EIIDICAL JOURNAL ] IREVIEWS,19I atmosplhere of cule. Special hospitals, were necessary, but tntudler military conditions a man must be eitlher doing miiilitary work of some kiind or be in lhospital, yet no person who lhad broken down witlh a functional nervous disorder was fit on the day lhe left secluded ward life to meet tlhe difficuilties of tlle everyday life of tlje soldier; the hospitals, therefore, must lhave grounds for treatment in tlhe stages between lhospital and duty. As patieInts

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... gilt show evidence of disorder of othler portions of thje body, tlle lhospital slhould not be too far from experts in otlher classes of disease and injury, nor too distant from a general military or large civil hospital. Military hospitals slhould be near a railway station or there would be difficulties in transport and conveyance botlh fQr patients and consulting staff. Tllere were two great groups of these cases: (1) Tlle passive suggestible lhysteric wlho lhad slhrunk into hjimself and developed fixed, circumscribed, obvious objective. difficulties, and was usually best dealt wvith by a force majeure sent in as a stimulus from the external environrment; and (2) the restless, discontented, hjypersensitive psyclho-neurastlhenic, witlh hiis mucll less easily comprehended subjective worries, fears, and bothers, ego-centric and yet expansive when ap-pIroaclhed symiipatlhetically, whlo, if treated in tlle mLanner adequate in the lhysteric would not only not be culred, but renidered wellnigh incurable. Occupation of a useful kind was essential, such1 as needleworlk, m-atmalking, -wood-carving for bed patients; for those wlho couild go about, traininig in sonme occupationi likely to be of use in after-life lhad provided the most stable recoveries. lnstruction in workslhops was a necessary part of treatnient in those wlho were not returning to tlhe fiahting ranlks, but for those whose civil and m-ilitary worli would in the future be out of doors work on the land slhould be provided. Entertainments, especially those witlh a coinlpetitive elemiienit in whicll the patients took part, generally increased the rate of recovery. Plhysical drill and fymnnastic displays were useful. MHuch. depended upon tllie traininig anid previous experience of the mledical 3fficer. lie mIust RDow eaclh patient and milust not hiave too inau)y oni his lhands. In general, fifty patients wotuld be a maximium. Modified psyclho-alnalysis wNas useftl dreamtus miiiglht be lhelpful in diagnosis auid in elucidating the divers problemls of psyclhological origiin witli which the patient was faced. Suggestion of soume sort was essential, wlhetlher used tlhroughi strong faradism2, by personal contact, or cduiring hiypnosis. Mllassage, electLicity (higll frequency, faradisim, static breeze, etc.), batls (siniusoidal, eamt courant, lot and cold dlouches, etc.), radiant hjeat, remedial exercises, gyiminastic exercises, aud plhysical training, were useful but secondary adjuncts. It would be wvell that tlhe nmilitarv autlhorities sdI)uld establislh near the special lhospitals repairing d4p6ts (te A.O.1)., time A.S.C., the A.S.C.M.T., and R.E.'s, whiere tie workiimg capacity of mien in special lhospitals might be [)ut to illmlne6iate usefuil nationial nmilitary worl. At tIme ;unime tilmle such dlep6ts would be a mtieans of trainilo -oldiers suffering fr'oili functioiial nervous disoider before trauisfereice to these specialist branclhes of the arlmly. Dr. Fearmisides gave ali analysis of resuilts of treatmeilt at thle Honiie of Recovery, Golders G3reen, for the five immouthls betWeen October 1st, 1917, alnd February 28tlj, 1918. T'je number of discharges was 186. Of these 24 were medically unsuitable, 12 resented treatm-lent, 3 left for-lgood famiiily reasons, auid 4 were disciplinary disclharges, a total of 43. Of the remaininig 143, 4 practically attained pre-war stanidard, 39 were fit for work, 53 returned to formier employment, 33 went to new wolli, and 14 went to furlther traininig. Captain E. D. ADRIAN, R.A.M.C., said tlhat whlen considlering treatment the psyclio-neurastlhenic mlust be regarded as a type apart from] the lhysteric. Of 1,000 patients wlho had passed through hlis hiands at Aldershiot, 70 poer cent. lhad been psyclho-neurasthenics. These mnen as a class were far more difficult to treat, and for them treatmuent had to be m-nore protracted. D)r. J. CHARLTON BRISCOE said that after disclharge from military service the men should be followed up alid given an inducem+entto work; at the time of theidischarge frouil Golders Green most weree not fit for full emlploym:ent, but many hlad beenl interested in the¢ emnploymuents offered there, and had applied for furthler training in caroentry, enlgineering" etc. When a man left institutional life he slhould at once go back to active enmploynment. Some seleme to ensure this happening in the case of every single individual patient was necessary. Sir R. ARMSTRONG-JONES, Dr. HENRY HEAD, and Sir JAMES FOWLER also spoke, and Major HIURST, in reply to various questions, said that under favourable conditionls about 50 per cent. of the patients could return to military duty, and at the time of diseharge the other lhalf were fit to earn their living in ordinary civil life. There was a great need for some scheme by whiell patients could be giveii work directly they left lhospital. Of the types he lhad seen at Netley the hysterics were the easier to treat; tlley formed about tlhe satme proportion as at Aldershot. More medical officers were required, and kindness and sympatlhy were needed. Tlle medical officer must be the patient's friend. Some means should be devised to prevent patients, before appearing at medical boards, being subjected to lobg and tiring journeys, or they would then seem muclh mote incapacitated for work than they really were. It was desirable that tle medical officer wlho lhad treated a patient slhould be a meinber of any board appointed to estinlate incapacity. MALARIA IN 'MACEDONIA. Two nmedical officers-Major W. G. WILLOUGHBY, R.A.AI.C., T1.F. (.M21.O.H. Eastbourne), and Captain Louis CASSIDY, R.A.M.C.-who have been serving in Macedonia, have pro- duced a book, entitled Antimalaria Work in Macedoniqt among British Troops,' which, small as it is, is likely to become a classic in the literature of malaria, for, although later editions miiay appear, this first issue, as giving the poilit of view of men actually facing tlle difficulties during the first two years in MIacedonia, will always retain historical value. We may say at once that the book is a very complete little treatise on the mlode of dissemination of nmalaria, aned of the m-leasures wlhlich can be taken with au arm)y in tl.c field for its prevention. As suclh it will be of immiense value to m-ilitary medical officers wlho serve inimalariouis counitries; and Iiot to thenm alone, for it puts the nmatter Sb clearly anid simply, but yet fully, thlat -it will serve as a useful vade miecum to officers of combatant uniits, of the Royal Engineers, and of the Army Service Corps. The natural chiaracteristics of the part of Macedoniia occupied by Britislh troops conduce to malaria. At tlhu foot of the mountains, whichi are traversed by many ravines and valleys, there are large plains througlh wlichl tlm water from the hiills finds its way to lakes and to tlhe sea In the ravines tlle watercourses, overlhung witll vegetation, are narrow, witlh frequent rocky pools, in whichl mosquito larvae are found. Moreover, in the dry season somne of tllese streamis may become very scanty, with many side p)ools for whichl there is no natural draina(ge. In tlho plains during the hot m-lalaria mnonitlhs the streaml-beds aLe oinly partially filled with water, leaving pools and patchlles of stagnant water generally full of weeds and many weedy slhallows. In addition there are lakes witlh large surrounding patches of marsly ground overgrown witlh rushies and reeds. Thlere are also many village springs, and wlhere the flow is constant all the year rounid tlhe overflow formiis semi-stagnant waterlogged areas. Wells are less commion, but they also are inifested witli larvae. Owing to these natural clharacteristics ot tlhe country anid to the great hleat of tlle suimmer, mosquitos, botlh calex and anopheles, lhave no difficulty in m-naintaininig themselves. The native inlhabitants are probably all more or less carriers of the parasite, so tlhat the mosquito lhas easv work in transmitting m-lalaria. Its opportunities lhave been greatly increased by thle large nurlber of soldie-s who suffe-ed fromn the disease duving 1916. Attention is directed to the need for desti-oyinig the adult insect, botlh wlhen hibernating and during tlhe suimimier, wlhen it infests the vegetation on thle borders of streams anid lak-es, and also in buildings and dug-outs.