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partially counteract an astigmatism only revealedwhen the accommodation is paralysed. That thissegmental action exists is not generally admitted,though in support of the theory that it does a physio-logical experiment of Hensen and Voelkers (the lattername misprinted in this book) may be cited. Text-books on refraction are generally discreetly silent onthis point, though by their insistence on the necessityfor complete cycloplegia for the correction of smallastigmatic errors they implicitly support the theorythat segmental accommodation is possible. Anapparatus for testing the visual acuity under varyingdegrees of illumination is illustrated in Dr. Smith’sbook, and this should be useful, not only for testingthe light sense, but in connexion with the prescriptionof tinted glasses for patients unusually sensitive toglare. The cyclophoria which sometimes is trouble-some when oblique cylinders are prescribed is discussed.The relative advantages of different forms of bifocallenses are pointed out, and there is a final chapter onthe cosmetic value of glasses. We cannot recommendthis little book as a complete guide to the art ofrefraction. At the same time anyone engaged in thiswork will find it worth reading, since it containsinformation and advice on many practical pointswhich are not ordinarily alluded to in the text-books.Its unconventional style is a further recommendation.

Saving Eyesight after ltZid-Zife. By T. HERBERTWHITE, M.D., Instructor in Ophthalmology in theHarvard Medical School, Cambridge (Mass.).Harvard University Press. 1927. Pp. 48. 4s. 6d.

THIS little book is one of a series termed " HarvardHealth Talks," and is addressed to the general readerand more especially to the middle aged. It is

principally occupied with a popular exposition ofglaucoma, and informs readers of the insidious natureof that disease in its chronic form. One-third of allblindness in America arising after middle life is saidto be due to this disease, and the chief purpose of IIthe book is to warn the public that periodic examina-tion by an oculist is necessary even though vision may ’be apparently normal, and to reassure them as

to the chances of a permanent good effect of an

operation undertaken in time.

DISEASES OF THE DIGESTIVE ORGANS.Fourth edition. By CHARLES D. AARON, M.D.,F.A.C.P., Professor of Gastro-enterology in theDetroit College of Medicine and Surgery. Phil-adelphia : Lea and Febiger. 1927. Pp. 1964.$11.

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THE new edition of this American text-book pre-serves the general character of its predecessors. Thebook is too verbose to make a strong appeal to manyEnglish readers, but it is a merit that some mention,if only a brief note, is made of nearly every subjectthat can in any way be associated with the alimentarycanal. The author gives no description of phyto-bezoars, Snapper’s test for porphyrins, or the blood-sugar curves after laevulose feeding in cases of hepaticdeficiency. But we have no doubt that these minutiaewill appear in future editions. The printing andillustrations are excellent.

JOURNALS.JOURNAL OF PATHOLOGY AND BACTERIOLOGY.

Vol. XXX., No. 3, July, 1927.-InterferencePhenomena in the Action of ChemotherapeuticAgents in Trypanosome Infections, by C. H. Browningand R. Gulbrausen (Glasgow). Parafuchsin will killT. brucei in mice : so will trypaflavin. But trypa-flavin will not act in animals which have previouslyreceived a non-sterilising dose of parafuchsin. Thetherapeutic action of other substances-e.g., arsacetin-is also interfered with by parafuchsin.-The Titrationof Scarlet Fever Antitoxin in Rabbits, by H. J. Parishand C. C. Okell (Beckenham). It is difficult to measurethe antitoxic value of sera prepared with the scarlet

fever streptococcus by their capacity to neutralisetoxin in animals, but satisfactory titration can beachieved by testing their efficacy to protect rabbitsagainst the septicaemia produced by the streptococcusitself. The values thus obtained show close agreementwith human Schultz-Charlton and therapeutic tests.-Osteoclastoma (Myeloid Sarcoma) of the HumanFemale Breast, by H. J. B. Fry (London). A caseof this rather rare tumour containing sarcomatousfibrous tissue, cartilage, osteoid tissue, and giantcells of myeloid type, with a good discussion andaccount of the literature.-A Statistical Study ofRelapse in Enteric Fever and Erysipelas, by M. Young(London). Working on data from the BelvidereFever Hospital, Glasgow, it appears that relapsingcases do not differ from non-relapsing cases in theduration of or degree of febrile disturbance in theprimary attack. The relapse is on the average abouthalf as long as the primary. The interval betweenprimary and relapse tends to be longer as the primaryattack is longer, and there is a slight relationshipbetween the severity of the primary and that of therelapse.-A New Design of Porcelain Filter, by C. E.Jenkins (Salford). Adapted to filter a few c.cm. ofliquid with very little loss.-Diphtheria Bacilli inBile, by J. McCunn and A. M. L. Greaves (London).Pure cultures of Corynebacterittiii cliphtherice were

obtained from an acute cholecystitis at operation.-Cross Immunity with Rat Tumours, by S. Russ andG. M. Scott (London). Rats inoculated with tumourcells killed by X rays show afterwards a considerabledegree of resistance to the implantation of the sameand also of some other tumours.-MicroscopicEvidence of the Different Manner of Clumping ofMotile Bacteria with Somatic and Flagellar Agglutinins,by J. A. Arkwright (London). With flagellar agglutininthe bacilli are immobilised ; with somatic agglutininthe free flagella continue to move the adherentbacilli.-Lamb Dysentery, by T. Dalling (Beckenham).Toxin-antitoxin mixtures given to the ewes reducesthe lamb mortality from 8 to 0-9 per cent. ; anti-welchii serum given to the lambs reduces it from16 to 0-2 per cent.-Seasonal Variation in Pneumo-coccal Virulence, by J. F. Gaskell (Cambridge).The virulence of laboratory cultures regularly fallsin the summer and reaches its maximum in thepneumonia season, December to April.-The Deter-mination of Virulence of Pneumococci FreshlyIsolated from Human Lesions, by C. H. Whittle(Cambridge). A few subcultures on agar or egg donot alter the virulence.-Demonstration of Spironemapallida in the Nervous System, by G. W. T. H.Fleming (Dorchester). Jahnel’s method is tediousbut gives good results.-A Case of UnrecognisedCancer of the Breast, by C. J. Polson (Manchester).A small scirrhous cancer of the right breast gaverise to large masses of growth in the abdomen,apparently via the lymphatics of the thoracic walland the umbilicus.-A Qualitative Chemical Differ-entiation of Thyroid Secretion from Thyroid Colloid,by G. S. Williamson and I. H. Pearse (London).The secretion of the active adenoid tissue containsno biological iodine as colloid does.-Adenocarcinomaof the Ovary in a Hen, by J. Gordon and F. C. Happold(Leeds).-A Rapid Method of Examining TissueMicroscopically for Malignancy, by B. T. Terry(Nashville, U.S.A.). Thick freehand sections are

stained on one side only with polychrome methylene-blue.-Proceedings of the Pathological Society ofGreat Britain and Ireland.-This issue of the journalcontains a portrait of A. Balles Lee, some extra copiesof which may be had from the editor at 17, Loom-lane,Radlett, Herts.

BIRTHDAY HONOURS.—In the list of recipients ofBirthday Honours published in THE LANCET of June llth(p. 1247) we regret the omission of the name of AlfredGeddes Tresidder, Major, LM.S., who was appointed aCompanion of the Indian Empire. Major Tresidder issurgeon to H.E. the Governor of Bombay, and aural surgeonto the Gokuldas Tejpal Hospital, Bombay, and the SassoonHospital, Poona.

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THE LANCET.

LONDON, SATURDAY, JULY 30, 1927.

LUNACY LAWS AMENDMENT.A LEADING article in the Times, aptly entitled

"The Lunatic at Large," drew public attention

recently to the need for lunacy law reform. Thisarticle elicited a congratulatory letter from Dr. J. S.RISIEN RUSSELL, in which he conveyed the suggestionthat medical practitioners " ought not to be vestedwith their present powers, but that they should berequired to appear before a judicial authority and giveevidence on oath as to the grounds for certification,as is required in any other class of case in which adoctor has to give evidence." Dr. C. 0. HAWTHORNE,Chairman-elect of the Representative Body of theBritish Medical Association, said that the sole

"power" " that a doctor possesses in these matters isto give a written opinion or certificate to the effectthat in his judgment the patient is of unsound mindand requires to be restrained either in his own interestor in the interest of the community. When such acertificate is placed with other relevant documentsbefore the proper judicial authority (a speciallyselected magistrate) it is open to that authority tomake or not to make an order for the patient’sdetention. It is the magistrate, not the doctor, whohas the power to restrain the patient. The presentpower vested in the doctor is the signing of a

professional certificate ; if this is taken away everycase of certification will become a judicial inquiry withcopious evidence from experts and with correspondingexpense and waste of professional time. Already,under the Act of 1890, the magistrate can require thecertifying medical practitioner and any other witnessto appear before him and give evidence on oath.The machinery of Dr. RisiEN RussELL’s proposaltherefore exists if the magistrates consider that theinterests of the patient or the public require its

operation.At the meeting of the British Medical Association

the Section of Mental Diseases held a discussion

jointly with the Royal Medico-Psychological Associa-tion on the recent report of the Lunacy Commission.This was opened by Dr. G. M. ROBERTSON, Presidentof the Royal College of Physicians of Edinburgh,whose words as an ex-president of the Associationand a leading psychiatrist carried weight with themeeting, as they had previously carried weight withthe Royal Commission responsible for the Report.Dr. RoBERTSON found that the Provisional Treat-ment Order, the second of the procedures recom-mended in the Report for the involuntary treatmentof mental cases, was open to serious criticism in thatthe signature of one doctor alone was required.The doctor would often be a general practitioner, andmight possess little experience in the treatment ofmental cases, but the procedure was to be legalisedby the intervention of a justice of the peace whowould have no medical experience whatever. Heheld that the addition of the legal authority in noway served the interest of the patient, laid stresson the absence of proved cases of improper detentionas taking away the argument for the intervention ofthe justice, and urged that for the purposes of theProvisional Treatment Order the justice of the peace

should be replaced by the Board of Control. SCl7eral’speakers on the same and other grounds favouredthe elimination of the judicial authority unless itwere possible to select magistrates with knowledgeof the subject, and to provide through local authori-ties specialists to assist the general practitioner.Dr. RISIEN RUSSELL welcomed the ProvisionalTreatment Order as supplying the medical professionwith a claim for protection, and thought that theexamination of the patient by a legal authoritywould be an advantage ; if the justice had no medicaltraining he would view the matter from a standpointdifferent from the medical one. This argument wascountered by an explanation from Earl RUSSELL, a

member of the Royal Commission on Lunacy Reform,who interpreted the recommendation of the Reportas the introduction of a pure formality to meet publicapprehensions which must prevail with the legisla-ture. He pointed out that a vast body of uninformedand uneducated public opinion regarded doctors as-

too ready to certify, and, while it was needless or-

undesirable for the justice in these circumstances to-have medical knowledge, the part he was asked toplay was still useful, his duty being to see, and simplyto see, that due care had been taken in the patient’sbehalf, and that all the legal papers were in order.But Earl RUSSELL looked also at the Board of Controlas the real safeguard, and so came into line with the,view that involuntary treatment was not an infringe-ment of a patient’s liberty to be compared withdetention in other circumstances. This valuablediscussion closed without any formal summing-up orresolutions, but its general outcome was. in spite ofthe critical remarks here alluded to, an expression ofsatisfaction with the Report. The objections to the-introduction upon the scene of the justice of thepeace for the main part were based upon the viewsof clinicians that any circumstances which embar-rassed the rapid commencement of treatment inrespect of early mental disease ought to be anxiouslyavoided, and it is to be hoped that ultimate legislationwill reflect this view.

It is a fallacy to suppose that the proceedingsunder the Lunacy Act are or can be entirelyassimilated to other judicial proceedings. The

grievance of the certified patient, which takesthe form of actions such as Harnett v. Bond or DeFreville v. Dill, is that he has wrongfully been deprivedof his liberty. There can be no analogy to thecommon law action for damages for wrongful imprison-ment. In the nature of things lunacy proceedingshave the essential peculiarity that the lunatic cannotconduct anything like a defence to the allegation of’

lunacy. In every other form of judicial proceedinganyone in the position of a defendant is entitled to a,clear statement of the allegations made against him,and is entitled to make his reply thereto. In lunacyproceedings this is impossible ; moreover, considera-tions of urgency seldom permit the dilatory andprotracted preliminaries of ordinary judicial actions.But if the analogy of lunacy cases to ordinary judicialtrials cannot be pressed, it remains the fact thatdoctors who certify a lunatic are no more thanwitnesses who supply evidence upon which-as inordinary criminal or civil trials-a judicial authoritymakes up its mind. At present the medical practi-tioner is being asked to certify at the risk of anunlimited personal liability in damages-a threat orpenalty to which no other kind of witness is exposed.This is the point at which the lunacy law must bereformed if the country does not desire to see doctorsdeterred by a series of adverse verdicts from volun-teering their evidence in future. The medical