A NEW TRACHEOTOMY TUBE.

656 IMPERIAL SOCIAL HYGIENE CONGRESS. Published by the British Social Hygiene Council, Inc., Carteret House, Carteret-street, London, S.W. 1926. Pp. 300. 4s. THE proceedings at the Imperial Social Hygiene Congress, held at the British Empire Exhibition in October of last year, have now been published by the British Social Hygiene Council, and the volume contains a collection of facts and experiences presented by doctors, administrators, and social workers from all parts of the Empire in connexion with the various problems of venereal disease and social hygiene as they arise at home and overseas. The Congress gave an excellent opportunity, as could be gathered from the reports published at the time, for the interchange of opinion on many poignant matters, and Mr. Amery, with whose opening address to the Congress the volume starts, deals with the imperial aspect of social hygiene, will find all medical men in agreement with his pronouncement that the administration of the empire as a whole, as well as the administration of this country, must be based on a sound health policy. The addresses of delegates from the Crown Colonies, the Irish Free State, South Africa, New Zealand, Newfoundland, and India echo the same message, and prove that on fundamental questions of sanitation and prevention of disease our Colonial Office will have the various populations under their charge as supporters of hygienic reform. The volume contains important contributions, written out of practical experience, upon the position of the Army and Navy and mercantile marine with regard to venereal diseases, and upon the vast and various difficulties incurred in the treatment of venereal The problems in the Colonies, disease in India. Protectorates, and Mandated Territories are mentioned cursorily, but many of the notes here, while they make terrible reading, prove that not only is the public conscience awakened all over the world, but that many sinister foci of disease have been detected and Sir Kingsley Wood, Parliamentary dealt with. Secretary to the Ministry of Health, reviews the position with regard to venereal disease in Great Britain as well as in the self-governing Dominions, and is excellently supplemented in an exposition from Colonel L. W. Harrison of what has been done in England and Wales during the nine years which have elapsed since the V.D. scheme was set up. The effect of recent activities on the condition of affairs as disclosed by the report of the Royal Commission is remarkable, and no less remarkable are the lessons to be learnt from a study of the working of the scheme. All medical men should read the debate on the position of venereal disease in Great Britain and the self-governing Dominions, when Sir Kingsley Wood was able to argue that between 1920 and 1924 there had been a fall of nearly 50 per cent. of new cases of syphilis and of some 22 per cent. of new cases of gonorrhoea. Colonel Harrison showed that the cost of the venereal disease scheme amounted to about 22d, per head of the population. TROPICAL EQUIPMENT. Hints on Equipment and Health for Intending Residents in the Tropics. By J. BALFOUR KIRK, M.B., Ch.B. Edin., D.P.H. Oxf., D.T.M. & H. Eng. London: Bailliere, Tindall and Cox. 1926. Pp. 120. 3s. 6d. IN the form of a series of letters, written in colloquial style to fictitious characters of differing age and sex who contemplate visiting the tropics, Dr. Balfour Kirk has effectively outlined the chief dangers to health that may be encountered. The modest volume contains sound advice, and its 18 chapters are worthy The subject matter covers the of detailed study. necessity of the preliminary medical examination and inoculations, the details of outfit, head covering, underwear, and special items of clothing to protect against mosquito infection. Personal hygiene, dietary, and the abuse of alcoholic liquors are discussed, as

are also the best means for maintaining health by regular exercise, rest, and recreation, and for securing Advice a comparatively cool house in hot weather. on the prevention of malaria, and also of what are termed the filth diseases-namely, cholera, dysenteries, and the enterica-includes descriptions of the measures to combat the vectors, such as mosquitoes, flies, ants, cockroaches, and of the best methods for the disposal of excreta. The information relating to tropical parasites might well have been somewhat amplified, and in a future edition a chapter embodying the experience of the author as to the types of or should not entertain resiSome dence in the tropics would be of value. physicians still advise those suffering from tuberculosis to visit or live in the tropics without qualifying the advice ; the subject of tuberculosis in tropical regions is one which merits discussion. This little book contains sound advice on many points not always considered in more ambitious works.

individual who should

New Inventions. A NEW TRACHEOTOMY TUBE. IN THE LANCET of Sept. 10th, 1921, I described a tracheotomy tube devised on the model suggested

by Rushton Parker, but with certain modifications, with a view to (a) facilitating cleaning, (b) permitting breathing during introduction with pilot in situ, (c) ensuring the retention of the tube in the case of patients with fat new s. I found in use that there were still one or t" points which were capable of improvement, and I have therefore modified the design One modification has as shown in the illustration. been made to overcome the difficulty of the shield

being in the way while the tube is being put into the incision in the trachea, and also the slight trouble experienced of getting the dressing under the shield. With the new tube the dressing can be put round the tube when it is in situ, and the shield is afterwards fastened on to the tube by a quarter rotation and then tied round the neck. The inner tube has no rotating catch to hold it, but has a small bead on one side which, catching into a hole in the outer tube, prevents it being coughed out. The pilot is in the same form as in the original model-i.e., made so that the patient can breathe through the tube while it is in place, but a clip has been added which positively holds the tube. This clip can be released by depressing the handle of the clip. It has been found, as a matter of practical experience with tracheotomy tubes, that when in frequent use the pilots become loose and the tubes have the tendency to drop off during introduction, but the addition of the clip above mentioned will prevent this trouble. The whole tube has been designed in such a way as to be as simple as possible and to be easily kept clean. The new tube is not intended entirely to replace the old one, but it will, I think, recommend itself to those surgeons who have these instruments in frequent use. The manufacturers are Messrs. Down Bros., Ltd., 21 and 23, St. Thomas’s-street, London, S.E. 1. A.

CUBLEY, M.R.C.S., L.R.C.P. Lond.

North-Eastern Hospital, Tottenham.