galvanocautery operation, and the high-frequency spark operation introduced by Bugbee. These operations are described, and in this connection the author says, "The trend of modern surgery in the treatment of these cases is undoubtedly toward suprapubic operation notwithstanding the claims made by the advocates of the palliative forms of treatment."

In the treatment of the enlarged prostate, as in many surgical conditions, operative treatment has become gradually perfected to the point where radicalism has proved itself safer than any method of palliation, hence the author devotes a chapter to the indications for radical treatment by suprapubic and by perineal prostatectomy. The most recent development in the surgery of the prostate, namely, the two-stage operation, is believed by some to meet the requirements of a routine procedure, but to this the author takes exception, believing that this method of treatment should be selected only in a certain class of cases. For practical purposes he divides all operable cases into three groups, as follows: Group I comprises all patients in the initial stages of prostatism who present no complications necessitating preliminary treatment. In this group, if we are able to demonstrate a small quantity of residual urine in the absence of marked distention, inflammation or atony of the bladder wall; if the cystoscopic examination demonstrates sufficient prostatic obstruction at the vesical outlet to explain the presence of the residual urine; if the patient's vital organs are in good condition; if his kidney function is approximately normal, immediate operation is deemed not only safe but wise.

Group II, which comprises the great majority of patients with prostatic hypertrophy, includes all cases in which some form of preparatory treatment is necessary if the operation is to be undertaken with safety. Cases in this group are always moderately advanced in prostatism; the effects of urinary obstruction are evident, primarily in the bladder and the upper urinary tract and secondarily in the general effects of urinary stasis and in the systemic effects consequent upon a distressing affliction.

To attempt prostatectomy immediately in patients belonging to this group is to invite disaster. In the great majority of instances catheterism, either intermittent or continuous, together with the treatment appropriate to the complications present, will result in an improvement sufficient in degree to permit prostatectomy being attempted with every chance of success. The operation may be performed in one stage, but more often it should be done in two stages. Group III includes those patients in whom for any reason palliative treatment is contraindicated and in whom immediate relief of urinary obstruction is a necessity. This group therefore includes

all patients whose condition demands removal of the prostate gland, but in whom instrumentation is impossible, and for this reason preliminary cystostomy is demanded.

After determining the advisability of prostatectomy in any given case we must next carry out preliminary treatment designed to get the patient in the best possible condition for operation. Having succeeded in this, we choose the method of operation best suited to the needs of the individual case. We have before us a choice of two routes of access to the prostate gland, the suprapubic and the perineal, and a number of variations in the operative procedure by either route. According to the author the preferable route for total enucleation of the prostate is the suprapubic. The perineal operation is best confined to those cases where the prostate is small, fibrous, and sclerosed; where the removal of the floor of the prostatic urethra and the main part of the lateral lobes of the prostate will lower the vesical orifice sufficiently to make a clear-water way; and where there is little chance of the only portion of the prostate left (the superior commissure) subsequently enlarging and causing renewed obstruction.

In the closing chapters of the book the author gives the technic of the various modern operations, including the preparation of the patient, and the after treatment.

The volume is replete with illustrations depicting the anatomy and pathology of the prostate gland and the details of the various steps in operative interference.

VENEREAL DISEASES IN THE AMERICAN EXPEDITIONARY FORCES, by George Walker, M. D., late colonel, Medical Corps, U. S. A. Medical Standard Book Co., Baltimore, Md., 1923.

The object of this book is to record the experiences of the American Expeditionary Forces in the control of venereal disease. In it the author discusses the methods which really proved effective and those which were found to be futile, and he has brought together a mass of data of great value to those interested in the prevention of venereal disease in all its various phases.

NURSERY GUIDE FOR MOTHERS AND NURSES, by L. W. Sauer, M. A., M. D., senior attending pediatrician, Evanston Hospital. C. V. Mosby Co., St. Louis, Mo., 1923.

This is an excellent small manual which considers in detail the care of the infant. There are chapters on the general care of the infant, the nursing infant, the premature infant, artificial feeding, nutritional disturbances of the artificially fed infant, some of the common ailments of children, and the care of the sick infant. The book is well written and illustrated.

APPLIED PSYCHOLOGY FOR NURSES, by Donald A. Laird, assistant professor of psychology, University of Wyoming. J. B. Lippincott Co., Philadelphia, Pa., 1923.

This little volume is an excellent addition to the series of nursing manuals published by the Lippincott Company. We are living in an age of applied science, and psychology is taking a place alongside of electricity, chemistry, and mathematics in the practical work of everyday life. In this book the author has attempted to select from the literature of psychology "those facts that will be of most immediate aid to nurses in understanding the patients, themselves, and their fellow men as organisms that act, think, and feel." The facts discussed are presented from the biological point of view.

The author treats his subject in four parts. Part 1, which is introductory, tells the reader what should be expected from psychology. The second part presents the biological foundations of behavior, while in the third part the more practical results of the biological adaptations of psychology are presented, such as gaining skill, skill in thought, the use of skill, temperament, use and abuse in thought, and the use of suggestion. The fourth portion of the book deals with certain aspects of mental hygiene with which every nurse should be familiar.

THE DIVISION OF PREVENTIVE MEDICINE. Lieut. Commander G. R. PHELPS, Medical Corps, United States Navy, in charge.

Notes on Preventive Medicine for Medical Officers, United States Navy.

INSTRUCTIONS TO MEDICAL OFFICERS.

FURTHER REMARKS RELATIVE TO VACCINATION AGAINST SMALLPOX IN THE NAVY.

Perhaps medical officers may have an idea that this subject should not be discussed again without apology. It is true that existing regulations and instructions fully cover all questions likely to arise. It is also true that the Navy in general is well vaccinated; very few persons in the service escape vaccination and the great majority of all officers and enlisted men are known to possess immunity as evidenced by one or more pitted scars indicative of a previous primary take, further checked by a recent reaction of immunity.

Nevertheless, it is a reflection upon the Medical Corps of the Navy that the bureau should have to furnish the data presented below when asked by the International Health Board for the vaccination histories in 77 cases of smallpox recorded in the Report of the Surgeon General for the year 1922 as occuring in the Navy during the preceding year.

The International Health Board and many other unofficial health agencies as well as Federal, State, and local health organizations are constantly forced to defend vaccination in seeking to secure legislation or prevent the enactment of laws inimical to the public health as urged by persons and cults opposed to compulsory vaccination. Inasmuch as the Navy is supposed to be completely vaccinated the incidence of the disease looked bad, and doubtless those interested will be relieved to know that persons who oppose protection against smallpox can not find consolation in the figures. But, on the other hand, the figures are certainly not a credit to the Medical Department of the Navy.

The bureau is aware of the difficulties presented by ever-shifting personnel and the sudden transfer of large drafts from receiving ships or stations and occasionally from ships, but the Navy can be

insured against all but residual cases of smallpox that may occur after exposure in rare instances as a result of vagaries of immunity in the exceptional individual.

Such insurance can be kept up only if each and every medical officer who examines naval personnel before or after transfer, or is responsible for health conditions on board ship or at a naval station, sees to it that the vaccination status of each man is checked up by himself or with equal thoroughness by a junior medical officer as a matter of routine and in such a systematized manner that omissions and mistakes can not occur.

The use of a rubber stamp in place of the written signature is pernicious, and it is not to be expected that a conscientious medical officer before whom the health record and the man later pass for review will place any credence whatever upon a stamped entry. The medical officer who actually saw the result of vaccination is the only person in a position to record an immunity reaction or a posi tive "take." The entry of a negative result means nothing except that vaccination must be repeated with fresh virus. The time for recording the result of vaccination is immediately after reading the result. This plan requires little or no extra time. The medical officer can sit at his desk and study each man's arm as he appears and presents his health record, which has been handed to him by a hospital corpsman.

The use of typewritten lists of the names of men who have been vaccinated introduces an unnecessary and a weak link in the chain. of evidence. Many mistakes have been made in copying results from such lists into health records.

Even when the medical officer has initialed the stamped entry the use of the stamp still suggests that someone else did the work, or the copying, and that the medical officer did not as a matter of fact know or remember for himself that the result was as recorded in the particular case.

Many instances of obviously incorrect entries initialed by medical officers have been reported to the bureau by other medical officers. The cases in which a positive result has been recorded but no pitted scar remains as evidence and the man himself states frankly that it did not take, have about balanced the number of cases in which the result has been recorded as negative while the man indignantly protested that it did take and he was able to show a pitted scar more or less recent in origin.

Often the obviously incorrect entry has been made at a naval training station and initialed by the senior medical officer. Some other medical officer probably saw the result; he should have recorded it at the time he made his reading.