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1357 do not include any of which the police took no cogni- nervous patients who cannot be relied upon to keep More than half of all the accidents-i.e. 2727, sance. during the operation, but when operating with occurred in Copenhagen, with a population of 708,600. avertin it is necessary to fix the eyeball firmly with The total population of Denmark is 3,518,000. As forceps during the incision, and this fixture is not so great a proportion of the accidents as 83-9 per cent. convenient as voluntary depression by the patient concerned motor-cars. In 55 per cent. of the traffic himself in obedience to the surgeon’s directions. accidents, the blame was laid exclusively on the Nevertheless any method of relieving apprehension drivers of motor-cars; in 13-7 per cent. bicyclists either before or during an operation on the eye is The main contra-indications were held responsible, in 8-5 per cent. pedestrians and worth a great deal. passengers; only in 2 per cent. were physical conditions, to the use of avertin are a serious degree of nephritis such as the state of the roads or visibility, held or severe disturbances of the liver. Old age is not responsible, and in 1-2 per cent. the state of the motor itself of importance, and though the authors of this vehicle. In the remainder. the responsibility was paper have not used the drug on children under 16, shared by a combination of two or more of the above there seems to be no reason why they should not do factors. Travellers familiar with the swarms of so. Avertin is a narcotic rather than an anaesthetic, bicyclists in the streets of Copenhagen will not be and one of its main advantages is that it can be used surprised to learn that they and pedestrians play to remove the patient’s anxiety for an hour or so a much more important part in the genesis of motor before operation. accidents than is the case in other countries. Among the improvements effected of late, the filling in of THE I.M.S. ditches beside the roads in order to provide bicycling IN an ample quarto volume Lieut.-Colonel D. G. paths deserves special mention. This reform has Crawford, whose " History of the I.M.S." did very been made possible by the arrangement which allots nearly as much for the service as Boswell did for part of the revenue from motor-car taxation to the ’, Dr. Johnson, has continued his labours in a volume local authorities. There are over 2500 doctors in ’, entitled " The Roll of the Indian Medical Service."l Denmark-i.e., one for every 1360 inhabitants, and The title is, perhaps, unfortunate, since it suggests if Copenhagen and its 629 doctors are discounted, a book on the lines of the Army List or Bradshaw. the proportion of doctors to inhabitants is as one to In fact Colonel Crawford takes the opportunity, in 1500. Thanks to the comparative density of the the introduction, of bringing his history up to date, population even in the country, the radius of action and apart from the brief individual records of service of a general hospital (of which there were 170 in 1929) many notes testify to the enterprise of the author in is seldom more than 15 kilometres. Copenhagen discovering interesting material in the most unexpected is served with 16 and the rest of the country with sources. The term I.M.S. has been used in a very 139 ambulances, the radius of whose action is about broad sense to cover the name of every man who 15 kilometres. For the purpose of comparison it served, even for the shortest period, in the East should be noted that the corresponding radius of India Company’s land medical services, including the action in England is about 25 kilometres. The part surgeons’ mates (assistant surgeons), who were not played by the Danish Red Cross with regard to commissioned officers, but served under warrants ambulances consists largely of financing them at issued by the colonels commanding their regiments. the outset ; later, they are often taken over and run Some remarkable histories may be deduced from the by the local authorities. laconic entries in this Roll. In the Madras list occurs the name of Mungo Park, the son of the famous African explorer, who had himself been surgeon’s AVERTIN IN OPHTHALMOLOGY. mate of an Indiaman. Readers of Lockhart’s " Life IN the British Journal of Ophthalmology for Scott " may remember how the father, having November Mr. 0. Gayer Morgan and Mr. J. M. obtained by influence the promise of a post in the Lees record their experience of rectal narcosis with company’s service, provided he could qualify as a avertin, based on more than 50 cases, including surgeon, rushed off to commence his medical studies, cataract extraction, acute glaucoma, excision, eviscera- and in six months time returned with the required tion, acute dacryocystitis, removal of the lacrymal diploma. Other even more striking examples of sac in chronic dacryocystitis, and minor and major adaptability are not difficult to find. A sergeant in plastic operations on the eyelids. They conclude the St. Helena garrison was given dispensary duties, that it is not a dangerous drug when given with care, and served in that capacity for 15 years and that it well merits a trial in ophthalmic surgery. was having assistant surgeon. Later he went to appointed The amount injected should never exceed 1.0g. per obtained the M.R.C.S., and returned England, kg. of body-weight, and the temperature should not eventually to become full surgeon at St. Helena. be more than 40° C., for otherwise the avertin may As time went on, and medicine rose in the social decompose and set up colitis; to ensure against this scale, I.M.S. men not only cured the wives and families two drops of Congo red solution can be added to of potentates, and shook pagoda trees, but distinguished 5 c.cm. of avertin, and decomposition will be shown themselves in many other ways, rendering eminent by appearance of a blue colour. If any of the solution, services in several branches of science, furnishing as injected, be returned by the patient it is unsafe administrators and diplomats, and to attempt to make up the amount by an extra distinguished commercial houses the names of which are founding injection, since absorption is so rapid that it is still household words in India. The firm of Jardine impossible to estimate how much of the drug has been and Mathieson was started by one of the company’s rejected. In most cases no other anaesthetic, general surgeons, and the well-known publishing house of or local, was used, but Morgan and Lees employed a Thacker and Co., which produces Colonel Crawford’s preliminary injection of morphia gr. with atropine work, is also said to have had a medical origin. gr. 1/100, though this is not considered necessary. The Roll contains several interesting appendices, If the claims of its advocates are confirmed the drug tables of honours and rewards, and analyses of has obvious advantages where a general anaesthetic notably 1 Roll of the Indian Medical Service, 1615-1930. Compiled is contra-indicated or a local anaesthetic is insufficient. Lieut-Col. D. G. Crawford, Bengal Medical Service, ret. In cataract extraction it is chiefly applicable to very by London : W. Thacker and Co. 1930. Pp. 711. 28s.

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