265

easily have been overlooked. The healthy ovary was so

small and shrunken that its functional activity seemed some-what problematical. The return of menstruation and con-

ception shortly after the removal of the diseased ovarysuggested that some inhibitory action was exercised by thediseased organ.

Dr. H. JELLETT said that he did not approve of leaving thesecond ovary if the first was known to have undergonemalignant change of any kind, as the danger of a simul-taneous malignant condition in both ovaries was too great.-Sir W. SMYLY and Dr. B. SOLOMONS also spoke.Dr. JELLETT showed a pyosalpinx and ovarian abscessremoved from a patient aged 23, who had a double uterus.The left side alone was affected, the right horn of the uterusand corresponding ovary and tube being quite healthy. Theuterine cornu on the infected side was also removed. The

pus from the abscess contained streptococci and colon bacilli.The patient was making a good recovery.-Dr. R. J. ROWLETTEalso spoke.

500 Consecutive Operations at Mercer’s Hospital.Dr. BETHEL SOLOMONS read a paper on 500 Consecutive

Operations Performed at Mercer’s Hospital. The main con-clusions arrived at were that: 1. Skin disinfection was bestaccomplished by some reagent which hardened the skin. Etherfollowed by iodine was an excellent method. 2. There was lesschanceof pulmonary embolism if the patients were encouragedto move about freely in bed after operation. A lengthy stayin bed was inadvisable. To prevent pneumonia and pneu-monitis care should be taken that the patients were warmlyclad going to or coming from the theatre. 3. Curettage,when carefully performed, was a beneficial operation. 4. Ofthe many operations described for the cure of backwarddisplacement, the modification of Tod Gilliam’s technique,which he described in the paper, had been found to be thebest. Ventral suspension and Atexander-Adams’s operationhad their indications, and ventral fixation was satisfactoryafter the menopause. 5. When it was necessary to treat

sterility by operation it was justifiable to open the abdomento examine the state of the adnexa. even though there wereno marked signs of disease. Tubes of normal size withclosed ostia, hydrosalpinges, and very small cysts of the

ovary were often discovered. 6. This paper on imme-mediate results of operation for gynaecological ailmentswas presented as a preliminary to the presentation at a laterdate of the remote effects, which were more important. The

perc entage mortality was small, the morbidity was practicallynil. and the after-results were excellent. In a large numberof operations for the cure of sterility there were no deaths. Bycomparing these results with those obtained by the workersin radium and X rays knowledge could be gained as towhich was the better.

Sir WILLIAM SMYLY said he believed in the modifiedGilliam operation for backward displacement. Despite theunfortunate results which had been reported followingventral suspension, he still did the operation with satis-.factory result. He did not approve of Alexander-Adams’s

operation, as he liked to see the inside of the abdomen. Heagreed with the main principles of Dr. Solomons’ paper.

Dr. ELLA WEBB asked if the cases of pneumonia wererecent and if pure ether was the anesthetic employed. Sheagreed that great care must be taken to keep the patientswarm in going to and coming from the theatre.

Dr. R. J. ROWLETTE said that a definite diagnosis as tomalignancy in large ovarian tumours was sometimes impos-sible. He thought that most papillomatous tumours weremalignant. He suggested that chloroform might be re-

introduced as an anaesthetic ’when the doctors came backfrom France, and he did not welcome the idea.

Dr. AsHB said that he agreed with the author of the paperthat it was important to exclude the male as the cause ofsterility before operating on the female.

Dr. JELLETT considered Alexander-Adams’s operation to bethe ideal one for all cases of undoubtedly uncomplicated back-ward displacement, but thought that it was contra-indicatedin cases associated with sterility or any possible pelviccomplication.

Dr. SOLOMONS, in reply, said that he had had no recentcases of pneumonia. Ether, or gas and ether, was theanaesthetic employed in his cases, and he would never permitthe use of chloroform. He thought that many women wouldbe saved unneceRsary operations for sterility if the malesemen were examined.

Reviews and Notices of Books.! The Physiology of Industrial Organisation. By Professor

JULES AMAR. Director of the Laboratory of PhysiologicalResearch in tht- Conservatoire des Arts et Métiers, Paris.Translated by BERNARD MIALL. Edited by ProfessorA. F. STANLEY KENT, M.A., D.Sc. With 135 iilastra-tions. London : The Library Press, Ltd. Pp. 371. 30s.

, So excellent a book as this must inevitably be translated

,

sooner or later. The French edition has already been,

reviewed in THE LANCET 1; the translation has been,

admirably carried out by Mr. Bernard Miall, who whileretaining the French turn of thought has not failed to writeexcellent English. The book has been edited by Professor

, Kent, who in addition to writing an introduction has,

supplied some useful notes. The shorter hours of work, ofwhich there are now more than indications, render all themore important the organisation of industrial work. Thisbook gives us a timely exposition and criticism of F. W.Taylor’s methods of increasing output in factories. Taylorapparently judged the optimum rate of work by meansof an instinctive knowledge of the appearances of fatigueacquired as the result of experience ; Dr. Amar pointsout that observations as to the degree of fatigue pro-duced made at a glance cannot replace objective testsand measurements. In the case of work performed by warcripples the physiological limitation of great numbers ofpersons of this class, the necessity of using them in goodearnest. and the social problem created by their employmentin industry demand a completer system of scientific controlcapable of analysing all the factors of human energy.

In addition to describing the methods (derived fromthe physiological laboratory) by which he investigatesfatigue he gives practical directions on such mattersas the optimum weight of tools and the best attitudesof the body for particular kinds of work. The bookincludes the result of his investigations of the scientificprinciples involved in the construction of artificial limbs. Bymeans of his dynamographic gangway he is able to registerall the phases of support and propulsion, the locomotiveefforts, and the duration of the elements of activity of thetwo legs, the normal and the artificial. With the respirationgauge he measures the expenditure involved by walking agiven distance with the model under examination, and bythese two means is enabled to appraise the relative value ofthe various makes of artificial legs. The well-known Canetmechanical arm was constructed as the result of investiga-tions carried out under the direction of Dr. Amar. Descrip-tions are given of several forms of registering apparatusused for the physical re-education of men with arm stumps.

JOURNALS., The American Review of Tuberculosis. Baltimore: NationalAssociation for the Study and Prevention of Tuberculosis.October, 1918. 35 cents.-Of the five original articles in thisnumber two are devoted to psychic aspects of tuberculosis,three to treatment by artificial pneumothorax. The paperby Dr. Charles L. Minor on The Psychological Handlingof the Tuberculous Patient is a well written essay ontact and optimism, tempered by judgment, in the treatmentof the consumptive. The author illuminates observationsperilously akin to platitudes by his facile and sympatheticstyle. In a paper by Dr. Tohru Ishigami on " The Influenceof Psychic Acts on the Progress of Pulmonary Tuberculosis "the opsunic index is used as a guide, and its fall, as a sequelto psychic factors, is taken as evidence of their ill effects.More convincing is the author’s observation that psychicacts often cause transient glycosuria. He has found thatboth sugar and adrenalin inhibit opsonic reaction. His con-clusion, based on valuable and evidently laborious researchwork, that mental overstrain in youth contributes largely tothe mortality from tuberculosis will be endorsed by many.The three papers on artificial pneumothorax, by Dr. E.Morris, Dr. S. A. Slater, and Dr. H. F. Gammons, aretypical of the mature and deliberate verdict which mostAmerican specialists in tuberculosis give in favour of thistreatment. The first of these papers deals with as many as202 cases. The second records a case in which this treat-ment proved beneficial during pregnancy and labour. Thethird is a plea for artificial pneumothorax in acute tuber-culous pneumonia, a case being recorded in fall to point theauthor’s argument. ,

1 THE LANCET, 1917, i., 615.