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694 " refuse destructora," "destructor accessories," and the performed in that clinic during the six years 1892-97. Six economic means available for utilizing the heat of combus- of the cases were examples of rickety, flattened pelves, while tion of waste materials, as in the application of Mr. Halpin’s the remaining case was one of a Naegel6 oblique pelvis. Of and 5 multiparæ; of the system of thermal storage recently installed at the Shore- the mothers 2 were ditch Destructor and Electricity Station. This installation former 1 died from sepsis and acute albuminuria, the latter in particular is fully described on pages 327 and 328, and complication being present upon her admission to the clinic. the engineering principles involved in the working of this All the children were born alive, 3 being delivered by ingenious system are made perfectly clear. A more mis- forceps and 4 by version. In one patient the operation was cellaneous mixture than common house garbage can hardly performed for the second time, her second pregnancy having be imagined, and this fact largely militates against its been terminated by symphysiotomy in 1892. At the first economic destruction by heat, not to say utilisation of operation a tear occurred through the anterior vaginal wall into what fuel value it may possess for the purpose of the operation wound, and at the second operation a similar steam-making. But considerable advance has been made in accident happened in spite of every care being taken to prethis direction only within the last few years. It was not vent it. The urethra and bladder, however, escaped injury long ago when a great proportion of London house refuse and the wound healed well. In the event of this patient again was dumped down on almost every available open space to becoming pregnant Professor Pinard considers that Ca3sarean the exceeding detriment of the inhabitants near by and the section would be indicated on account of the cicatricial tissue depreciation of the property. Huge heaps have thus accu- present in the anterior vaginal wall. That symphysiotomy mulated on the marshy grounds on the banks of the lower may produce some permanent enlargement of the pelvis reaches of the River Thames. With the great increase in seems to be shown by the fact that 4 of the patients the metropolitan and suburban population the evil grew at delivered spontaneously during the year had previously had an alarming pace and the problem had to be seriously faced. symphysiotomy performed upon them. The report is of Engineering has been brought to bear upon the matter with interest as enabling us to watch the progress of the operation. success, and with few exceptions now I I destructors " are at Professor Pinard justly points out that in any future history work on all sides. And these heat appliances in some instances of symphysiotomy a very important place will have to be " also-that is, assigned to the work done at the Clinic Baudelocque. That are not mere " destructors " but "converters extracting and utilising, perhaps in the production of electric the operation is now established upon a firm basis is shown, energy, any calorific value that the rubbish" may possess. he thinks, by the fact that in the discussion at the Moscow So far the dust problem has gone ahead of the sewage Congress no one was found to attack the favourable opinions problem from the points of view of both disposal and expressed about it by Varnier, Zweifel, and Ki7istner. utilisation. We venture to think that this is because the sewage disposal question, unlike that of garbage, is not LIBRARY TABLE. exclusively one for engineers to approach. It requires the Transactions of the Reading Pathological Society, joint efforts of the chemist, biologist, and engineer. With 1896-97.-The oldest pathological society in the United this essential combination at work we may soon hope for a has only issued two volumes of Transactions, of Kingdom satisfactory solution of the sewage problem; and indeed very which the one under review is the second. It is edited by encouraging results, as is well known, have already been the President, Dr. H. Phillips-Conn, and the honorary obtained as an outcome of the three aspects of the problem secretaries, Dr. W. J. Maurice, Dr. Guilding, and Dr. having been attacked in concert by experts severally con- J. B. Hurry. Eighteen articles are contributed by various cerned in the three branches of science just indicated. members of the society. Perhaps the most interesting from But there are other matters affecting the health and a practical point of view is a note by Mr. H. G. Armstrong comfort of the public, and with these also Mr. Maxwell He quotes on the Distribution of the Rash in Scarlet Fever. deals. Indeed, it will be seen that such a book all whom that the rash does of authorities, say nearly is indispensable to our local health authorities, vestries, sundry affect the face, and one of whom (Aitken, 1880) says that and similar bodies, and we believe we are right in saying the rash appears first on the face. Thomas of Leipsic says that it is the first really comprehensive work on the subject. that the rash appears only on the temples and forehead and On reflection this must be so, for the material in the chapters Mr. Armstrong has made notes of so does Fagge (1891). is in the main based on quite recent advances in methods of eleven cases with the result that he considers Thomas’s disposal and utilisation. In the first chapter the sewerage opinion strictly correct. He says : "As the flush disappears and cleansing of streets, the question of the best materia on the termination of the fever the upper margin of the for paving streets, and the removal of snow, are amongst true exanthem may be seen on the neck just below the ramus the important subjects touched upon. To grapple efficiently of the jaw and occasionally on the temples and forehead with these problems is the duty-and it is often an arduous at the roots of the hair, the lobes of the ears being almost one--of our local authorities, who in particular owe Mr. makes its always affected....... The rash of rubella Maxwell a word of thanks, we think, for placing at their first appearance on the cheeks and at the root of the nose." disposal so much valuable material and information on just Mr. Armstrong thinks this a valuable diagnostic point. Dr. those subjects which are of direct practical concern to them. Alfred Ashby has a very interesting paper upon Small-pox The book is well written, well devised, and comprehensive, and Vaccination. so far as the subject goes-and none can dispute that the subject is a broad one. Mr. Maxwell has contributed a ILFORD MEDICAL SOCIETY.-At a of valuable book of reference and a guide upon a most impor- medical men held at Mr. M. J. it residence, Houghton’s tant branch of work which is closely connected with the was unanimously decided to form a medical society for this district. Twelve gentlemen attended. Mr. Best was elected health and well-being of the public. President, Mr. Drought treasurer, and Mr. H. Ernest Watts secretary. A small sub-committee consisting of the officers Dec. De la Symphyséotomie à la Clinique Baudeloequ.e. 7th, elected and three other members, Mr. Bell, Dr. Fraser, and 1896-Dec. 7th, 1897. By Professor PINARD. Paris: Dr. Appleyard was also appointed. Meetings are to be held monthly at members’ houses in rotation, when a paper is to G. Steinheil. be read, cases are to be shown, and medical topics disDURING the year ending Dec. 7th, 1897, the operation cussed. The subscription is nominal. The first meeting of symphysiotomy was performed 7 times in the Clinic will be held at the President’s house, High-road, Ilford, Baudelocque, making a grand total of 89 such operations on Oct. 6th, at 9 P.M.

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