... ,- ......-C’ 1---] -.--..-_..4... -i-__ 4--4- -* A- -1 - - - --- 4- - ---ajLer me ue 01 local Htgem.;-’. 111 liUl:, iu is ensy uu sec

how, unless great care and skill are exercised, localinfiltration in the neighbourhood of a septic tonsil-and, of course, most of those to be removed are septic-very easily gives rise to serious trouble in the form ofa local cellulitis or a more general septic poisoning.In answer to this. of course, it might be urged thatthe avoidance of these undesirable results is as muchin the hands of the surgeon as is the avoidance ofaccident in anaesthesia in the hands of the anaesthetist;that skilled use of injection, in fact, is no moredangerous than skilled use of chloroform. Eachmethod has an inherent possibility of danger that isonly repressed by the knowledge and skill of theuser of the method. Yet when it comes to reckoningthe safety of the method itself, if ether be substitutedfor chloroform, we imagine that the inherent dangeris larger in the case of injection than in that of inhala-tion. Some would maintain that this is especially the