In view of Dr. Mott's coming address at the Medical and Physical Society on the subject of alcohol, Cogan's list of the "six inconveniences of drunkeness" may be of interest.

"First it weakeneth and corrupteth the liver, making it unable to change the nourishment into bloud, whereof ensueth commonly either Dropsie or Leprie. Secondly, it marreth the braine, and killeth the memory, whereof commeth madnesse or forgetfulnesse. Thirdly, it weakeneth the sinewes, which is the cause that drunkards tremble both with head and hands. Fourthly, it breadeth diseases of the sinewes, as the Crampe and Palsey. Fiftly, it engendreth apoplexies and the falling evill, through overmuch moysture of the braine, stopping the wayes of the spirits to the inferior members, Sixthly, it bringeth oftentimes sudden death."

Doctor Cogan however was no abstainer and has much to say in favour of his favourite beverage, beer, which it is interesting to learn was "so profitably invented by that worthy Prince Gambrinius, anno 1786, before Christ, as Lanquette writeth in his chronicle." Is it possible that a certain noted establishment in the west-end is still being conducted by the descendants of the worthy Prince?

ON

St. Chomas's Home for Paying Patients.

the 31st January, St. Thomas's Home for Paying Patients was transferred to the new building which has just been completed at the corner of the Westminster and Lambeth Palace Roads. Block 1 has been remodelled. The offices have gone from the corner of the building adjoining the Bridge, and this part is now occupied by the Treasurer's House. The old Treasurer's house is connected with the new building which has been erected at the corner of the Westminster Bridge and Lambeth Palace Roads, wherein accommodation is found for 180 nurses, but the basement, ground and first floors of this building have been reserved for the accommodation of St. Thomas's Home Paying Patients. Since this Home was first established in March, 1881 the advantages it offered to patients who otherwise had no opportunity of securing admission to a Hospital have been heartily appreciated and the experience gained in working this Home has been fully utilised by those responsible for the arrangements in the new building. In 1881 the Home owed its origin to the fact that there were two empty wards and the question was what could they be used for. Now the necessity of the provision of such a Home as St. Thomas's provides is an established fact, and

the new building has been erected for the purpose of providing the most suitable accommodation for the patients who come here. The ground floor is given over to male patients, and the first floor to women patients. Each patient has a separate room, except for the fact that there is no door at the front opening on to the general passage which is protected by a curtain. There is a Dining Room and a writing room on each floor, the latter in the men's floor serving as a Smoking Room. A very spacious balcony has been erected, quite large enough to accommodate all the beds from the Female Ward on a fine day, and from this Balcony there is a very good view of the river and the Houses of Parliament. In the old Home there was no accommodation for cooking, and the meals were served from the general kitchen. In the new building a kitchen is reserved for the sole use of the St. Thomas's Hospital Paying Home.

The first principle on which the Home is run is that each patient employs his own Consultant. The Resident Medical Officer is responsible for admission and for the treatment of each case under the direction of the Consultant. Strict enquiry is made by the Steward in all applications for admission, and the greatest care is taken to ensure each case remaining under the care of the Consultant in charge of the case.

There are 19 rooms on the ground floor and 19 on the first floor. Each of these rooms is about 12 ft. by 9 ft. 4 ins. The first impression on entering the main passage is that the ceiling is too low, but turning aside into any one of the rooms it is seen that each room is of ample height and that the lowness of the ceiling in the passage is caused by an air trunk connected with each room for extract purposes. Electric fans operate at the head of each of these extract shafts. The supply is regulated in each room through a small grating and the air passes through the bars of a radiator before entering the These radiators are on a new principle known as the Reck system. Water is heated in a calorifier in the basement taken to a cylinder in the roof where the water is again heated by the admission of steam, and thereby it is claimed that a much quicker circulation is secured and the supply pipes to each radiator are reduced to quite a small size. It is found in fact, that this delicate instrument requires very careful tuning to secure efficiency. On enquiry from the patients themselves, who had been moved from the old Home to the new, the reports are satisfactory and gratifying.

room.

A very complete little theatre for all these Home cases has been erected on the ground floor with a large service lift for bringing the patients to the theatre floor. The operating room is 15 ft. 6 ins. by 15 ft. and is approached through the Anesthetising room which is 15 ft. by 9 ft., the Recovery room being 12 ft. 6 ins. by 17 ins. It is top lighted with a northerly aspect. Patients are removed from this

Theatre to the Recovery room. No pains have been spared in making this an absolutely complete department for operations. Closely adjoining are a Surgeon's room, a Nurse's room, and a Mackintosh room for all cleaning up purposes. The cubic area of the Theatre is 3,800 cubic ft., of the Anæsthetising room 2,000 cubic ft., and of the Recovery room 3,100 cubic ft., and by the ventilating fan the introduction of air to the Operating Theatre is 53,000 cubic feet per hour, to the Auæsthetising room 20,000 cubic feet per hour, and to the Recovery room 19,500 cubic feet per hour, giving an average of slightly over 13 changes per hour. The air is passed through a hair screen which revolves through a water trough. The amount of sediment found at the bottom of this trough at the end of 24 hours is remarkable, showing how efficient the method of washing is; but as a further precaution, and to dry this air to a certain extent it is made to pass through cotton wool of which as large an area as possible is exposed for the purpose of facilitating the passage of the air. The room into which the air after infiltration is received is divided into two, in the further of which are a series of hot-water pipes for warming the air. A valve operated by a handle in the Theatre itself controls the supply of air from either the cold or the hot air chamber, and as the air passes through talc valves into the hot air chamber if this supply is shut off in the Theatres the temperature of the air in the hot room is very considerably raised and at any time when the Theatre is in use 6 or 7 degrees extra warmth can be secured in the Theatres in 5 or 6 minutes by the complete opening of the hot air valve.

A few of these rooms are reserved at £3 3s. per week for the admission of cases who, being unable to afford a Consultant's operating fee, are dealt with by the Resident Medical Officer. The other rooms may be had at £4 4s. per week which covers the charge for Medical attendance by the Resident Medical Officer, nursing, food, medicine and dressings, Once a patient has fixed with his or her consultant the fee to include operation assistant and anæsthetist, the inclusive cost of all that is required in the Home is known. Special treatment in an isolated room may, if found necessary be provided at £1 1s. per day, the increased charge being made to defray the expenses of the special Nurses required.

We may add that in the event of any of our readers desiring to avail themselves of the opportunities afforded in this Home they should communicate either with the Steward or with the Resident Medical Officer stating the full particulars of their case.

Books for Review.

LINE AND EVOLUTION. By F. W. Headley. Duckworth & Co.

While this is not, strictly speaking, a medical work, the subject is one which strongly appeals to every scientific mind, and we cannot too strongly recommend this book to all who wish to obtain some smattering of the great problem of evolution,

The book is brightly written, and it is not too much to say that every page is intensely interesting; it has no pretensions to being an advanced scientific manual, being written rather for those who are interested but not learned in its subject.

The text is so full of charm that we could wish it had been still further edited by a competent physiologist, and certain minor errors eliminated, but this will doubtless be done in future editions.

"Line and Evolution " is of especial interest to St. Thomas's men, in that many of the excellent illustrations are the work of J. C. Maclean, while the entire subject matter has been reviewed by O. Z. V. Simpkinson. CANCER OF THE BREAST, AND ITS OPERATIVE TREATMENT. By W. Sampson Handley, Assistant Surgeon to the Middlesex Hospital. 12s. 6d. net. (London: John Murray.)

This book, which is beautifully produced, gives us a complete account of the work and views on this all-important subject, most of which was embodied in the Hunterian lectures delivered in 1905 by Mr. Handley. It is a book which all those interested in the surgery of the breast should not only read but possess A very strong case is made for the theory of metasatasis by "lymphatic permeation," accounting for deposits in both bones and viscera. though the author admits occasional distribution by the blood stream. A careful description of the operation which the author thinks necessary for the eradication of mammary carcinoma is given, and if others will adopt the same extensive removal of deep fascia for an area of some ten inches around the primary focus of disease, we believe, with the writer, that the results will be improved, and it seems right to assume that we can by operation planned in accordance with pathology, absolutely prevent recurrence in the scar, which is a reproach to the surgeon. Mr. Handley recommends the removal of both pectoral muscles and the costo-coracoid membrane, and we agree with him that the fixity of the arm occurring after some breast amputations is due rather to a badly-placed scar than to loss of muscular power. We consider this to be a book of considerable interest, and, though the author labours needlessly to prove some of his points, it should compel the admiration of the most sceptical.

RETRO-PERITONEAL

HERNIA. By B. G. A. Moynihan, M.S., F.R.C.S. Second edition. Price 7s. 6d. net. (London: Ballière, Tindall & Cox.) That a second edition of a work on a difficult subject such as this should be called for, proves the appreciation that the medical profession feel for the works of Mr. Moynihan, and there is no doubt that the subject is dealt with in its anatomical, pathological and surgical aspects in a masterly fashion. The first chapter gives a general description of the development of the intestinal canal and the peritoneum, and a thorough mastery of this is essential if

the succeeding descriptions of the various peritoneal fossae is to be fully understood. The duodenal fossae are so numerous that the author has failed to make the subject easy to follow, and the only consolation for the "practical surgeon" is that he will not often be called upon to deal with hernia into these fossae. The book concludes with a series of photographs of hernia into these retroperitoneal fossae, and it is satisfactory to note that the two which Mr. Moynihan himself admires the most are of specimens in

our own museum.

AIDS TO SURGERY. By Joseph Cuming, M.B., B.S., F.R.C.S., Eng. 4s. 6d.. pp. 383. (London: Ballière, Tindall & Cox.) Reprint.

This is an example of a "pre-digested" surgical text book, issued by the same firm as the larger work, and we have confidence in recommending it to those "foolish virgins" among medical students who have failed in their allotted years of clinical work to extract for themselves the essential oil of surgical wisdom, and who find themselves in the darkness of ignorance a few weeks before their examination. Personally, we feel that such a flare of knowledge as this book will provide may fail to blind the eyes of the examiners, and we infinitely prefer the more gradual and comfortable process of mental absorption and assimilation.

CANCER ITS TREATMENT BY MODERN METHODS. By Edmund Owen, Hon. LL.D. (Aberdeen), Senior Vice-President of the College of (London: Ballière, Tindall & Cox.)

Surgeons. Price 1s. net. In this form Mr. Owen has published his Bradshaw lecture, delivered before the College of Surgeons on Dec. 12, 1906; anl though we have rather a strong objection to medical literature published at "popular prices," yet we are bound to confess that the matter could hardly have been dealt with in a more honest spirit or in a more readable manner. Put briefly, the writer confesses that he knows of no better curative agent at present than the knife, but we heartily agree with him in saying that we look forward to the time when there will be less human sacrifice and more cure in the battle against that common enemy, the "cancer cell."

Club Notices.

The London Hospital

Once again the season of cup matches is with us. have defeated King's somewhat heavily, and have, probably, the best team they have ever turned out. By the time this number returns from the printer's hands, our match with Guy's will have been decided for better or for worse! Let us devoutly hope for the former.

And now, while the ink is still wet, let us urge upon the hospital the paramount importance of keenness and enthusiasm as a great factor in the attainment of ultimate success. This can be shown by the teams in training and turning out regularly to practices; and by the rest of the hospital in coming down to the matches and giving support to the Hospital teams in voice as well as in body and spirit.