This work is based

WHEN a disabled man has been fitted with an artificial
limb he has to learn a trade which will enable him to supplement
his pension and provide for himself and his family. In our opinion,
which we believe we have expressed more than once in this book, it is
nearly always advisable to determine what profession will ultimately
be possible before ordering the artificial limb. This principle is
perhaps not always thoroughly understood, although there are fitting
centres where it is fully recognised (a proof of this may be found in
a recent article by Nové-Josserand and Bouget).

It is unnecessary to repeat that whilst every effort must be made to
associate form with function, the latter is bound to take precedence
of the former. It is, however, not always easy to impress upon
patients, and more especially upon their protectors, that _form_ is
for Sundays and holidays, and _function_ is for workdays.

The grave problem of re-education of amputation cases, and in a more
general sense of all the maimed, now confronts us. We believe it to be
worth while to indicate the general principles so far as they are at
present understood.

I

At the outbreak of war the idea of the disabled in general, and
particularly of those who had had a limb amputated, was often to give
up any really active trade and to seek a “situation” generally as an
official with no actual manual labour. It must be confessed that many
people, especially the nurses, encouraged them in this, and possibly
the latter would not deny having done so.

It has rapidly become evident that there are too many maimed to
be supplied with situations as caretakers of public gardens or
doorkeepers, and that they will not be able to gain a living by making
tricoloured decanter-mats of string or raffia or artificial flowers,
when bazaars organised for their benefit by tender-hearted souls have
gone out of fashion.

One of us was present a short while ago at the following little
scene:–

In a hospital where there were two amputation cases, one through the
lower fourth of the thigh, the other through the middle of the leg,
both agricultural labourers, a distinguished man of letters, actuated
by the best intentions, asked them what they counted on being able to
do after they had been fitted with artificial limbs. The first replied
that he hoped to return to agricultural work, the second that he would
never be able to do that but would look out for a “situation.” Our
friend was much surprised to hear us say that he would be ill employed
in using his influence to obtain his desire for the second patient,
because a man with only one leg could work on the land with almost
no diminution of his ordinary capacity, even with the old-fashioned
kneeling peg leg.

As Jean Camus has well said in a recent article in the _Paris
Médical_, “We are beginning to pass beyond the phase when re-education
of the maimed was left to chance. It is felt now that the frivolous
efforts of benefactresses who, acting with the best intentions but
without reflections, are delighted to be able to transform into a
shorthand typist an honest farm labourer who had a strong attachment
to the soil and could quite well return to it, must be avoided. Such
feats are both culpable and absurd.”

These fantastic ideas must be got rid of, and all our efforts must be
co-ordinated, the complexity of the conditions to be dealt with being
duly weighed.

Given a maimed man the first care should be to educate to the maximum
all the uninjured and remaining parts. It is too often forgotten that
among the parts remaining the brain plays a leading rôle, even the
chief rôle, not only because it is the organ of “good will” without
which all attempts at re-education are fruitless, but also because
good will being given the intelligent man will succeed better and
will be able to adapt himself to more delicate work. “Physiotherapy
cannot be prescribed,” says J. Camus, “as quinine is prescribed. The
malarial patient who takes the latter medicine benefits whether he
wishes to or not. The wounded man who submits each morning to his
mechanotherapeutic treatment does not recover unless he wishes.”

It is very difficult to make the layman understand this. He invariably
takes for granted the good will of the patient, with all of whose
complaints he sympathises, without for a moment realising that they
sometimes degenerate into jeremiads, often with an ulterior motive.
An examination by a doctor–and an experienced doctor–is therefore
necessary in order to determine under what physical and mental
conditions an amputation case can be re-educated; so that he may
understand that it is entirely to his interest to work as quickly and
as well as possible, that begging is degrading, and above all that
private charity is temporary and exhaustible; and that in consequence
he must as quickly as possible put himself into a condition to
supplement by a salary justly earned the pension or gratuity which is
certain to be insufficient for his maintenance.

It can never be sufficiently insisted upon in dealing with the maimed
that by resuming work, and on account of the functional improvement
resulting from doing so, they need have no anxiety that their pension
will be reduced, because the amount of this is based on the extent of
the injury itself and on the man’s rank, and not on his profession
before he became a soldier. In the same rank the pension is the same
for a surgeon or a lawyer, if both have lost a hand.

It is a deep-seated notion, instilled into the minds of injured
workmen by the often suspicious folk who advise them, that if they
begin work before their case has been settled their pension will be
less.

It must be acknowledged on the other hand that the civil expert
is often faced with a difficulty. As our law stands–and it is
unfair–work cannot be resumed partially with provisional half-pay
followed later by whole-time work with permanent salary. This
difference is important to our wounded soldiers, who have everything
to gain by a rapid and complete re-education and whose duty it is
to do whole or part-time work while their legal position is being
arranged and before the wound, in legal phraseology, has become
“consolidated,” that is to say, before the completion of treatment.

It is only fair to add that the patients are not alone to blame and
that the administration has for long been guilty of an error against
which reaction is growing, viz. delaying re-education until the time
when the local condition has become permanent and the patient has been
discharged and has received his prosthetic apparatus.

This delay is deplorable, on both medical and social grounds. On
medical grounds because in very many cases before treatment is quite
complete the addition of carefully graduated and supervised work is
an important part of the treatment. On social grounds because it is
necessary to fight in every possible way against the common tendency
of the patient to fall into habits of laziness and intemperance.

This is now understood, and almost everywhere to-day the wounded
soldier can resume work in workshops attached to the centres of
physiotherapy, and thus begin his re-education while continuing his
treatment.

At a certain stage resumption of work becomes the best therapeutic
agent of all.

It is obvious that this resumption of work cannot supply the place
of certain special treatments such as electrical treatment during
the regeneration of a nerve, balneotherapy, or graduated gymnastic
exercises; but is it not true that work with its continual active
movement is infinitely superior to passive mobilisation by means of
apparatus however ingeniously the latter may be contrived? Morover it
is surely a more efficacious course of mechanotherapy when the patient
works for half or all the day than is provided by the special course
occupying only an hour or two.

The tendency to-day is in this direction, as, for example, at the
Grand Palais, thanks to the efforts of J. Camus, and also in the
agricultural centre of the XIIIth district under the direction of
Belot and Privat. At a given moment all treatment may be suspended and
the patient may devote himself exclusively to work with results the
excellence of which Nepper and Vallée have demonstrated.

The workmen are then eligible for work in a town in private workshops,
but so far this freedom has more inconveniences than advantages. A
man whose working capacity is much reduced, and more especially a man
who requires re-education, has no place in an ordinary workshop where
neither the proprietor nor the foreman nor his fellow-workmen are in
truth much inclined to concern themselves about him. Where actual
education is necessary this is best supplied in special workshops
where the patient will be among comrades handicapped like himself,
whose progress he will be able to watch and whose efforts he will
imitate, rather than among able-bodied workmen, by comparing himself
with whom he is bound to be discouraged.

The problem has been solved by the Belgians in a remarkable
establishment opened at Port-Villerz, and by the Austrians at Vienna
under the direction of Spitzy, as Nové-Josserand and Bouget inform
us, by delaying a maimed soldier’s discharge from the army until his
re-education is as complete as possible. This method has proved to
be to the interest both of the individual and of the State, but we
do not seem to have considered this solution, and it is still to be
feared that it would accord ill with the independence of our national
character. The actual fact, though it has not been brought into
prominence, is that our usual system of “watertight compartments” has
been applied by adding to the centres of physiotherapy centres of
agricultural or industrial re-education, the results obtained in which
are dependent upon the efficiency of the director of physiotherapy.

This matter seems to have received very little special attention in
connection with amputation cases. It is, however, of great utility to
develop the strength and agility of the remaining limbs by suitable
gymnastic exercises, to teach a man with only one leg, for example,
to jump without an artificial limb and to climb a slippery rope or a
ladder; or to train the left hand of a man who has lost his right;
to develop the greatest possible strength in the stump by training
it in movement combined with the exertion of force. In addition to
this, early and provisional equipment with artificial limbs must
become general. These temporary limbs are undoubtedly rudimentary
contrivances, but they are functionally good and are useful on account
of their mere weight.

In this connection the temporary arms used by Nové-Josserand and
Bouget in their agricultural re-education centre are very interesting
models. The great advantage of using a temporary limb is that the
time required for the construction of the permanent apparatus, often
a considerable period, is not lost in idleness, the mother of all the
vices.

II

It was said at the beginning of the last chapter that whenever
possible a disabled man should be given a real trade and not one of
those frivolous and trifling occupations which were at one time the
fashion.

In the choice of a trade the ruling principle is that of aiming to
restore as nearly as possible the man’s former occupation. This
principle should not, however, be carried to an extreme.

As Camus has justly said, by his previous work a man has stored up
a mass of ideas, a fact which is too little realised, especially by
himself. These include the manner of choosing, holding, and attacking
the materials upon which he works, and of appreciating their qualities
and faults; knowledge of their market value, of the value of the
labour, etc. This should be utilised in his future work even though it
be realised, as M. Bourillon has remarked, that the resumption of his
trade in its entirety may be impossible.

With the tools that have been described a man who has lost his forearm
may be able, for example, to undertake a locksmith’s work and to
execute correctly all the movements required in plying the trade.
Granted; but how long will he take to make one piece, let us say,
as well as his neighbour? If he produces little he will not find an
employer to give him daily work, while if he does piecework, apart
from the fact that it is not in good repute among those who are the
actual leaders of the working classes, it will not be remunerative,
and to earn 3 frs. a day when a comrade earns 10 or 12 frs. is
practically an impossible solution.

The case may be cited of a woman suffering from congenital deficiency
of the hand with a very short rudiment of the wrist which is only
slightly mobile. By means of contrivances which we need not describe,
and with no prosthetic apparatus, she threads her needle and sews as
quickly and as well as anybody. This is not an argument, for: (1) it
is a congenital lesion and the educability of a child is well known;
(2) the woman is extremely intelligent, and unhappily this favourable
factor cannot always be counted upon. It would be wrong to conclude
from this that a case of amputation at the wrist should be put to
sewing.

It must never be forgotten that intelligence and will are factors of
the first importance, so that however little intellectual capacity
the disabled man may have, he is bound to profit by his passage
through the school of re-education in learning to read and write if
he is illiterate–this is more frequent than is usually believed–or
to improve his knowledge if he has already had some instruction. It
is, in fact, by brain work that many learn to replace their physical
defect. Let us take, for example, a disabled bricklayer. If he is
intelligent and is given a helping hand in the shape of the necessary
instruction, he may become a builder on his own account in a small way
when he knows how to make plans, work out estimates and keep accounts.

This is not a Utopian fancy. In the small towns and villages there
are many owners of businesses such as masons, decorators, joiners,
etc., workmen who cannot spell, but who are intelligent, have business
minds and a gift for overseeing, who have given up the trowel and will
build you a house as well as, or often better than, many “architects.”
It is with similar aims to these in view that a bricklayer should
be re-educated when it is judged that his intellectual capacity is
sufficiently great.

Where there is no intelligence education can do little. There are in
civil life innumerable “casual labourers” with limbs intact who have
never been able to learn a regular trade and who earn a miserable
livelihood by doing what “turns up.” Their situation becomes serious
when they lose some of their physical capacity. They can, however,
be rescued, particularly by encouraging them to become agricultural
labourers. It is indeed especially agricultural labourers who should
be urged to return to the land, and those mechanics who will be
unable to work in a factory for the future should also be encouraged
to take up this work. One reason for this is that the workman’s
arm–especially if it has not been too much elaborated–is useful
for the execution of a considerable variety of work on the land. It
is unnecessary to speak of cases of amputation below the knee, since
their usefulness on the land may be taken for granted.

In the country as a matter of fact a man never dies of hunger; and
this cannot be said of the town. Apart from actual cultivation of the
land, which is in part impossible for the maimed, there are numerous
and important occupations of which a town dweller would not think. It
is when he goes to the centre of re-education in agricultural work,
first of all to view it and then to work, that the disabled man takes
note of what he can or cannot do, and of the work in connection with
agriculture which is open to him, such as poultry rearing or bee
keeping.

This applies to other employments than agriculture.

Apart from his actual trade which the workman can no longer ply with a
sufficient return for his labour, he may be able to work at one or two
of the accessory employments which would not of themselves bring him
in a living but which would yield a satisfactory supplementary income.

In certain re-education centres there seems to be a marked
predilection for crafts in which the apprenticeship is short
and the installation costs little, though these are in fact the
characteristics of those trades which give the labourer a poor return,
that is to say, time-work in a large or small workshop.

At the beginning of the war an attempt was made to show that there
would never be enough tinkers, sabot makers, shoemakers, or saddlers
in the country. It is quite a false idea that a disabled man can
gain a living at one of these crafts in a village. It is true that
he can do so if, working as an agricultural labourer, he can act
as a barber in his spare time, and is capable of executing small
jobs, especially repairs, which the villagers would readily give to
him rather than have to go several miles to get them done. When the
disabled man has this additional work in his hands he will gradually
be able to ascertain whether the needs of the countryside and his own
personal capacity are compatible with its development. In that case,
however, he will be, in fact, a small proprietor buying his own tools
and materials and fixing a retail price. But the great majority of
workmen have no notion of such calculations and such organisation
as are indispensable when a man runs a business even if he is
alone. It follows, therefore, that the education of his mental, and
especially his commercial, faculties must be considered, and it must
be ascertained whether the man is likely to profit by such education.
It is useless to install in a hamlet a shoemaker who is incapable
of working except as an assistant, and in the town at the actual
factories the prospects are poor.

Moreover, conditions of life in the disabled man’s native place must
be considered as a matter of importance. A man from the Mediterranean
country has no idea beyond the cultivation of meadows, and one from
Picardy none beyond the making of cane baskets for packing flowers.

Judgment is difficult, and in order that the choice may be exercised
as reasonably as possible, the careful collaboration of the patient,
the doctor and the managers of the workshops is essential. We repeat
that this is one of the principal objects for which the centres of
re-education are useful. There are some efficient men, we know, who
without asking anything of anybody find quickly and unerringly the
exact work that suits them. There is no need of anxiety in such cases.

A certain metal worker from the invaded area suffering from
pseudarthrosis of the shoulder, whose wound we were treating, sent
for his wife, and they began to rear geese. We know two cases of
amputation of the right arm, an operative at an aeroplane works and
a worker in stucco, who during their stay at hospital and before
they had been supplied with artificial limbs, had taught themselves,
the one technical design the other ornamental design. Both of them,
as soon as they were discharged, have been taken on by their former
masters, who no doubt were fully conscious that they were thus
combining a good deed with good business. To come to a decision of any
value, however, cases of this sort must not be taken as a criterion,
for they are in fact exceptional. The majority of the men are in need
of guidance.

The procedure employed at the Belgian centre of re-education at
Port-Villerz consists in allowing the patient to frequent the
workshops at will for a few days, during which time he sees what is
going on and is not slow to make his choice, which it appears rarely
needs to be amended.

We have dealt chiefly with the conditions which are suitable for the
re-education of a man who has lost an upper limb, or, speaking more
generally, is disabled in one arm, for whom resumption of work in a
workshop will often be out of the question. The question is easier
of solution for the lower limb. Cases of amputation of the leg can
work standing, if supplied with an artificial limb, at practically
any trade. Cases of amputation of the thigh have numerous manual
occupations open to them in which they sit for at least part of
the time. It must be understood, however, that these professions
which require skill can, as a rule, only be learnt in well-equipped
workshops at the price of a fairly long apprenticeship. Two or three
years are necessary to make a good mechanic, a good watchmaker,
glass cutter, etc. This should not deter us in the case of fairly
young men. The difficulty is to organise special workshops, often with
a complicated equipment, where the maimed man can at least pick up
the rudiments of the work, for it is not to be thought of that he can
remain there during the whole time occupied in a complete training.

In conclusion, we should like to draw attention to the law of 1831,
which regulates the distribution of pensions by means of groups
classified according as the loss is of two limbs or of one. No
distinction is made with regard to the seat of the amputation. But
a man who has lost both legs and has been suitably equipped with
artificial limbs can earn a fair wage, whereas a man who has lost
both arms is completely disabled so that he cannot even wash or
dress himself. Among the amputation cases the difference is also
considerable in the lower limb, between amputation through the leg
and through the thigh, and even more in the upper limb, between an
amputation retaining the movements of the elbow and one in which they
are lost. There is, moreover, a great difference in the quality of
stumps and the consequent utility of the artificial limb. It is of
course impossible to allow with mathematical precision for all degrees
of disablement, but the several general distinctions which we have
enumerated could be taken into consideration without difficulty.

INDEX

American chuck, 122

Angle at which foot is set, 34, 49

Appliances for use instead of hand, 108
with mobile joint, 123
with universal joint, 126

Artificial hand, 96
spring grip thumb, 97
automatic thumb, 98
Beaufort thumb, 99
for commercial travellers, 102
automatic fingers, 105

Bearing points, 6
upon ischium, 13
upon condyles of femur, 62
upon tuberosities of tibia, 67
upon end of leg stump, 77

Bouget, 145, 151

Bonreau’s appliances, 112
function of the artificial hand, 117
hook and ring, 124
length of artificial forearm, 118

Braces for suspension of artificial leg, 24
with extending sling, 43
for amputation below knee, 73

Brunet’s grip, 107

Brushmaker’s hook, 119

Camus, Jean, 147

Cardan joint, 126

Chauffeur’s bell, 125

Combined mechanism for knee and ankle joints, 55

Combined suspension for artificial leg, 26

Condyles of femur, amputation through the, 60

Convertible peg leg, 58

Deltoid muscle, amputation through the, 143

Duplex foot, 54

Elbow joint, for above elbow amputations, 133
for below elbow amputations, 91
for below elbow amputations, short stumps, 95
for worker’s arm, 139

Elephant boot, 79

Equilibrium in an artificial leg, 35

Federation leg, 33

Flexed knee, walking upon the, 66

Foot, construction, 35
with movable ankle, 50
with lateral mobility, 54

Foot, partial amputation of the, 81

Fork rest, Raynal’s, 109

Frees’ foot and knee, 57

Gripouilleau, vine-dresser’s hook, 112
agricultural hook and ring, 124, 126
ploughman’s hand, 141

Guyon’s amputation, 78

Hip joint, disarticulation at the, 64

Hook and ring, agricultural, 124
Boureau’s, 124

Index finger, length of, 102

Knee extending mechanism, 37
artificial muscle, 37
extending sling, 43
combined with ankle movement, 55

Knee joint, amputation through the, 60

Knee joint, for amputation through the leg, 73

Leather-cutter’s hand, 116

Leg bucket, shape of, 67
material, 68

Marks’ leg, 34
knee joint, 41
braces, 45

Materials for bucket, 3
for artificial arms, 84

Nové Josserand, 145, 151

Nyrop’s grip, 121

Packer’s hand, 115

Peg leg, 28
with joint at knee, 29
with show leg and foot, 31
conversion into leg with free knee joint, 58

Perineal concavity, 15

Plumber’s hand, 115

Postman’s hand, 113

Ratchet at elbow, 133

Re-education of amputation cases, 145

Rotation of artificial arm, prevention of, 89

Shoulder joint, disarticulation at the, 143

Spade holder, 127

Stop to limit extension of knee, 38
for amputation below knee, 76

Stump, length of, 3
condition of allowing end bearing, 7
Suspension of artificial arms, 85, 129
to condyles of humerus, 85
to shoulder, 87
for worker’s arm, 138

Syme’s amputation, 77

Thigh bucket, shape of, 13
wooden, 17
leather and steel, 20
for amputation through knee joint or condyles, 60

Thigh corset, 73

Thumb, spring grip, 97
automatic, 98
Beaufort, 99

Tram driver’s bell, 125

Vine-dresser’s hand, 113

Waist belt, 22

Worker’s arm, 138

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functional conservation. The two things are not so closely
allied as is supposed. There is no conservative surgery
save where the function is conserved. The essential point
of the treatment of diaphysial fractures consists in the
early operative disinfection, primary or secondary, by an
extensive sub-periosteal removal of fragments, based on exact
physiological knowledge, and in conformity with the general
method of treating wounds by excision. When this operation has
been carefully performed with the aid of the rugine, with the
object of separating and retaining the periosteum of all that
the surgeon considers should be removed, the fracture must be
correctly reduced and the limb immobilised.

FRACTURE OF THE LOWER JAW. By L. Imbert, National Correspondent of the
Société de Chirurgie, and Pierre Réal, Dentist to the Hospitals of
Paris. With a Preface by Medical Inspector-General Février. Edited by
J. F. Colyer, F.R.C.S., L.R.C.P., L.D.S. With 97 illustrations in the
text and five full-page plates. Price 6/- net

Previous to the present war no stomatologist or surgeon
possessed any very extensive experience of this subject. Claude
Martin, of Lyons, who perhaps gave more attention to it than
anyone else, aimed particularly at the restoration of the
occlusion of teeth, even at the risk of obtaining only fibrous
union of the jaw. The authors of the present volume take the
contrary view, maintaining the consolidation of the fracture
is above all the result to be attained. The authors give a
clear account of the various displacements met with in gunshot
injuries of the jaw and of the methods of treatment adopted, the
latter being very fully illustrated.

_The cost of postage per volume is: Inland 5d.; Abroad 8d._

LONDON: UNIVERSITY OF LONDON PRESS, LTD.,
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THE SPECTATOR: “For our physicians and surgeons on active
service abroad or in military hospitals at home these are the
very books for them to dip into, if not to read through.”

FRACTURES OF THE ORBIT AND INJURIES OF THE EYE IN WAR. By Felix
Lagrange, Professor in the Faculty of Medicine, Bordeaux. Translated
by Herbert Child, Captain R.A.M.C. Edited by J. Herbert Parsons,
D.Sc., F.R.C.S., Temp. Captain R.A.M.C. With 77 illustrations in the
text and six full-page plates. Price 6/- net

Grounding his remarks on a considerable number of observations,
Professor Lagrange arrives at certain conclusions which at
many points contradict or complete what we have hitherto
believed concerning the fractures of the orbit: for instance,
that traumatisms of the skull caused by fire-arms produce, on
the vault of the orbit, neither fractures by irradiation nor
independent fractures; that serious lesions of the eye may often
occur when the projectile has passed at some distance from it.
There are, moreover, between the seat of these lesions (due
to concussion or contact) on the one hand, and the course of
the projectile on the other hand, constant relations which are
veritable clinical _laws_, the exposition of which is a highly
original feature in this volume.

HYSTERIA OR PITHIATISM, AND REFLEX NERVOUS DISORDERS. By J. Babinski,
Member of the French Academy of Medicine, and J. Froment, Assistant
Professor and Physician to the Hospitals of Lyons. Edited with a
Preface by E. Farquhar Buzzard, M.D., F.R.C.P., Captain R.A.M.C.(T.),
etc. With 37 illustrations in the text and eight full-page plates.
Price 6/- net

The number of soldiers affected by hysterical disorders is
great, and many of them have been immobilized for months
in hospital, in the absence of a correct diagnosis and the
application of a treatment appropriate to their case. A precise,
thoroughly documented work on hysteria, based on the numerous
cases observed during two years of war, was therefore a
necessity under present conditions. Moreover, it was desirable,
after the discussions and the polemics of which this question
has been the subject, to inquire whether we ought to return to
the old conception, or whether, on the other hand, we might not
finally adopt the modern conception which refers hysteria to
pithiatism.

WOUNDS OF THE SKULL AND THE BRAIN. Clinical forms and medico-surgical
treatment. By C. Chatelin and T. De Martel. With a Preface by the
Professor Pierre Marie. Edited by F. F. Burghard, C.B., M.S.,
F.R.C.S., formerly Consulting Surgeon to the Forces in France. With 97
illustrations in the text and two full-page plates. Price 7/6 net

Of all the medical works which have appeared during the war,
this is certainly one of the most original, both in form and
in matter. It is, at all events, one of the most individual.
The authors have preferred to give only the results of their
own experience, and if their conclusions are not always in
conformity with those generally accepted, this, as Professor
Pierre Marie states in his preface, is because important
advances have been made during the last two years; and of this
the publication of this volume is the best evidence.

_The cost of postage per volume is: Inland 5d.; Abroad 8d._

LONDON: UNIVERSITY OF LONDON PRESS, LTD.,
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From THE TIMES: “A series of really first-rate manuals of
medicine and surgery … the translations are admirably made.
They give us in English that clearness of thought and that
purity of style which are so delightful in French medical
literature and are as good in form as in substance.”

LOCALISATION AND EXTRACTION OF PROJECTILES. By Assistant Professor
Ombrédanne, of the Faculty of Medicine, Paris, and M. Ledoux-Lebard,
Director of the Laboratory of Radiology of the Hospitals of Paris.
Edited by A. D. Reid, C.M.G., M.R.C.S., L.R.C.P., Major (Temp.)
R.A.M.C. With a Preface on Extraction of the Globe of the Eye, by
Colonel W. T. Lister, C.M.G.. With 225 illustrations in the text and
30 full-page photographs. Price 10/6 net

This volume appeals to surgeons no less than to radiologists.
It is a summary and statement of all the progress effected by
surgery during the last two and a half years. MM. Ombrédanne and
Ledoux-Lebard have not, however, attempted to describe all the
methods in use, whether old or new. They have rightly preferred
to make a critical selection, and–after an exposition of all
the indispensable principles of radiological physics–they
examine, in detail, all those methods which are typical,
convenient, exact, rapid, or interesting by reason of their
originality: the technique of localisation, the compass, and
various adjustments and forms of apparatus.

WOUNDS OF THE ABDOMEN. By G. Abadie (of Oran), National Correspondent
of the Société de Chirurgie. With a Preface by Dr. J. L. Faure. Edited
by Sir Arbuthnot Lane, Bart., C.B., M.S., Colonel (Temp.), Consulting
Surgeon to the Forces in England. With 67 illustrations in the text
and four full-page plates. Price 7/6 net

Dr. Abadie has been enabled, at all the stations of the
army service departments, to weigh the value of methods and
results, and considers the following problems in this volume:
(1) How to decide _what is the best treatment_ in the case
of penetrating wounds of the abdomen; (2) How to install the
_material organisation_ which permits of the application of this
treatment, and how to recognise those conditions which prevent
its application; (3) How to decide _exactly what to do in each
special_ case–whether one should perform a radical operation,
or a palliative operation, or whether one should resort to
medical treatment.

WOUNDS OF THE BLOOD-VESSELS. By L. Sencert, Assistant Professor in
the Faculty of Medicine, Nancy. Edited by F. F. Burghard, C.B., M.S.,
F.R.C.S., formerly Consulting Surgeon to the Forces in France. With 68
illustrations in the text and two full-page plates. Price 6/- net

Hospital practice had long familiarised us with the vascular
wounds of civil practice, and the experiments of the
Val-de-Grâce School of Medicine had shown us what the wounds
of the blood-vessels caused by modern projectiles would be in
the next war. But in 1914 these data lacked the ratification
of extensive practice. Two years have elapsed, and we have
henceforth solid foundations on which to establish our
treatment. In a first part, Professor Sencert examines the
wounds of the great vessels in general; in a second part he
rapidly surveys the wounds of vascular trunks in particular,
insisting on the problems of operation to which they give rise.

_The cost of postage per volume is: Inland 5d.; Abroad 8d._

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GLASGOW HERALD: “The whole series is heartily commended to the
attention and study of all who are interested in and responsible
for the treatment of the injuries and diseases of a modern war.”

THE AFTER-EFFECTS OF WOUNDS OF THE BONES AND JOINTS. By Aug. Broca,
Professor of Topographical Anatomy in the Faculty of Medicine,
Paris. Translated by J. Renfrew White, M.B., F.R.C.S., Temp. Captain
R.A.M.C., and edited by R. C. Elmslie, M.S., F.R.C.S.; Orthopædic
Surgeon to St. Bartholomew’s Hospital, and Surgeon to Queen Mary’s
Auxiliary Hospital, Roehampton; Major R.A.M.C.(T.) With 112
illustrations in the text. Price 6/- net

This new work, like all books by the same author, is a vital and
personal work, conceived with a didactic intention. At a time
when all physicians are dealing, or will shortly have to deal,
with the after-effects of wounds received in war, the question
of sequelae presents itself, and will present itself more and
more. What has become–and what will become–of all those who,
in the hospitals at the front or in the rear, have hastily
received initial treatment, and what is to be done to complete a
treatment often inaugurated under difficult circumstances?

ARTIFICIAL LIMBS. By A. Broca, Professor in the Faculty of Medicine,
Paris, and Dr. Ducroquet, Surgeon at the Rothschild Hospital. Edited
and translated by R. C. Elmslie, M.S., F.R.C.S., etc.; Orthopædic
Surgeon to St. Bartholomew’s Hospital, and Surgeon to Queen Mary’s
Auxiliary Hospital, Roehampton; Major R.A.M.C.(T.). With 210
illustrations. Price 6/- net

The authors of this book have sought not to describe this or
that piece of apparatus–more or less “newfangled”–but to
explain the anatomical, physiological, practical and technical
conditions which an artificial arm or leg _should_ fulfil.
It is, if we may so call it, a manual of _applied mechanics_
written by physicians, who have constantly kept in mind the
anatomical conditions and the professional requirements of the
artificial limb.

TYPHOID FEVERS AND PARATYPHOID FEVERS (Symptomatology, Etiology,
Prophylaxis). By H. Vincent, Medical Inspector of the Army, Member
of the Academy of Medicine, and L. Muratet, Superintendent of the
Laboratories at the Faculty of Medicine of Bordeaux. Second Edition.
Translated and Edited by J. D. Rolleston, M.D. With tables and
temperature charts. Price 6/-net

This volume is divided into two parts, the first dealing with
the clinical features and the second with the epidemiology
and prophylaxis of typhoid fever and paratyphoid fevers A and
B. A full account is to be found of recent progress in the
bacteriology and epidemiology of these diseases, considerable
space being given to the important question of the carrier in
the dissemination of infection.

_The cost of postage per volume is: Inland 5d.; Abroad 8d._

LONDON: UNIVERSITY OF LONDON PRESS, LTD.,
18, WARWICK SQUARE, E.C.4

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From THE LANCET: “The names of the editors are sufficient
guarantee that the subject matter is treated with fairness and
discrimination.”

DYSENTERIES, CHOLERA, AND EXANTHEMATIC TYPHUS. By H. Vincent, Medical
Inspector of the Army, Member of the Academy of Medicine, and L.
Muratet, Superintendent of the Laboratories at the Faculty of Medicine
of Bordeaux. With an Introduction by Andrew Balfour, C.B., C.M.G.,
M.D., Lieut.-Col. R.A.M.C. Edited by George C. Low, M.A., M.D., Temp.
Capt. I.M.S. Price 6/- net

This, the second of the volumes which Professor Vincent and
Dr. Muratet have written for this series, was planned, like
the first, in the laboratory of Val-de-Grâce, and has profited
both by the personal experience of the authors and by a mass
of recorded data which the latter years of warfare have very
greatly enriched. It will be all the more welcome, as hitherto
there has existed no comprehensive handbook treating these great
epidemic diseases from a didactic point of view.

ABNORMAL FORMS OF TETANUS. By MM. Courtois-Suffit, Physician of the
Hospitals of Paris, and R. Giroux, Resident Professor. With a Preface
by Professor F. Widal. Edited by Surgeon-General Sir David Bruce,
K.C.B., F.R.S., LL.D., F.R.C.P., etc., and Frederick Golla, M.B.
Price 6/- net

Of all the infections which threaten our wounded men, tetanus is
that which, thanks to serotherapy, we are best able to prevent.
But serotherapy, when it is late and insufficient, may, on
the other hand, tend to create a special type of attenuated
and localised tetanus; in this form the contractions are as a
general rule confined to a single limb. This type, however,
does not always remain strictly monoplegic; and if examples
of such cases are rare this is doubtless because physicians
are not as yet very well aware of their existence. We owe to
MM. Courtois-Suffit and R. Giroux one of the first and most
important observations of this new type; so that no one was
better qualified to define its characteristics. This they
have done in a remarkable manner, supporting their remarks by
all the documents hitherto published, first expounding the
characteristics which individualise the other atypical and
partial types of tetanus, which have long been recognised.

WAR OTITIS AND WAR DEAFNESS. Diagnosis, Treatment, Medical Reports.
By Dr. H. Bourgeois, Oto-rhino-laryngologist to the Paris Hospitals,
and Dr. Sourdille, former interne of the Paris Hospitals. Edited by J.
Dundas Grant, M.D., F.R.C.S.(Eng.); Major R.A.M.C., President, Special
Aural Board (under Ministry of Pensions). With many illustrations in
the text and full-page plates. Price 6/- net

This work presents the special aspects of inflammatory
affections of the ear and deafness, as they occur in active
military service. The instructions as to diagnosis and treatment
are intended primarily for the regimental medical officer. The
sections dealing with medical reports (_expertises_) on the
valuation of degrees of disablement and claims to discharge,
gratuity or pension, will be found of the greatest value to the
officers of invaliding boards.

_The cost of postage per volume is: Inland 5d.; Abroad 8d._

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GUY’S HOSPITAL GAZETTE: “The series is a most valuable addition
to the medical literature of the war…. We deem it to be almost
indispensable to a medical officer, and have no hesitation in
unreservedly recommending it.”

SYPHILIS AND THE ARMY. By G. Thibierge, Physician of the Hôpital
Saint-Louis. Edited by C. F. Marshall, F.R.C.S. Price 6/- net

It seemed, with reason, to the editors of this series that
room should be found in it for a work dealing with syphilis
considered with reference to the army and the present war. The
frequency of this infection in the army, among the workers in
munition factories, and in the midst of the civil population
where this is in contact with soldiers and mobilised workers,
makes it, at the present time, a true epidemic disease, and one
of the most widespread of epidemic diseases. Dr. Thibierge,
whose previous labours guarantee his peculiar competence in
these difficult and important questions, has, in writing this
manual, very notably assisted in this work. But the treatment of
syphilis has, during the last six years, undergone considerable
modifications; the new methods are not yet very familiar to all
physicians; and certain details may no longer be present to
their minds. It was therefore opportune to survey the different
methods of treatment, to specify their indications, and their
occasionally difficult technique, which is always important if
complications are to be avoided. It was necessary before all
to state precisely and to retrace, for all those who have been
unable to follow the recent progress of the therapeutics of
venereal diseases, the characters and the diagnostic elements of
the manifestations of syphilis.

MALARIA IN MACEDONIA: Clinical and Hæmatological Features. Principles
of Treatment. By P. Armand-Delille, P. Abrami, G. Paisseau and Henri
Lemaire. Preface by Professor Lavern, Membre de l’Institut. Edited by
Sir Ronald Ross, K.C.B., F.R.S., LL.D., D.Sc., Lieut.-Col. R.A.M.C.
With illustrations and a coloured plate. Price 6/- net

This work is based on the writers’ observations on malaria in
Macedonia during the present war in the French Army of the
East. A special interest attaches to these observations, in
that a considerable portion of their patients had never had any
previous attack. The disease proved to be one of exceptional
gravity, owing to the exceptionally large numbers of the
Anopheles mosquitoes and the malignant nature of the parasite
(Plasmodium falciparum). Fortunately an ample supply of quinine
enabled the prophylactic and curative treatment to be better
organised than in previous colonial campaigns, with the result
that, though the incidence of malaria among the troops was high,
the mortality was exceptionally low. Professor Laveran, who
vouches for this book, states that it will be found to contain
excellent clinical descriptions and judicious advice as to
treatment. Chapters on parasitology and the laboratory diagnosis
of malaria are included.

An early announcement will be made in regard to further volumes under
consideration.

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