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After denuding the anterior surface he picked up thebladder pillars and brought them together in front of thebladder. These pillars he believed to be part of thepubo-coccygeus muscle. It was not necessary to sutureMackenrodt’s ligaments in order to cure the prolapse : infact there was danger of including the ureter in doing so.To cure a high rectoc4e he brought together tissue highup in the vagina which might or might not be the utero-sacral ligaments.-Prof. O’DONEL BROWN, replying,said that he had placed markers of bismuth and othermaterials in the lower uterine segment at known intervalsduring gynaecological operations, and had subsequentlyseen the radiograms of those markers throughout thepregnancy. He believed high rectoc Ie to be a herniaoccurring through the posterior vaginal fornix, fromabove, in contradistinction to low rectocele, commonlyseen following skin tears incurred during delivery andtaking place in the lower part of the vagina. He hadencountered only two cases of high rectocele and hadcured them by approximation of the inner borders of theutero-sacral ligaments. In his opinion, high rectoc Iecould occur as a congenital deformity, and had been suchin one of the two cases he had seen. He disagreed withapproximation of the bladder pillars as a step in thetreatment of prolapse. Anatomically, these so-calledbladder pillars could not be demonstrated by dissectionor at operation unless a fold was artificially created eitherby picking up the tissues with a dissecting forceps, byplacing stitches so as to pucker the bladder wall, and thusproduce something that appeared as a pillar of thebladder.

Amputation and Repair of the CervixDr. EDWARD SOLOMONS reported on a series of 302

cases operated on between 1931 and 1939 ; only 104came subsequently to hospital for examination. Theoperations performed were Emmet’s trachelorrhaphy,Schrceder’s partial amputation of the cervix and circularamputation of the cervix ; included in the last were someSturmdorf amputations. The suture material usednearly throughout the whole series was chromic or tannedcatgut. Patients were later questioned concerningbenefit from the operation, symptoms then present, thepresence of discharge, the number of children sinceoperation, the nature of the confinements, marital rela-tionship since operation and whether any change inmenstrual discomfort had occurred. A careful bimanualexamination, followed by inspection of the cervix, wasthen made. If discharge was present it was investigated.He found that of the 104 subsequently examined 94 werebenefited, backache being the commonest remainingsymptom ; 70 had no discharge after operation ; 3 had aworse discharge after operation than before, discharge hadimproved in the remainder. Trachelorrhaphy gave thebest results for fertility, 23 out of a possible 30 subse-quently becoming pregnant. Healing was complete in72, the result was bad in 1, and the remainder showedvarious degrees of slight ectropion or erosion. No casesof carcinoma of the cervix have been encountered afteramputation or repair.

Dr. QuiN wanted to know what Dr. Solomons re-

garded as indications for operation in these cases.

He believed that some cases of erosion would respond tobeing left alone or to treatment with mild caustics.Dr. A. W. SPAIN agreed that most erosions could be curedby cauterising the cervix two or three days after the men-strual period. He did not think that cancer of the cervixresulted from these conditions of the cervix. Prof.DAVIDSON said that unless the cervix was very muchhypertrophied he preferred the electric cautery tooperation. A fine anatomical cure followed the use ofthe cautery ; and he thought that subsequent pregnancyand labour should be easier when cauterisation wasadopted than when an operation was performed. In caseswith small simple erosions the pH of the vagina was ratherhigh. If the patients were treated by acid media for twoor three- months, or in some cases two or three weeks, itwould be found that the erosion would completelydisappear. Dr. BETHEL SOLOMONS said that in hisexperience cauterising methods were only suitable for thevery early types of erosion. A carefully performedtrachelorrhaphy or amputation cured nearly every case.Dr. E. SOLOMONS in reply said that of the 302 cases, 18had been nulliparous, and of these 18, 4 were single

women suffering from erosion of the cervix. In 60% to70% of all the patients some other operation had beenperformed. The choice of treatment depended on thelesion present.

Reviews of Books

Essentials of General Anaesthesia

By R. R. MACINTOSH, D.M. Oxfd, F.R.C.S.E., D.A.,Nuffield professor of anaesthetics in the University of

Oxford; and FREDA B. PRATT, M.D. Lpool, D.A., firstassistant in the department of anaesthetics in the university.Oxford : Blackwell Scientific Publications. Pp. 334. 25s.

’1’His book is written tor senior students, and tormedical and dental practitioners who want to refreshtheir knowledge of general anaesthesia, but there is muchin it which will also interest specialist anaesthetists. Allforms and methods of general ansesthesia are described,but the main bias of the book is towards anaesthesia fordental surgery. The problems of dental anaesthesia arediscussed fully and practically. Difficulties and dangersare dealt with frankly, and continual stress is laid on thenecessity for cooperation between dentist and an.Ts-

thetist. The book is obviously the outcome of wide experi-ence, and indicates a sympathetic knowledge of humanfrailties, both of patients and of anaesthetists. Drugsand methods used in dental anaesthesia are carefullydescribed, and the chapter on Pentothal is particularlywelcome. The authors emphasise that the effects ofthis drug vary with the speed of its injection.The description (accompanied by excellent illustra-

tions) of the difficulties of tracheal intubation comes as awelcome relief after the bland assumption, by some, thatsuch difficulties do not exist. The chapters on physio-logy and the theories of anaesthesia, no doubt purposelyover-simplified, are full of practical points. Methods ofanaesthesia for major surgery might, perhaps, have beendiscussed more fully. As it is, such interesting and usefuldrugs as cyclopropane and Vinesthene, which have littleplace in dental surgery, have had to be passed overrather lightly, and only one apparatus has been describedfor the administration of nitrous oxide and oxygenin dental surgery ; but, as the authors point out, theapparatus is less important than the man behind it.

Manson’s Tropical Diseases

(llth ed.) By PniLip H. MANSON-BAHR, M.D. Camb.,F.R.C.P. London: Cassell and Co. Pp. 1080. 35s.

IN this edition, the fifth by Dr. Manson-Bahr, muchhistorical and technical matter has been replaced by fiftypages of information on life in the tropics, on bodily andmental conditions that make for success in that life, andon measures that help towards this even before transferto the tropics is made. The author’s signal range ofknowledge on tropical medicine is set out with discrimi-nation, and he acknowledges his debt to constructivecriticism. So might not the time-honoured figure ofnecator by Placencia be replaced by one showing theattitude which it takes up when killed as usual by hotspirit, and which permits immediate naked-eye identifica-tion ? 2 Again in the specific name Wiichereria there isdivergence from the Code of Zoological Nomenclaturewhich demands that names should be Latin or latinised,for Latin had no umlaut. As C. W. Stiles urged 40 yearsago, medical men who have to enter the zoological fieldshould keep the zoological rules. It is not strictlyaccurate to say that Clayton Lane devised floatation forthe diagnosis of nematode eggs in faeces. An indirect-gravity floatation method was devised by Bass in 1909and therefrom developed the direct-gravity floatationmethod of Willis and the direct centrifugal floatation ofLane. Further, the abolition of the stickiness of hook-worm eggs, which the floating solution produces, allowsof their being herded into an area of a few squaremillimeters with consequent rapid diagnosis, the weightof the floating fluid used varying with the specific gravityof the egg species which it is desired to lift.The few small historical and technical blemishes on a

body of great clinical experience and clear expositionare worth mentioning only with the wish to betterthe good.