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number of cases of phthisis seems to be increasing.The mortality-rate from tuberculosis is now 2 per1000, the same as it was in the United States thirtyyears ago. Control is extremely difficult in thisscattered population with no proper travel facilities,and a large number of people with active and openlesions are at large and a source of danger to theirfamilies and friends. More hospital beds are urgentlyneeded both for early treatment and the isolationof chronic cases. Dr. Curtis would like authority tocompel infectious patients, too poor or too ignorantto observe the rules of hygiene, to enter an institution.

BOURGEOIS BABIES

THOSE non-members who read the new edition ofthe little book written for the Chelsea Babies Clubby its medical officers (Recipes for Food and Conduct.London: Chelsea Babies Club, 35, Danvers Street,Chelsea. 1938. Pp. 84. 2s. 6d.) will envy thechildren and mothers of the professional classes inChelsea who can enjoy advice and help of a typehitherto reserved for the working-class at welfarecentres. The book consists of sixteen short chapterson prenatal care, breast-feeding, weaning, diet,exercise, clothing, and general management. Simplywritten, so that directions can be followed by thoseunused to medical terms, it yet contains the essentialsof modern paediatrics. The directions for prenatalcare are practical and unalarming ; the rules forbreast-feeding are excellent, keeping the balancebetween the need for regularity and the avoidanceof depressing monotony in the mother’s life. Simpledirections are given for calculating the amount ofbreast-milk required by the infant and methods oftest-weighing are given in detail. Weaning, balanceddiets, vitamins, patent foods, and protective inocula-tion are sensibly reviewed and the essential differencesbetween the various commercial milks sold and thedangers of raw milk are made clear. The modernviews on sound tooth formation are embodied in the

warning against excess of cereals in the diet. Thereis an excellent chapter on exercise in infancy, with asympathetic plea for babies too much confined toplay-pens or strapped into perambulators with littlepossibility of either physical or mental exercise. Thesection on sun-bathing contains a salutary warningagainst over-enthusiastic exposure, especially at theseaside. The book throughout is balanced in outlookand the apt quotations from the works of the sixteenth-century French physician, Saint-Martin, add to itsattractiveness. Many medical readers will findinstruction in it.

CATALOGUING IN SPECIAL LIBRARIES

Mr. J. L. Thornton, the librarian of St. Bartholo-mew’s Hospital medical college, has made a concisesurvey of the methods of cataloguing adopted in the" special " libraries in this country (London : Graftonand Co. 1938. Pp. 268. 10s. 6d.). He uses the termspecial to indicate all other than public and countylibraries, and he covers the large field compre-hensively though without pretence to completeness.Although the book is intended to deal mainly withone particular branch of librarianship-cataloguing-Mr. Thornton manages to include a mass of usefulinformation on other aspects of the subject in manyof the sections devoted to individual libraries.Beginning with the university and college libraries,he goes on to discuss in turn medical and scientificlibraries (such as those of St. Bart.’s, the School ofHygiene, and the Royal College of Surgeons) ; thoseattached to scientific and learned institutions andsocieties; government libraries ; business, com-

mercial, and technical libraries; and finally poly-technic and other libraries catering for the moregeneral types of student. At present the methods ofcataloguing are widely divergent and the achievementof a satisfactory degree of cooperation and uniformityamongst such a varied collection of libraries will beno easy task. Yet this is what Mr. Thornton isaiming at, and if his book succeeds even partially in

making order out of chaos it will have performed auseful service. The book may not interest everydoctor, but those who are constantly using scientificlibraries, and more particularly the special librariansthemselves, will find it rich meat.

THORACIC SURGICAL IMPLEMENTS

IN a lecture given to the Institute of British SurgicalTechnicians on Jan. 20, Mr. T. HOLMES SELLORS saidthat his object was to try to help bridge the gapbetween the user and the maker of surgical imple-ments. Thoracic surgery was an extremely specialisedbranch requiring special tools. Rib resection involvedfreeing of the bone from its attached soft tissueswithout injuring the pleura or lung. All ribrugines raspatories, or strippers were based on theFaraboeuf periosteal elevator. The short curvedstripper generally sufficed, but modifications werenecessary in dealing with a rib hidden deep beneathmuscle or under the scapula, and the angle at whichthe rib lay in relation to the operator determinedthe shape of other forms. Another tool, which wasneeded to reach the deep surface of the rib, was theDoyen raspatory, invented fifty years ago and neversince improved, except by cranking the handle orchanging the size of the hook. The rib, after beingfreed, had to be cut. Rib shears fell into two maintypes : guillotine and forceps. The guillotine typewith a hook or a complete ring made a clean truecut, but could not be used round corners. In thesecircumstances, or when the rib was unduly tough,the compound double-action Swedish patterns wereinvaluable. There were also punch and gougeforceps for clearing sharp or projecting stumps ofbone.

After resection of the rib the opening had to beenlarged with a rib spreader, generally based on theTuffier or the De Quervain types, to allow of intra-thoracic manipulations, for which the instrumentshad to be longer and lighter than usual and safefrom any chance of springing or slipping off. Thetying of ligatures constituted a problem, and for thisreason most forceps were curved to let the surgeonsee the tips. There were two ways of controlling thethin-walled vessels at the hilum: (1) isolating eachvessel tediously and ligaturing it, and (2) grasping.vessels and bronchi together in a special snare ortourniquet, which was left in place until stitchescould be slipped round the vessels and lung stump.

Lighting the operation field was sometimes a problem.The big shadowless or multiple-unit lights were

valueless. Lighted retractors or a small lamp werealmost essential. With reference to thoracoscopes,bronchoscopes, and all other electrical implementsMr. Sellors emphasised the possibility of a break-down due to faulty cable or to a lamp blowing out.There was one motto : " Duplicate everything."Electrical connexions should be more or lessstandardised.The operating-table as used in general surgery

was too high for chest work. The patient lay onhis side for most of the thoracic procedures, and itwas difficult for the surgeon to stand over the operationfield without using a platform. A lower base wasnow being fitted on many tables for this reason, withfittings to keep the patient on his side.One of the latest problems to be solved was that of

continuous suction needed in the treatment of chronicempyema. Hand-pumps and water siphonage werenot wholly efficient. Electric suction was the onlyfeasible method, and a small, low-consumption,silent, and reliable motor had been produced. He hadhad one " ticking over " continuously for six months.

Mr. Sellors ended with a plea for the invention ofa substitute for rubber tubing-something with thinwalls and an effective lumen, flexible, and not hardenough to erode the tissues. He also put forward the" hopeless request " for an instrument that wouldtie a half-hitch knot round the tip of a curved forcepsat a good distance from the surgeon’s fingers.