The securing of a safe anæsthesia during operations is more important than ever before, partly because of the mere number of operations, and partly because of the greater extent to which other operative risks—hæmorrhage, shock and infection—have been overcome. The risk from the anæsthetic is now so very small that the joint aim of the surgeon and anæsthetist to abolish it altogether is not far from being accomplished. The author of this volume has done a good deal to accomplish this end, and it is a matter of congratulation that he has now published an account of his methods, so that a larger circle may benefit from his teaching and his experience.

The author very properly goes further and maintains that anæsthesia must not only be safe but must also be good; good anæsthesia is absolutely vital to good surgery. Only a generation back many surgeons professed to see no difference as to who gave the anæsthetic; at the present day no one willingly embarks upon a difficult operation without the aid of a skilled anæsthetist.

In various parts of the book the author has very rightly laid great emphasis upon the influence which the work of the surgeon has upon that of the anæsthetist. The latter may learn much from an occasional glance at the field of operation. He should not interest himself in the details of operative procedure to the distraction of his mind from his own responsibilities; but he can, in abdominal surgery, see for himself whether the muscles are properly relaxed, and observe the state of operation, so that he can when necessary deepen the anæsthesia in good time, while not maintaining deep anæsthesia when a light one would suffice. Finally, he can check his other sources of information as to the condition of the circulation by noticing the force with which cut arteries spout, the colour of the blood and the size of uncut veins.

Like other branches of medicine, adequate study as well as practical experience is required in order to master the art of administering anæsthetics, and that a reliable manual of instruction is essential, goes without saying; I feel on perfectly safe ground in recommending this book as such both to the student and the practitioner.

ALEXIS THOMSON.