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’quarter ot the year and there was a very distinct relation-ship manifested between the temperature of the earth atfour feet below the surface and the number of deaths

registered as due to the disease. About 80 per cent. ofthe deaths were among children under one year oldand 11 per cent. of those who died under nine monthsold were said to have been fed entirely upon mother’s milk.Dr. Howard-Jones stated that he had never had a case of

epidemic diarrhoea among the patients at the Newport FeverHospital where all the milk they consume is sterilised, whileamoog the staff who do not habitually use sterilised milkattacks of diarrhaea are not at all uncommon. It is ofinterest to learn that those localities in Newport wherehouses have been erected on made ground, which isballasted with town refuse, are more severely affected withcases of diarrhoea than those parts where the soil is notpolluted, and that streets with steep gradients which are

washed naturally by rainfall show a marked freedom fromdeaths from this disease, the one exception being a districtwhere there are many stone drains and sewers whichreceive the drainage from an old cemetery. It is satis-

factory to find that the Newport corporation has at last

appointed a female health visitor 1 whose services ought tobe of the greatest assistance to the medical officer of healthin his endeavours to lessen the amount of infantile diarrhoeain the town.

Incorporated Society of Medical Officers of Health.In his presidential address delivered before the West of

England and South Wales Branch of the IncorporatedSociety of Medical Officers of Health at Cardiff on

Nov. 27th Dr. Richard Prichard dealt at some lengthwith the question of the prevention of infectious diseasefrom the point of view of paying attention to the unsatis-factory condition under which so many persons of the poorerclasses are housed and having especial regard to the evilinfluences of impure air in badly ventilated bedrooms. He

,expressed the opinion that much could be done by improvingthese conditions to strengthen the phagocytes or ’’ defensiveproteids," so that the system might be able to resistinfection or at least to such an extent as to prevent a severeor malignant attack, for he considered that the conditionswhich produce malignancy are identical with those whichconduce to an attack of the disease. Numerous instanceswere given by Dr. Prichard of the malign influencewhich prolonged residence in an overcrowded house has

upon the course of an attack of scarlet fever, and as

it is quite impossible to insure the ventilation of sleepingrooms at night he urged that instruction in this subjectshould be given in public elementary schools and alsothat medical practitioners should lose no opportunity of

impressing upon their patients its great importance. In the- course of a discussion which followed the reading of theaddress Mr. Ebenezer Davies, medical officer of health ofSwansea, said that it was impossible to labour the questionof ventilation too much as it was one of the most importantfactors in the spread of infection, but the means of ventila-- tion and the use of ventilation were two very different things.Mr. Davies said that in his experience the earlier periodswere the most fatal in epidemics of cholera, small-pox, and,diphtheria, indicating attenuation of the virus as the diseaseprogresses.

Royal United -Hospital, Bath.The annual meeting of the Ladies’ Working Association

- connected with the Royal United Hospital, Bath, was heldon Nov. 22nd. The report showed that 1180 articles hadbeen made for the patients during the past 12 months, thevalue being estimated at <6200. The sum of f:70, whichhad been collected by some of the ladies, was handed tothe President of the hospital (Rev. E. Handley) towardsthe support of the children’s ward.

Dec.1st.

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

The Medical Institute, Belfast.ONE of the most pleasing features of the vice-regal visit

to Ulster was the opening by the Viceroy of the BelfastMedical Institute. This beautiful building has been erectedand furnished by the generosity of Sir William Whitla, and

1 THE LANCET, August 2nd, 1902, p. 317.

it is vested in the hands ut -even medical t] u:"tee:" j Jor theuse of the Ulster Medical Society. The building contains alibrary, reading-room, lecture-hall, dining-room, billiard-room, and smoking-room. Shortly after midday on

Nov. 26th Lord and Lady Dudley arrived at the Instituteand were met at the main entrance to the buildingby Sir William and Lady Whitla. On reaching the lecture-room, where there was a large assemblage of medical n3(nfrom Belfast and the neighbourhood, the chair was taken bythe President of Queen’s College, Belfast, who referred in

graceful terms to Sir William Whitla’s generous gift. That

gentleman having replied and having handed over the trutdeeds to the incoming president (Dr. John Campbell), LordDudley said that it was his duty to declare the buildingopen. His lordship referred to the many services whichIrishmen had rendered to the profession of medicine andafter votes of thanks had been passed to their excellenciesand to Sir William Whitla the ceremony terminated. In theafternoon Lady Dudley unveiled the memorial window toMr. William Smyth of Burton Port who died on Nov. 19th,1901, from typhus fever contracted in the discharge of hisprofessional work on Arranmore. The only man who daredto help him, Dr. Brendan MacCarthy, is also commemoratedin the window.

Ulster Medical Society.The annual dinner of the Ulster Medical Society was

held on Nov. 27th in the new Medical Institute,Belfast. The chair was occupied by the President, Dr. JohnCampbell, and, including guests, there were about 100

gentlemen present. After dinner, during which a select pro-gramme of music was performed, the President havingproposed the toasts of "The King," ’-The Queen," "ThePrince and Princess of Wales and the other Members of theRoyal Family," and "The Lord Lieutenant and Prosperityto Ireland " (to which the High Sheriff of Belfast, AldermanLawther, D.L.. replied), Dr. A. Dempsey gave the toast of"The Donor of the Institute," referring to the great giftbestowed on the medical profession, to which Sir W. Whitlareplied. The next toast was " The Memory of Mr. W.

Smyth," proposed by Sir W. Whitla, which was drunk in .silence. ’’ Our Guests " was proposed by Professor J. A.Lindsay, to which Sir James Henderson, D.L., Dr. BrendanMacCarthy, who had been so much associated with Mr.

Smyth in his heroic work, and Mr. H. Warnock replied.Mr. Warnock, who had attended the late Mr. Smyth, saidof him that he was

" One who never turned his back but marched forward-Never doubted clouds would break,Never dreamed, though right were worsted, wrong would triumph,Held we fall to rise, are baffled to fight better,Sleep to wake."

The last toast, "The President," was proposed by SirThomas Myles, and Dr. Campbell having responded, the

proceedings terminated with the National Anthem.

Health of Belfast.From the report presented to the city corporation on

Dec. lst for the period between Oct. 19th and Nov. 15th,1902, it appears that 330 cases of zymotic disease havebeen notified-113 cases of scarlet fever, 82 of typhoid fever,50 of simple continued fever, 46 of erysipelas, 20 of diph-theria, 16 of membranous croup, and three of puerperalfever. The death-rate from all causes was 21-4 per 1000,which is not very high. The number of cases of typhoidfever, as well as the deaths therefrom, have decreasedconsiderably during the past month and the decrease stillcontinues. The outbreak of scarlet fever, which is confinedto one district, is decreasing and in 113 cases reportedthere were only three deaths. Measles has been veryprevalent during the month and appears to have beenattended with a great amount of fatality. The medicalofficer of health says in his report that he has no means ofknowing the number of cases, but on inquiry from themedical officers in whose districts the disease was mostprevalent he found that not only were the cases numerousbut that the disease was of a severe type, the mortalitybeing mainly due to pneumonia.

Cork Hospital Aid Society.Two years ago the Cork Hospital Aid Society was estab-

lished tor the purpose of making an annual collection in thecounty towns for the benefit of the city hospitals. At a

meeting held on Nov. 29th the honorary secretary announcedthat after deducting expenses this year’s collection realiseda little over ;S500 which was available for distribution. The

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following allocation was accordingly made : North Infirmary,E90 ; South Infirmary, .690 ; Mercy Hospital, E65 ; VictoryHospital, E70 ; Eye, Ear, and Throat Hospital, 55 ;St. Patrick’s Hospital, z35 ; Erinville Hospital, ,635 ; FeverHospital, E25 ; Maternity, z10 ; and Queenstown Hospital,.627. A vote of thanks to the lady collectors brought

Ithe proceedings to a close.Dec. 2nd.

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PARIS.

(FROM OUR OWN CORRESPONDENT.)

Schools of Nwrsing for the whole of France.THE Minister of Instruction has just sent out a circular to

all departmental prefects inviting everyone to bring aboutas rapidly as possible a school of nursing in his district, inaccordance with the terms of the law of July 15th, 1893.At first sight it appears remarkable that a decree of Parlia-ment should have remained a dead letter for nearly ten years.The reason is that except in Paris and other large townsthere seems to be no very special need for such schools andthat the deputies who voted for the foundation of such schools

Iforgot at the same time to vote the necessary grants in aidfor their upkeep. Nursing schools are doing admirable work Iat Paris and at Lyons where there are large hospitals and Imany patients-in a word, they have grown where they were (required in accordance with the physiological law that where

Ia function is necessary there also is an organ to carry it out. IIn the smaller towns, however, where the hospitals are quiteunpretending establishments, mostly founded by religioushouses and worked by nuns, such schools would be useless.Throughout nearly the whole of France, the care of the sickis in the hands of the Church-that is to say, "they are lookedafter by nuns-and the lay nurse is almost unknown, for veryfew among them have the opportunity of making a livingexcept in the capital. This accounts for the great differencewhich is to be observed between the French infirmi&egrave;re andthe English nurse, for the former is drawn from a muchlower social stratum and is little more than a servantwith a certain amount of professional training. Evenif schools were started in every department to turn outnumbers of nurses of this type there would be but littleresult, for there would not be enough work for them all.The real reason of the sudden anxiety of the Ministerregarding this slumbering law is, as always, a political one.The expulsion of the teaching religious congregations hasbeen accompanied by lively protests on the part of the

populace and the Minister in charge of the Bill has been

obliged only to expel those congregations who look afterschools and to give out that those who concerned themselveswith works of charity would be let alone. He hoped by thismeans to allav the fears of the sick and infirm who werecared for by the sisters and who if they had to leave theirpresent quarters would have nowhere to go except the street.It is quite evident, however, that the expulsion of the hos-pital sisters is only put off and that the only object of thecreation of a large body of lay nurses throughout the countryis eventually to make these take the place of the nuns. It isnot so easy to found these schools, for teachers for the pupilshave to be found. The Minister in the above-mentionedcircular informs the prefects that as there are no funds topay the teachers every prefect should ask the medical menin his district to give gratuitous instruction, and it is impliedthat payment will be made by the medium of distribution ofoffices and of decorations.

The .fi’ight against Congenital Debility.Professor Budin, who for many years has given his atten-

tion to lessening the evils of congenital debility, has thisyear devoted his opening lecture to this subject. Thestatistics and the conclusions at which he has arrived arefounded on observations made by him in the wards allottedto the treatment of feeble children at the Maternity Hos-pital, where he has had every opportunity of studying thematter. Of all causes of death chill is the most dangerous,or, at least, the most widely spread. The child’s tempera-ture may fall to 33’5&deg;C., to 32&deg; C., or even lower. Amongthose children whose temperature falls below 320 C. the

mortality is 98 per cent., if at the same time the weightfalls below 1500 grammes ; 97’ 5 per cent. in thosewhose weight is between 1500 and 2000 grammes ;and 75 per cent. in those whose weight is over 2000grammes. When the child’s temperature ranges between

320 and 35’ 50 C. the mortality for the three groups ofchildren according to weight is 97’3 per cent., 85’6 percent., and -67 per cent. Mistakes in feeding are also thecause of many deaths, either from gastro-enteritis when toomuch milk is given or from circulatory failure (eyanose)when too little milk is given. The feebleness of the patientsalso makes their powers of resistance to infectious diseasesvery low and from such they often die. The mean mortalityof all the feeble children is 60 per cent., and this does notinclude children brought to the hospital dead or dying, ofwhom there is a great number. At the clinique in the Rued’Assas the proportion of children born feeble is 10’6 percent. For preventing the onset or the evil effects of chillProfessor Budin relies on an incubator kept at a temperatureof 25&deg; C., or on warm baths of which the temperature is

, gradually raised. He has formulated a set of rules for feed-

ing by which every child gets a certain quantity of milk,varying according to his age and weight. All suspects

"

are carefully isolated to preserve others from infection.. Even with all these precautions, out of 657 feeble

children 79 died within the first 48 hours. Leavingi out non-viable children there remain 589 premature

children, of whom 90 per cant. left the hospitalalive, which brings the mortality down to 10 per cent. At

the Charity Hospital M. Maygrier, using the same methods: of treatment, arrived at almost the same figures-namely,111’ per cent. Out of 66 older premature children brought up

! on Professor Budin’s plan, one only died and that at the ageof five months from broncho-pneumonia-a fact which wouldappear to legitimise the induction of premature labour fromthe point of view of the child’s life. As a matter of fact, in26 cases in which Professor Budin has induced prematurelabour, two children only succumbed, being a mortality of7’9 per cent.Dec. 2nd.

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SWITZERLAND.

(FROM OUR OWN CORRESPONDENT.)

Operations for Perforating Ulcers of the Stomach andDuoden2cna.

AT a meeting of the medical practitioners of the canton ofZiirich held at Ziirich on Nov. 18th Dr. Brunner gave aninstructive r6sumg of 350 cases of ulcer of the stomach and77 of ulcer of the duodenum. These were all the cases ofwhich he had been able to find any record and nearly two-thirds of them had been reported by English surgeons.America and France followed in order of sequence. Dr.Brunner inferred from these cases that gastric ulcer wastolerably frequent in these countries. The ratio of males tofemales was one to four in gastric ulcer, but nine to one induodenal ulcer. The majority of cases of gastric ulcer were-found in females between 15 and 20 years of age, but casesof duodenal ulcer were evenly distributed over all periods oflife. The site of the ulcer when noted was found in 263 casesto be on the anterior wall of the stomach and in 40 casesonly on the posterior wall. With regard to the symptoms,an acute onset with very severe pain was recorded in everycase. In 87 per cent. ot the cases the pain was localised inthe region of the stomach. In cases of ulcer in the-duodenum the pain was often localised in the region of theappendix, which might lead to false diagnoses. Vomiting,followed by considerable contraction of the muscles of theabdomen, was generally present. The percussion note overthe liver was resonant in half of the cases, but sometimessmall areas, dull on percussion, were found in abnormal

places on the abdomen from 10 to 20 hours after the first,onset of symptoms. The respiration was of the pure costaltype and the abdomen was distended. Some 90 per cent. ofthe patients said that they had previously suffered from

symptoms of gastric ulcer for an average period of three anda half years. Without operation only 5 per cent. of the

patients recovered, whereas in cases operated upon 51.6 percent. recovered. This high percentage, however, referred tothe total cases reported and not to the total cases operatedupon. Cases which ended fatally were probably less

frequently recorded than successful ones. Of the cases ofulcer of the duodenum only 17 per cent. recovered, while83 per cent. succumbed after operation.The" Physical Health Societies" and the Medical Profession.During the last ten years a movement against the medical