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methods of prescribing differ considerably from ours, especially in their palatability, and valuable suggestions may be obtained for prescribing, especially the more active drugs and those having a strong or nauseous taste.

The art of making nice" medicine instead of nasty is of more importance than the junior practitioner is always aware. Taking iron as an example, the methods given in the “Formulaire Magistral for making it up are varied and palatable. Other portions of the work refer to diet in all possible circumstances. We most particularly notice the diet tables for diabetic patients. Mineral waters and springs in all parts of Europe are described. We can imagine the French "Formulaire as extremely useful in getting over difficulties in refined prescribing.

Nervous and Mental Diseases. By ARCHIBALD CHURCH,

M.D., and FREDERICK PETERSON, M.D. London : W. B.

Saunders and Co. Fourth Edition. We have already had an opportunity of reviewing this work. A new edition shows that the opinion then formed was correct, namely, that Drs. Church and Peterson's text-book is of substantial value to the profession. Revision of the book has been thorough, and we notice the addition of much new matter, and many additional illustrations. The healing of nerves—a subject on which some light has been thrown by recent investigations—is among the added matter. There are many interesting clinical conditions with an obscure pathology to be met with in practice. Their indefinite nature is perhaps the reason why they do not find a prominent place in ordinary text-books, or do not arrest the student's attention. Consequently, when a case is met with, the disease is not recognised, and so an opportunity for further clinical observation is lost. To this division belongs the large class of tropho-neuroses so-called, acroparesthesie, intermitting limping, angioneurotic oedema, and adiposis dolorosa. This group of diseases is particularly well described by Drs. Church and Peterson.

Advances in neuro-physiology have brought to light many interesting phenomena in connection with some of the commoner lesions. Thus the recognition of astereognosis as a sign of lesions of the sensori-motor cortex is important, and supports recent views taken of the rôle of the cortical portions of the brain. This and other signs are fully described. The “ Tics” are a curious and difficult group of diseases, concerning which we require to learn more. The chapter given to them by Drs. Church and Peterson is too elementary.

Dr. Peterson is responsible for the section on Mental Diseases. It is almost a pity to unite these and the more general diseases of the nervous system in one volume. At the same time, the 250 pages given to them contain clear and well-authenticated information. We can cordially recommend the book to the advanced student of medicine.

MEDICAL PREPARATIONS.

We have received a sample of Nestlé's Milk Food for Infants. The food is prepared by first pasteurising the milk, and then condensing it and drying it, after admixture with ground wheaten biscuit, into which the greater part of the starch has been converted into maltose and dextrin. A small quantity of cane sugar is then added. The composition of the food is as follows : Fat

5.26
Proteids

14.02
Sugar of Milk 6.38
Maltose and Dextrin 26.12
Cane Sugar

27.67
Starch

14.95 Mineral Matter

1.95 Water

3.65

100 The food, prepared according to the directions given, is palatable, and should afford a valuable addition to the list of infants' foods.

BOOKS RECEIVED.

From Evans and Hastings

Annual Report of the Vancouver Board of Trade, 1903-4.
From Cassell and Co.-
The Student's Handbook of Surgical Operations. TREVES.

New Edition.
Serums, Vaccines, and Toxines in Treatment and Diag-

nosis. BOSANQUET. From George Standring-

The State Remedy for Poverty. From Elliott Stock

Municipal Shortcomings. SMALLCROSS. From H. K. LewisEnlargement of the Prostate. MANSELL MOULLIN. New

Edition. Deaths in Childbed--A Preventable Mortality. WILLIAMS. From Young J. Pentland

The Nervous Affections of the Heart. G. A. GIBSON. From Cornish Bros.

On the Sterilisation of the Hands. LEEDHAM-GREEN.

OPERATIVE METHODS-NEW AND OLD-IN

TUBERCULOSIS OF THE KNEE JOINT. BY SIR WILLIAM THOMSON, C.B., F.R.C.S., Surgeon to the

Richmond Hospital, Dublin ; Hon. Surgeon to the King in Ireland.

MR. PRESIDENT AND GENTLEMEN,

I have to thank the Committee of this Society for the honour they have done me in inviting me to address you at this opening meeting of your session. I feel that you have paid a flattering courtesy not only to myself, but to the country from which I come, and I wish most cordially to acknowledge it.

When I first put to myself the question, “ What shall be the subject of my address ? ” it occurred to me that I might find

you sated with the whole range of problems in what I may call the transcendental surgery of to-day's fashion, and that you might for a change be inclined to go with me along some paths more prosaic, but not less interesting and important. So discussing the matter in my mind, I came at last to the decision to ask you to consider with me the treatment of tuberculosis of the knee joint. I think you will admit that it is not in a quite satisfactory position—and the variety of methods points to the fact that there is great difference in the views of surgeons as to what is best to be done. The disease is common enough—but if it is common, it is not commonplace. It influences severely the life-history of the poor, among whom almost every individual must be a breadwinner; it mars many a career, which otherwise might be so successful, among those with the best social surroundings. It is, then, of great importance among the things that form the activities of a surgeon's life; and in dealing with it he may worthily exercise his best qualities, for not only does it

*An Address delivered before the Midland Medical Society at Birmingham,

October 27, 1904.

demand high powers of brain and hand, but it will test his skill and patience to the utmost. And to my younger confreres may I say that they will meet tubercular arthritis far more frequently than abdominal mysteries, with all their fascinating perplexities? So it seems to me that I am justified in trying to lay before you shortly the claims of competing methods, and to arrive at a fair appreciation of them.

I start with the admission that by far the greater number of cases, if seen early, are amenable to a certain degree to treatment by mechanical methods. Some appliance, such as Thomas's splint, which gives rest to the joint, and enables the patient to take exercise in the open air, supplemented by generous constitutional treatment, will frequently stay the progress of the disease, and leave the patient with a joint which may be damaged, but useful. It is for this reason that we seldom find it necessary to interfere actively with children of the better class. The watchful care which they enjoy leads to an early recognition of symptoms, and medical aid is sought. But unhappily that is not so with the children of the poor, whom we see in such numbers in the outpatient departments and hospitals of large towns. Their condition is not recognised by parents who are too often unobservant or neglectful: or their complaints are attributed to some passing strain, or to “growing pains.” When we see these cases, many of them have far advanced on the road which leads not only to permanent damage, but to the imperilling of the joint or limb altogether. What is to be done for them? Our hospitals have too many demands upon their space to give shelter to all these poor creatures. They cannot provide themselves with suitable splints and crutches, for they cost inoney.

So we treat the less urgent of them as extern patients. We put up the limbs in plaster of Paris, and send their owners back to their wretched dwellings--to every hostile condition that we can conceive-bad air, bad food, bad clothing. And with what result? There are some who appear to think that joints will in such circumstances get well in time. I envy them their optimism. In my experience they do not get well. The poor live their uncared-for,

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