- Email: [email protected]
ROYAL ACADEMY OF MEDICINE IN IRELAND.
1255
taking solid food, and apparently nothing came the fistula. 2. A case of Excision of Tuberculous Wrist in a man. When treatment by trypsin injections was commenced some six months ago the arm looked hopeless, and the treatment was given a chance before amputation was definitely decided on. Improvement speedily set in and had progressed steadily. Mr. J. F. DoBSON showed a case of Diffuse Papillomata of the Bladder treated by suprapubic cystotomy, and subsequently by implantation of both ureters into the colon. The patient was perfectly comfortable and able to retain urine for five hours. The suprapubic wound was healed and nothing escaped from the bladder. Cases were also exhibited by Mr. W. THOMPSON, Mr. J. A. COUPLAND, Mr. H. SECEER WALKER, and Dr. A. L. WHITEHEAD.
January, 1911, examination under an anaesthetic revealed an enlarged uterus with lacerated cervix and rectocele. Dr. Solomons performed curettage, tracheloflhaphy, and colpoperineorrhaphy. The curettings were found to be glandular endometritis. The patient enjoyed good health for about six months, when she became pregnant again, and was treated with potassium iodide and mercury during the pregnancy.
was now
through
ROYAL ACADEMY OF MEDICINE IN IRELAND.
,
SECTION OF OBSTETRICS. Teterus.—The Relation between the lllechanisna and Congenital Management of the Third Stage of Labour.-Exhibition of
Specimens.
At six months she was delivered of a macerated fcetus. This was examined by Professor P. T. O’Sullivan, who reported that there was no trace of the spirochasta pallida. A year ago menorrhagia and metrorrhagia started. These symptoms became aggravated in the last six months, and severe backache troubled her during the last two months. Dr. Solomons found a uterus in normal position with two large myomata, one growing from the back and the other from the side of the cervix. It might be asked wh) he did not perform myomectomy, which appeared from the specimen might have proved easier. He performed hysterectomy for the following reasons : (1) The age of the patient ; (2) her fear of having more macerated babies ; and (3) the fear of malignant degeneration having commenced. Dr. A. Stokes, who examined the specimen, reported as follows:"Endometrium, glandular endometritis. Myoma, simple, with early mucoid degeneration. Cervix normal." It was difficult to account for the frequent stillborn babies. Syphilis, endometritis, and tumours are generally regarded as the most common predisposing factors. There was evidently no syphilis. The endometritis might have accounted for the first two, but this was cured and could not have accounted for the last. The tumours were not present until two years after the birth of the first two, and until one year after the birth of the last stillborn child. Dr. TWEEDY showed a specimen of Myoma, recently removed, which had undergone mucoid degeneration.
A MEETING of this section was held on April 3rd, Dr. M. J. GIBSON, the President, being in the chair. Mr. SPENCER SHEILL read a paper on Congenital Icterus. -Dr. E. HASTINGS TWEEDY said that he had seen a great many cases of jaundice in infants, some of which had and he had seen a good many postterminated mortem examinations on these cases, and was surprised at the number of defective ducts found. He was particularly interested in the suggestion that these casesshould be subjected to surgical interference. He had not heard SOCIETY OF MEDICAL OFFICERS OF HEALTH.-A it suggested before. Infants bore abdominal section badly, and this was more particularly true of jaundiced infants. meeting of this society was held on April 17th, Dr. A. K. He inquired if there were any statistics of successful Chalmers. the President, being in the chair.--A paper was operations in these infantile illnesses. He mentioned read by Dr. B. A. Peters, lecturer on infectious diseases, that infants were frequently starved for want of water, Bristol University, on the Elimination of Cross Infection in and suggested that they did not get enough fluid in Fever Hospitals, in which he pointed out that, although the early days after birth. He thought that jaundice arose surgery had long since abandoned the idea of the air being from want of sufficient fluid, and that this was particularly an appreciable factor in the conveyance of infection to a the case in premature children. He pointed out that wound, medicine still regarded it as being the principal children were kept in a hot atmosphere and required a medium in the carriage of the common infectious diseases of good deal of water. He wondered if the insufficiency children. At the Bristol fever hospital all patients were kept of water would account for the viscosity of the bile. in bed for a fortnight after admission. During that time any - Dr. GIBBON FITZGIBBON asked whether at the opera- secondary infection which might be incubating would have tion on the gall-bladder it was possible to make out if developed, and if the case were a doubtful one a definite it was an obstructive jaundice ; also what was the con- diagnosis could be made. Each patient was provided with a dition of the liver ?’? Was there any enlargement or separate towel, face-flannel, piece of soap, comb, and throatanything which would suggest a syphilitic condition ?- brush, which were kept in a locker beside the bed. All Dr. SPENCER SHEILL, replying to the remarks, said on exa- ’, eating utensils were boiled after each meal, and other mination the liver appeared in every way normal. There utensils were cleansed and disinfected after use. The nurses wore rubber gloves lined with canvas when closely was no discolouration or enlargement, and it was not unduly ,hard or soft. He recognised that everybody was against handling a patient, which were immersed in perchloride of laparotomy in infants, as they were in nearly 90 per cent. mercury solution before going on to the next patient. These fatal. The literature on the subject was very scanty, but a methods had been quite successful in preventing the spread few men who had operated said that operation gives bad of scarlet fever, diphtheria, whooping-cough, rubella, or results unless distinct obstruction was found in the duct. In mumps when accidentally introduced into a ward not his case he did not think the gall-bladder was so distended intended for their reception. Previous to the introduction as to indicate obstruction, and the surgeon reported that the of this system in 1911 about 2’55 per cent. of the patients ducts were patent. He considered septic cord cases quite contracted a second disease while in hospital, the only - distinct. He was very particular about the prevention of available means for limiting the number of secondary cases over-clothing of infants, thereby sweating them, and not after the removal of the infecting patient being to cease making up for it by water taken. In replying to a question admissions to the infected ward until the secondary infecfrom Dr. BETHEL SOLOMONS, he said that the parents tion became extinct for want of further susceptible patients. refused any interference in the way of a Wassermann test, In the first year after the introduction of the new system and from the history no information of any value could be only two patients contracted measles and one chicken-pox. elicited. The next step was to keep the windows of the acute wards In the absence of Dr. J. R. FREELAND, Dr. TWEEDY read open all the year round, which procedure was completely his paper, entitled the Relation Existing between the successful in preventing the spread of secondary infection in Mechanism and the Management of the Third Stage of those wards in spite of 13 invasions of chicken-pox. One Labour : a report of 2000 cases from the Rotunda Hospital. important result of aseptic nursing was a marked diminu-The paper was not discussed. tion of late septic complications, including especially Dr. BETHEL SOLOMONS exhibited a Uterus with Cervical rhinitis. During the past two years the minimum detenMyomata removed from a patient 37 years old, who had tion period in the Bristol fever hospital had been reduc(d been married 11 years. In her first three years of married to one calendar month in the case of scarlet fever, life she had two healthy bibies who are still alive. Two desquamation being ignored.-Dr. Robert Milne mainyears later she had an eight months’ stillborn child ; two tained that by swabbing the tonsils and pharynx with 10 per -and a half years later a nearly full-term stillborn child. In cent. carbolic acid every two hours for 24 hours, and rubbing
fatally,
,
1256 the patient until the tenth day of the infection was completely prevented.-Dr. G. S. Buchanan pointed out the importance of taking into consideration the limitations of all experiments in the infectivity of disease, for each infectious disease must have its own natural history, and infectivity was greater at one time than it was at another. He considered it highly probable that a reduction in the number of septic cases would result from the extreme care taken in regard to secondary infection.-Mr. E. H. T. Nash, referring to the success attending Dr. Milne’s own cases, pointed out that it was possible for him to begin to treat the cases occurring in the Barnardo Homes much earlier than a medical officer of health could begin treatment in an isolation hospital.-Dr. Meredith Young insisted upon the importance of getting cases into hospital early and of avoiding overcrowding. It was important also to recognise that otorrhoea He did not and rhinitis were definitely communicable. believe that infection was in the skin. Children were sent out of the Stockport hospital when peeling, but secondary infection rarely resulted.—Dr. G. F. Buchan maintained that Dr. Milne’s treatment was no treatment at all, yet his results appeared to be the same as those of Dr. Peters, who practised strict asepsis with abundant fresh air.-Mr. T. W. N. Barlow said that he had tried Dr. Milne’s treatment thoroughly for four years, but he got return cases and cross infections as frequently as ever.-The President referred to the enormous demand which aseptic treatment made on the nursing staff, and spoke of the great value of the use of gloves. He pointed to the possibility of there being some change in the organism of scarlet fever which was producing lessening virulence of infection.
eucalyptus
disease,
oil
over
cross
GUY’S
HOSPITAL:
LECTURES
ON
INDUSTRIAL
DISEASES.—The following is the syllabus of thesixlectures on Industrial Medicine to be delivered at the Medical School of Guy’s Hospital by Dr. Frank Shuffiebotham during May and June :-Lecture I., May 8th : The Symptoms and Diagnosis of Lead Poisoning. Lecture IL, May 15th : The Post-mortem Appearances associated with Lead Poisoning. Lecture III., May 22nd: Miners’ Nystagmus, with a demonstration on living cases. Lecture IV., May 29th : Industrial Fibroid Lung. Lecture V., June 5th: Anthrax. Lecture VI., June 12th : The Medical Aspect of the Workmen’s Compensation Act. The lectures will be given on Friday afternoons at 4 P.M. in the pathological
theatre.
VICTORIA
HOSPITAL, BURNLEY.-A proposal
Reviewsand Notices of Books. Thcorie und Praxis der Inneren Medizin. Von Dr. E. KINDBORG. Band III. With 71 illustrations. Berlin: S. Karger. 1914. Pp. xiv. + 752. Price 13 marks.
WE welcome the appearance of the third and last volume of Dr. Kindborg’s text-book of internal medicine, which is designed for the use of practitioners and students of medicine. The diseases of the kidneys, blood, and nervous system are con. sidered at full length in the greater part of the volume ; the last 100 pages are devoted to the general infections and the chief acute and chronic poisonings, both receiving rather short shrift, as though for lack of space. The author’s style is good, and his writing makes easy reading. The text is not overburdened with facts and figures, percentages and proportions, correlations between physical signs and post-mortem observations, and it does not contain a vast amount of detail The book in the sections devoted to treatment. is clearly not meant for the student who has examinations to pass, nor is it a bedside manual, if such an expression may be allowed, nor the sort of book to refer to when an obscure case has to be diagnosed. Dr. Kindborg writes spaciously, viewing the disorders he describes from a philosophical and physiological standpoint, dealing in general considerations rather than in the particulars of disease; he is at pains to show how physiological conditions may pass on into pathological, and gives impressionist pictures rather than detailed presentments throughout. Matters are brought rather more to a focus in the tables scattered throughout the text, but these, too, are lacking in the definiteness and dogma that one is accustomed to find in medical text-books. Without doubt there are many medical men who will read Dr. Kindborg’s volumes with pleasure and profit, particularly physicians of a contemplative rather than an active or operative cast of mind. To the pure practising physician it will not appeal to warmly, in spite of its many excellencies.
to increase the number of beds in the Victoria Hospital, Burnley, has prompted Dr. John Brown, now of South Africa, to write an interesting letter which appeared in the Burnley Express on April 25th. Dr. Brown, who at Practical Saititatioiz. one time resided in Burnley, identified himself with many A Handbook for Health Officers. By FLETCHER GARDNER, movements in that town which had for their object the M.D., Captain, Medical Corps, Indiana National Guard, betterment of the poor, and among these movements was and J. P. SIMONDS, B.A., M.D., Professor of Preventive the building of the Victoria Hospital, which for the past Medicine, University of Texas. London : Henry Kimpton. 28 years has ministered to the medical needs of the town 1914. Pp. 403. Price 18s. net. and district. The Victoria Hospital adopted the circular THE authors state that their object has been to ward system, and so successful has this system proved, that the "Victoria Hospital wards," writes Dr. Brown, "are an provide within the covers of a single moderately example to the whole world as to the best manner of heating priced volume a plain, non-technical exposition of and ventilating, and in providing the largest possible floor the duties of the health officer, and to provide him space in the least expensive manner "; and he suggests with a safe way of meeting any emergency which an additional storey to the present building as the best may arise. The work deals first with individual means of providing space for new beds. That the board of diseases and groups of diseases under the heading of management have a difficult financial problem to consider " Epidemiology," next with various questions of is also recognised by Dr. Brown, when he says : " In the sanitation and sanitary organisation, and general present unprecedented deplorable state of the cotton trade in Lancashire, with its very gloomy outlook for the future, concludes with a brief summary of some principal your hospital extension must be conducted in the cheapest laboratory methods. The volume is well illustrated possible manner." Dr. Brown discusses the financial aspect and clearly printed, though curiously heavy for its of the question, and argues that an additional storey, for size. which the building is structurally suitable, would be better On the whole the authors have succeeded creditin every respect than the erection of new detached buildings. in the task which they imposed upon themably The letter, which is virtually a plea for, and an appreciation selves. The successive chapters are full of of, the circular system of hospital wards, will be read with well-ordered information authoritatively or even the concerned of interest by everyone with building hospitals, and should receive the careful attention of the board of didactically stated, and the information given is
of the Victoria of its writer.
management
personality
Hospital, considering
the
generally of the kind most ence by those who wish to
needed for rapid referknow the outstanding
taking solid food, and apparently nothing came the fistula. 2. A case of Excision of Tuberculous Wrist in a man. When treatment by trypsin injections was commenced some six months ago the arm looked hopeless, and the treatment was given a chance before amputation was definitely decided on. Improvement speedily set in and had progressed steadily. Mr. J. F. DoBSON showed a case of Diffuse Papillomata of the Bladder treated by suprapubic cystotomy, and subsequently by implantation of both ureters into the colon. The patient was perfectly comfortable and able to retain urine for five hours. The suprapubic wound was healed and nothing escaped from the bladder. Cases were also exhibited by Mr. W. THOMPSON, Mr. J. A. COUPLAND, Mr. H. SECEER WALKER, and Dr. A. L. WHITEHEAD.
January, 1911, examination under an anaesthetic revealed an enlarged uterus with lacerated cervix and rectocele. Dr. Solomons performed curettage, tracheloflhaphy, and colpoperineorrhaphy. The curettings were found to be glandular endometritis. The patient enjoyed good health for about six months, when she became pregnant again, and was treated with potassium iodide and mercury during the pregnancy.
was now
through
ROYAL ACADEMY OF MEDICINE IN IRELAND.
,
SECTION OF OBSTETRICS. Teterus.—The Relation between the lllechanisna and Congenital Management of the Third Stage of Labour.-Exhibition of
Specimens.
At six months she was delivered of a macerated fcetus. This was examined by Professor P. T. O’Sullivan, who reported that there was no trace of the spirochasta pallida. A year ago menorrhagia and metrorrhagia started. These symptoms became aggravated in the last six months, and severe backache troubled her during the last two months. Dr. Solomons found a uterus in normal position with two large myomata, one growing from the back and the other from the side of the cervix. It might be asked wh) he did not perform myomectomy, which appeared from the specimen might have proved easier. He performed hysterectomy for the following reasons : (1) The age of the patient ; (2) her fear of having more macerated babies ; and (3) the fear of malignant degeneration having commenced. Dr. A. Stokes, who examined the specimen, reported as follows:"Endometrium, glandular endometritis. Myoma, simple, with early mucoid degeneration. Cervix normal." It was difficult to account for the frequent stillborn babies. Syphilis, endometritis, and tumours are generally regarded as the most common predisposing factors. There was evidently no syphilis. The endometritis might have accounted for the first two, but this was cured and could not have accounted for the last. The tumours were not present until two years after the birth of the first two, and until one year after the birth of the last stillborn child. Dr. TWEEDY showed a specimen of Myoma, recently removed, which had undergone mucoid degeneration.
A MEETING of this section was held on April 3rd, Dr. M. J. GIBSON, the President, being in the chair. Mr. SPENCER SHEILL read a paper on Congenital Icterus. -Dr. E. HASTINGS TWEEDY said that he had seen a great many cases of jaundice in infants, some of which had and he had seen a good many postterminated mortem examinations on these cases, and was surprised at the number of defective ducts found. He was particularly interested in the suggestion that these casesshould be subjected to surgical interference. He had not heard SOCIETY OF MEDICAL OFFICERS OF HEALTH.-A it suggested before. Infants bore abdominal section badly, and this was more particularly true of jaundiced infants. meeting of this society was held on April 17th, Dr. A. K. He inquired if there were any statistics of successful Chalmers. the President, being in the chair.--A paper was operations in these infantile illnesses. He mentioned read by Dr. B. A. Peters, lecturer on infectious diseases, that infants were frequently starved for want of water, Bristol University, on the Elimination of Cross Infection in and suggested that they did not get enough fluid in Fever Hospitals, in which he pointed out that, although the early days after birth. He thought that jaundice arose surgery had long since abandoned the idea of the air being from want of sufficient fluid, and that this was particularly an appreciable factor in the conveyance of infection to a the case in premature children. He pointed out that wound, medicine still regarded it as being the principal children were kept in a hot atmosphere and required a medium in the carriage of the common infectious diseases of good deal of water. He wondered if the insufficiency children. At the Bristol fever hospital all patients were kept of water would account for the viscosity of the bile. in bed for a fortnight after admission. During that time any - Dr. GIBBON FITZGIBBON asked whether at the opera- secondary infection which might be incubating would have tion on the gall-bladder it was possible to make out if developed, and if the case were a doubtful one a definite it was an obstructive jaundice ; also what was the con- diagnosis could be made. Each patient was provided with a dition of the liver ?’? Was there any enlargement or separate towel, face-flannel, piece of soap, comb, and throatanything which would suggest a syphilitic condition ?- brush, which were kept in a locker beside the bed. All Dr. SPENCER SHEILL, replying to the remarks, said on exa- ’, eating utensils were boiled after each meal, and other mination the liver appeared in every way normal. There utensils were cleansed and disinfected after use. The nurses wore rubber gloves lined with canvas when closely was no discolouration or enlargement, and it was not unduly ,hard or soft. He recognised that everybody was against handling a patient, which were immersed in perchloride of laparotomy in infants, as they were in nearly 90 per cent. mercury solution before going on to the next patient. These fatal. The literature on the subject was very scanty, but a methods had been quite successful in preventing the spread few men who had operated said that operation gives bad of scarlet fever, diphtheria, whooping-cough, rubella, or results unless distinct obstruction was found in the duct. In mumps when accidentally introduced into a ward not his case he did not think the gall-bladder was so distended intended for their reception. Previous to the introduction as to indicate obstruction, and the surgeon reported that the of this system in 1911 about 2’55 per cent. of the patients ducts were patent. He considered septic cord cases quite contracted a second disease while in hospital, the only - distinct. He was very particular about the prevention of available means for limiting the number of secondary cases over-clothing of infants, thereby sweating them, and not after the removal of the infecting patient being to cease making up for it by water taken. In replying to a question admissions to the infected ward until the secondary infecfrom Dr. BETHEL SOLOMONS, he said that the parents tion became extinct for want of further susceptible patients. refused any interference in the way of a Wassermann test, In the first year after the introduction of the new system and from the history no information of any value could be only two patients contracted measles and one chicken-pox. elicited. The next step was to keep the windows of the acute wards In the absence of Dr. J. R. FREELAND, Dr. TWEEDY read open all the year round, which procedure was completely his paper, entitled the Relation Existing between the successful in preventing the spread of secondary infection in Mechanism and the Management of the Third Stage of those wards in spite of 13 invasions of chicken-pox. One Labour : a report of 2000 cases from the Rotunda Hospital. important result of aseptic nursing was a marked diminu-The paper was not discussed. tion of late septic complications, including especially Dr. BETHEL SOLOMONS exhibited a Uterus with Cervical rhinitis. During the past two years the minimum detenMyomata removed from a patient 37 years old, who had tion period in the Bristol fever hospital had been reduc(d been married 11 years. In her first three years of married to one calendar month in the case of scarlet fever, life she had two healthy bibies who are still alive. Two desquamation being ignored.-Dr. Robert Milne mainyears later she had an eight months’ stillborn child ; two tained that by swabbing the tonsils and pharynx with 10 per -and a half years later a nearly full-term stillborn child. In cent. carbolic acid every two hours for 24 hours, and rubbing
fatally,
,
1256 the patient until the tenth day of the infection was completely prevented.-Dr. G. S. Buchanan pointed out the importance of taking into consideration the limitations of all experiments in the infectivity of disease, for each infectious disease must have its own natural history, and infectivity was greater at one time than it was at another. He considered it highly probable that a reduction in the number of septic cases would result from the extreme care taken in regard to secondary infection.-Mr. E. H. T. Nash, referring to the success attending Dr. Milne’s own cases, pointed out that it was possible for him to begin to treat the cases occurring in the Barnardo Homes much earlier than a medical officer of health could begin treatment in an isolation hospital.-Dr. Meredith Young insisted upon the importance of getting cases into hospital early and of avoiding overcrowding. It was important also to recognise that otorrhoea He did not and rhinitis were definitely communicable. believe that infection was in the skin. Children were sent out of the Stockport hospital when peeling, but secondary infection rarely resulted.—Dr. G. F. Buchan maintained that Dr. Milne’s treatment was no treatment at all, yet his results appeared to be the same as those of Dr. Peters, who practised strict asepsis with abundant fresh air.-Mr. T. W. N. Barlow said that he had tried Dr. Milne’s treatment thoroughly for four years, but he got return cases and cross infections as frequently as ever.-The President referred to the enormous demand which aseptic treatment made on the nursing staff, and spoke of the great value of the use of gloves. He pointed to the possibility of there being some change in the organism of scarlet fever which was producing lessening virulence of infection.
eucalyptus
disease,
oil
over
cross
GUY’S
HOSPITAL:
LECTURES
ON
INDUSTRIAL
DISEASES.—The following is the syllabus of thesixlectures on Industrial Medicine to be delivered at the Medical School of Guy’s Hospital by Dr. Frank Shuffiebotham during May and June :-Lecture I., May 8th : The Symptoms and Diagnosis of Lead Poisoning. Lecture IL, May 15th : The Post-mortem Appearances associated with Lead Poisoning. Lecture III., May 22nd: Miners’ Nystagmus, with a demonstration on living cases. Lecture IV., May 29th : Industrial Fibroid Lung. Lecture V., June 5th: Anthrax. Lecture VI., June 12th : The Medical Aspect of the Workmen’s Compensation Act. The lectures will be given on Friday afternoons at 4 P.M. in the pathological
theatre.
VICTORIA
HOSPITAL, BURNLEY.-A proposal
Reviewsand Notices of Books. Thcorie und Praxis der Inneren Medizin. Von Dr. E. KINDBORG. Band III. With 71 illustrations. Berlin: S. Karger. 1914. Pp. xiv. + 752. Price 13 marks.
WE welcome the appearance of the third and last volume of Dr. Kindborg’s text-book of internal medicine, which is designed for the use of practitioners and students of medicine. The diseases of the kidneys, blood, and nervous system are con. sidered at full length in the greater part of the volume ; the last 100 pages are devoted to the general infections and the chief acute and chronic poisonings, both receiving rather short shrift, as though for lack of space. The author’s style is good, and his writing makes easy reading. The text is not overburdened with facts and figures, percentages and proportions, correlations between physical signs and post-mortem observations, and it does not contain a vast amount of detail The book in the sections devoted to treatment. is clearly not meant for the student who has examinations to pass, nor is it a bedside manual, if such an expression may be allowed, nor the sort of book to refer to when an obscure case has to be diagnosed. Dr. Kindborg writes spaciously, viewing the disorders he describes from a philosophical and physiological standpoint, dealing in general considerations rather than in the particulars of disease; he is at pains to show how physiological conditions may pass on into pathological, and gives impressionist pictures rather than detailed presentments throughout. Matters are brought rather more to a focus in the tables scattered throughout the text, but these, too, are lacking in the definiteness and dogma that one is accustomed to find in medical text-books. Without doubt there are many medical men who will read Dr. Kindborg’s volumes with pleasure and profit, particularly physicians of a contemplative rather than an active or operative cast of mind. To the pure practising physician it will not appeal to warmly, in spite of its many excellencies.
to increase the number of beds in the Victoria Hospital, Burnley, has prompted Dr. John Brown, now of South Africa, to write an interesting letter which appeared in the Burnley Express on April 25th. Dr. Brown, who at Practical Saititatioiz. one time resided in Burnley, identified himself with many A Handbook for Health Officers. By FLETCHER GARDNER, movements in that town which had for their object the M.D., Captain, Medical Corps, Indiana National Guard, betterment of the poor, and among these movements was and J. P. SIMONDS, B.A., M.D., Professor of Preventive the building of the Victoria Hospital, which for the past Medicine, University of Texas. London : Henry Kimpton. 28 years has ministered to the medical needs of the town 1914. Pp. 403. Price 18s. net. and district. The Victoria Hospital adopted the circular THE authors state that their object has been to ward system, and so successful has this system proved, that the "Victoria Hospital wards," writes Dr. Brown, "are an provide within the covers of a single moderately example to the whole world as to the best manner of heating priced volume a plain, non-technical exposition of and ventilating, and in providing the largest possible floor the duties of the health officer, and to provide him space in the least expensive manner "; and he suggests with a safe way of meeting any emergency which an additional storey to the present building as the best may arise. The work deals first with individual means of providing space for new beds. That the board of diseases and groups of diseases under the heading of management have a difficult financial problem to consider " Epidemiology," next with various questions of is also recognised by Dr. Brown, when he says : " In the sanitation and sanitary organisation, and general present unprecedented deplorable state of the cotton trade in Lancashire, with its very gloomy outlook for the future, concludes with a brief summary of some principal your hospital extension must be conducted in the cheapest laboratory methods. The volume is well illustrated possible manner." Dr. Brown discusses the financial aspect and clearly printed, though curiously heavy for its of the question, and argues that an additional storey, for size. which the building is structurally suitable, would be better On the whole the authors have succeeded creditin every respect than the erection of new detached buildings. in the task which they imposed upon themably The letter, which is virtually a plea for, and an appreciation selves. The successive chapters are full of of, the circular system of hospital wards, will be read with well-ordered information authoritatively or even the concerned of interest by everyone with building hospitals, and should receive the careful attention of the board of didactically stated, and the information given is
of the Victoria of its writer.
management
personality
Hospital, considering
the
generally of the kind most ence by those who wish to
needed for rapid referknow the outstanding