TONSILLECTOMY AFTER QUINSY

1189 with two tabular statements, the first illustrating the life of Comenius in connexion particularly with the development of scientific societies, and the second setting out the growth of these bodies and of that evolution of encyclopaedic ideas which marked the eighteenth century. These ideas had behind them a scheme for the organisation of society, and, to Comenius in particular, the spread of civilisation among the native tribes appealed forcibly. Mr. Young puts before us a series of contemporary documents which tell a remarkable story. In the first Komensky describes his " pansophic plan," a scheme for an international or central college for scientific research ; in another he describes his visit to England ; and from others we learn the effect that his writings and learning had upon the minds of contemporary leaders of thought. These documents have been selected and translated by Mr. Young and picture the rise of the scientific spirit in learning while illustrating Comenius as a man of noble imagination. The last document is a translation from a latin version of a passage from Comenius’s work the " Great Didactic," and describes the function of a universal college. This in his idea was to be " a school of schools and ... would bear the same relation to other schools that the belly bears to the other members of the body, that of a living laboratory supplying sap, vitality, and strength to all." An appendix deals with Comenius’s plans for the higher education of the Indian in Virginia and New England, and shows how many humane thinkers of the sixteenth and seventeenth centuries saw, in the native American populations, virgin material to be shaped into ideal citizens. What happened is a terrible commentary upon these humane imaginings. Indeed, in many ways this small book, which is a model of painstaking and learned research, makes sad reading, for the international spirit with which Comenius and his friends were imbued seems to have effected little for the world of to-day. TONSILLECTOMY AFTER QUINSY pretty generally agreed that such an operation as tonsillectomy should not be performed in the presence of signs of acute inflammation. Most authorities hold that under such circumstances the danger of haemorrhage is increased, and at a discussion initiated last year by J. M. le M6eat the American Hospital in Paris, the view was generally taken that an important factor in the avoidance of pulmonary abscess was to postpone tonsillectomy until any acute inflammation had subsided for at least three weeks. abscess Nevertheless, the treatment of peritonsillar " by immediate tonsillectomy a chaud has lately been advocated in France by Leroux and Halphen. In criticising these proposals, Prof. Georges Canuyt2 states that he has performed a large number of tonsillectomies " a chaud," but that he has never extolled the method for the treatment of quinsies. In his opinion, it is defensible if the preliminary incision of the abscess has liberated the tonsil in great part from its attachments, if the local anaesthesia has been successful, and if the general signs of infection are not very pronounced ; but these conditions are seldom realised, and he performs this operation " a chaud " less and less often. On the other hand, after the quinsy has subsided, tonsillectomy " a froid " is made much more difficult by adhesions between the capsule and the surrounding structures ; besides, many patients fail to return for tonsillectomy after the quinsy has been cured. Canuyt therefore

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recommends a compromise, and removes the offending tonsil " à tiede," in the tepid stage. He first incises the palate at the upper pole of the tonsil, separating the palatoglossus from the palatopharyngeus, and thus allowing the anterior pillar to retract outwards ; the abscess is then opened through a long vertical incision at the edge of the anterior pillar. The dissection of the tonsil is completed a few days later when the oedema has disappeared, the infiltrated tissues have recovered their mobility, the tonsillar bed is widely exposed, the greater part of the tonsil is detached, and the temperature has almost returned to normal. He claims that at this stage regional and local anaesthesia, are very good, that the operation is easy with a minimum of dissection because separation has been effected by the abscess, and that the patient recovers with surprising rapidity and without rise of temperature, hoemorrhage, or pain. It seems that this method may have advantages ; on the other hand, it is doubtful if they outweigh the drawbacks mentioned above, and in any case the time for the tonsillectomy must be carefully chosen. Perhaps, too, the dissection under infiltration anaesthesia, recommended for opening the quinsy, may not always be possible in a patient acutely ill and in great pain, who may be unable to open the mouth for more than a fraction of an inch. HEALTH IN WEST AFRICA THE four West African territories which come under the administration of the Colonial Office are, from north to south, the Gambia, Sierra Leone, the Gold Coast, and Nigeria, in increasing order of size and population. In these territories there are a. large number of non-native officials about whose health conditions the Crown Agents issue annual returns.1 The figures for the year 1932 representthe best results yet achieved. Whereas in the year 1903 there were only 1259 non-native officials engaged in West Africa, the number had increased to 3630 in 1932. A study of the death- and invalidingrates during this period of 30 years reveals that while the number of officials in the West African services had steadily increased, these rates have shown a progressive diminution. Thus from 1903 to 1912 the highest death-rate per 1000 in a year was 28.1, the lowest was 12-4; from 1913 to 1922 the highest was 16.5 and the lowest 8 ; from 1923 to 1932 the highest was 12.8 and the lowest 3-6. The skeleton Table appended shows the trend. While in England

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1 Rev. de Laryngol., Suppl., July-August, 1932. 2 Presse Méd., May 13th, p. 769.

death-rate of 3-6 per 1000 would be remarkable in a country with the evil reputation which West Africa has long had it appears little short of miraculous-it need only be recalled that in the period 1881-97 the death-rate per 1000 in the Gold Coast was 75-8, in Lagos 53-6. These non-native officials of course form a selected class ; they are selected as regards sex, age and, to some extent, physical and intellectual capacity. In so far as sex is concerned, however, it is notable that of the few a

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1 From the Crown Agents to the Colonies, 4, Millbank, London, S.W.1. 6d.