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detrimental to the moral and material interests of the

profession, and indirectly thereby to the public.A Soottish Joint Hospital Board and its Medical

Superintendent.In THE LANCET of April 13th, p. 1005, comment was

made under the above heading upon the action of the

Renfrew and Clydebank Joint Hospital Board in dismissingDr. William Butchart from his post of medical super-intendent of the board’s hospital at Blanarthill. Yourreaders know how pressure had been brought by the board toinduce Dr. Butchart to adopt for the scarlet fever patientsplaced under his care what is known as the "Milne

system," and how upon his refusing to do so they passeda resolution by a majority of one vote terminatinghis engagement. Apparently no such reconsideration as was recommended of the extraordinary step thus taken

by the Renfrew and Clydebank joint hospital board hasoccurred, and presumably a successor to Dr. Butchart is nowcarrying out the Milne system " at the institution referredto. I have great pleasure, however, in recording that apublic presentation has recently been made to Dr. Butchartat Clydebank, in recognition of his services at the hospitalfor 15 years, and of the independence of character and self-sacrifice shown by him in connexion with his dismissal fromhis post. An influentially signed testimonial accompanyingthe presentation referred with great approval to Dr. Butchart’sstand, made in the interests of the community and regardless- of the personal loss entailed on himself. It assured him ofthe esteem of his signatories and of their faith in him inhis professional capacity, which it declared to be based

’upon the high rate of recovery among the patients at theRenfrew and Clydebank Joint Hospital and the exceptionallylow death-rate there under his superintendency. Littlecan be added to this or to former comments on theconduct of the Hospital Board which adopted the singularcourse of making an experiment in medicine uponits own responsibility upon the bodies of children andothers committed to its care through the incidence ofa, dangerous infectious disease. The majority who, bya preponderance of one vote, adopted so inadvisable a

policy, appear to have been greatly influenced by apromised saving of cost per patient which they now, nodoubt, expect to realise. Dr. Butchart, in the modest andtemperate speech in which he acknowledged the presenta-tion made to him, denied the likelihood of even this takingplace. His observations, however, will have called theattention of his supporters at Clydebank to even more im-portant statistical points for their future scrutiny ; theywill watch to see whether figures show an increase or adiminution in the spread of disease.

St. Andrews University Graduation Ceremony.The annual graduation ceremony at St. Andrews Uni-

versity took place on July 17th, at which Principal SirJames Donaldson, Vice-Chancellor of the University, pre-sided. Sir Thomas Boor Crosby, Lord Mayor of London,and Sir John Batty Tuke were among those who receivedthe honorary degree of LL.D. Addressing the honorarygraduates, Principal Donaldson said that some of themin the course of their various vocations might come uponyoung men of remarkable ability, whose circumstancesrendered it difficult for them to find their way to the uni-

versity. He hoped they would recommend such young mento come to St. Andrews, and they of the University wouldtake care that means would be provided for overcoming theirfinancial difficulties and that encouragement would be giventhem to pursue their studies with vigour till they reachedhigh positions in the teaching and other professions.

Instruction on Medical Inspection of School Children. IDr. G. Rose, medical officer to the Aberdeen School Board,

has indicated to the University Court his willingness to givestudents for the Diploma of Public Health some instructionon the medical inspection of school children, the sanction ofthe school board to his doing so having been obtained.

Kingseat Asylum, Aberdeen.The average maintenance rate for all Scottish district

asylums for 1911 was .627 78. 7d. per patient. KingseatAsylum was f,26 12s. 3d. The Local Government Boardreport for 1911 contains the following paragraph :-" Thisstatement shows that. in the year 1910-11 the highest

expenditure under the head of food was £12 5s. 4d. perpatient and the lowest ;&9 4s. ld. in Aberdeen KingseatAsylum, which is £1 11s. 4d. below the average of alldistrict asylums."July 23rd.

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IRELAND.(FROM OUR OWN CORRESPONDENTS.)

The National Insurance Act.A VERY largely attended meeting of the medical profession

of the city of Belfast was held in the Medical Institute, onJuly 17th, to consider an important statement in the formof a letter, of which it was suggested that copies should besent to the secretaries of the various Friendly Societies andto the new approved societies under the Insurance Act.This document, which had been previously carefully con-sidered by the Belfast Local Medical Committee, was adopted,and the Local Medical Committee was instructed to issue itto all Friendly Societies and others concerned. It practicallyreiterates the demands of the profession, especially freechoice of doctor, an income limit of E2 per week for thoseeligible for medical benefits, and a minimum rate ofremuneration of 8s. 6d. per head per annum, exclusive ofmedicine and appliances. The names of members of theLocal Medical Committee, with that of the convener, 61medical men in all, are appended, and in addition the namesof 216 medical practitioners (inclusive of the 61 referred to)who have signed the following understanding :-

I, the undersigned, hereby promise that I will not individually enterinto any arrangements with an Insurance Committee or an approvedsociety, or other person or persons, under the National Insurance Act,or under any system or society worked independently of the Act,that I will only act through the Local Medical Committee of thedistrict in which I live and practise, and then only if the conditionsare satisfactory to and in accordance with the declared policy of theI.M.A. and B.NLA.

Effect of the Insurance Act on Belfast Hospitals.At a meeting of the board of management of the Royal

Victoria Hospital, Belfast, held on July 17th, it was reportedby the collectors that, as a result of the Insurance Act,subscribers and business firms were withdrawing theircontributions.

The IVonten’s National Health Association and the SanatoriumBenefit.

A grant of £145,000 was made to Ireland by the Treasuryfor providing accommodation for tuberculous patients inconnexion with the sanatorium benefit of the Insurance Act.The only allotment from this sum as yet is one of .625,000 tothe Women’s National Health Association, which has offeredto contract for the treatment of tuberculous patients withthe various county councils and insurance committees, madeprior to the formation of the insurance committees, andbefore the various local authorities could estimate the

probable number of patients or the sums they would require.It is generally felt that some explanation is required of thediversion of such a sum in such circumstances.

Attack on a Sanatorium.Since the announcement that the Women’s National Health

Association had obtained the house and demesne of Peamount,near Lucan, Co. Dublin, for a sanatorium, there has beenmuch local opposition to the scheme, expressing itself chieflyin letters to the newspapers, and in resolutions of local bodies.But on Sunday afternoon some 50 men-with picks, crow-bars, and ropes-gathered at Peamount and wrecked a

pavilion in course of erection, in spite of the efforts of theforeman in charge to protect the buildings. The publichostility to the erection of sanatoriums is becoming a dangerto public health work. It is impossible to avoid tracing theignorance shown in the present case to the attitude adopteda few months ago in relation to the extension of the RoyalHospital for Incurables at Donnybrook.

Milk-supply cf Dzcblin.The Department of Agriculture having forbidden the

movement of cattle from one pasture to another in con-,

sequence of the foot and mouth disease, many of the

pastures have become bare, giving rise to a fear that themilk-supply of Dublin would fail. A deputation of cow-

keepers, however, a few days ago obtained from the officers

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of the department certain concessions as to the moving ofcows.

Death of Surgeon-General S. B. Roe, C.B.The death is recorded of Surgeon-General S. B. Roe, C.B.,

D.L., which occurred at his residence, Ballyannall House,Cavan, on July 16th, at an advanced age. Born inCavan in 1830 he was educated at Portora Royal School,Enniskillen, and Trinity College, Dublin, where he graduatedin arts and medicine. After qualifying he joined the 92ndGordon Highlanders as assistant surgeon, and went with themto the Crimea. He then took part in the Indian Mutiny, andafterwards in the second Afghan campaign, 1879-80, and alsoin the Boer war of 1881. The Companionship of the Bath wasconferred on him in 1881 for his lengthened services to theBritish army in the field. He was Principal Medical Officeiin Madras in 1880, after which he retired from the army,with the rank of surgeon-general. In 1892 and 1893 he was

High Sheriff for county Cavan. He was a well-knownmember of all the local :public bodies in his own district, andtook the keenest interest in the welfare of the Church ofIreland, often attending at the Diocesan Synod. A verykindly and charitable gentleman, he was most popular withall classes in county Cavan.

Death of Dr. Dccvid Baldwin Jacob.The death, in his seventy-seventh year, of Dr. David

Baldwin Jacob occurred recently at his residence, Port Leix,Maryborough. He took his M. D. in the old Queen’s Universityin 1856, and became a Fellow of the Royal College ofSurgeons in Ireland in 1872. He was an ex-President of theIrish Medical Association and a Fellow of the Royal Academyof Medicine in Ireland, and had held infirmary, prison, andasylum appointments. He had been a J.P. for the Queen’sCounty since 1865. He retired from practice some years ago.

Death of Mr. R. J. Montgomery.The death of Mr. Robert J. Montgomery, F. R. C. S. Irel.,

assistant surgeon to the Royal Victoria Eye and Ear Hospital,Dublin, and for many years secretary to the Board ofExaminers of the Royal College of Surgeons in Ireland,occurred recently from acute pneumonia after a few days’illness.July 23rd.

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PARIS.

(FROM OUR OWN CORRESPONDENT.)

T7te Paris Hospitals.THE discussion of July 9th at the Academy of Medicine,

on the subject of the projected model hospital for Lyons wascontinued on July 16th by M. Gilbert Ballet, clinical professorof mental diseases. He expressed regret that no organicprovision had been made in the hospital for the acutelydelirious, those with obsessions, delirious melancholics,and intoxicated persons. The few rooms reserved, he said,were entirely insufficient. The utility of such servicesno longer needed demonstration. Among other advantagesthey serve to temper for those in a state of acute deliriumthe present rigors of the legislation regarding theinsane. M. Mesureur, director of the Assistance Publiqueat Paris, defended the Paris hospitals. He said that M.Mosny, in his remarks on the new Hotel-Dieu at Lyons, hadshown himself hypercritical, notwithstanding his kindlywords on the hospitals of Paris. If the city of Paris hadin the past few years spent 29,000,000 francs in the con-struction of new hospitals, it had also spent 30,000,000 overthe old ones. Of this sum many millions had beendevoted to laundries and other works, to the quartersfor the staff, and to repairs both internal and external.M. Mosny had cited the Institut Pasteur as one of thefew objects of his admiration. M. Mesureur remindedhim that the Institut Pasteur had a small hospital of

only 100 beds, and it was unreasonable to demand that the16,000 beds of the Paris hospitals should be maintainedunder the same conditions as regards luxury and isolation.Moreover, an experiment in hospitals on the pavilion planhad already been made in Paris at the Hôpital Bouclcaut.The daily expense there in 1900 was 6’ 20 francs, while themean of that in the general hospitals in Paris was

3’78 francs. At the last accounting, in 1910, the cost at theBoucicaut was 6’90 francs, while in the large hospitals it

did not exceed 4’75 francs. This economic considerationcould not be ignored. Finally, M. Mesureur reminded M.Mosny that in the new hospitals for children, the Bretonneau,the Herold, the Trousseau, each child is isolated, and that250 new beds are under construction at the Trousseau underlike conditions. The cost will rise to 2,500,000 francs. Inthe maternities, also, M. Mesureur pointed out, a deathrarely occurs although two-thirds of the women of Paris aredelivered there.

Ogston’s Operation in the Treatment of Tarsalgia.At the Société de Chirurgie, on July 10th, M. Kirmisson

upheld the efficacy of Ogston’s operation which he was thefirst to introduce into France. This operation, if properlyperformed, allows of a perfect reconstruction of the plantararch, while retaining the suppleness of the foot, providedonly that pains have been taken to ensure and maintain aperfect coaptation of the bony surfaces. M. Broca confirmed

absolutely M. Kirmisson’s statement.

,

The S’ucrgeon as an Operator on Hinaself.The press :recently published an account of an operation

for hernia performed on himself by Dr. Jules Regnault,medecin de la lere Classe de Marine, of Toulon, who hasdescribed the conditions under which he performed this feat.He used local anagsthesia by cocaine, a method which he hasemployed in upwards of 400 cases of hernia. Under certainconditions he combines adrenalin with the cocaine, with apreliminary injection of morphine. Dr. Regnault had withhim two surgeons prepared to intervene if necessary. His

operation he regarded as a scientific experiment on himself,from which he draws the practical conclusion that localanaesthesia by cocaine under certain conditions can replacegeneral or spinal ansesthesia in a large number of operations,since it has enabled him to operate on himself without pain.In case of urgent necessity, with this method of anaesthesiaan isolated surgeon can operate on himself painlessly, amatter of great importance for the ship’s surgeon or thecolonial medical officer, who may find himself alone on hisvessel or in an isolated camp in the bush.

Transitory Meningeal Disturbances of Tuberculous Origin.At the Société d’]tudes Scientifiques sur la Tuberculose,

which meets every month, matters of all kinds relating tothis disease are brought forward for discussion by scientificpersons especially qualified in regard to them. At the Junesession M. Barbier stated that alongside the cases of tuber-culous meningitis said to be cured, which are really quiterare, must be set a series of transitory meningeal dis-turbances which must be considered as having their originin the same source. These meningeal accidents are charac-terised by vomitings, convulsions, and somnolence. Theylast for some days, are liable to recur, and are frequentlyencountered in the early history of children who latersuccumb to meningitis or to tuberculosis. They may presentthemselves under a monosymptomatic form, such as zonaand certain neuralgic pains of radicular rather than neuritictype, which are observed especially in small children andwhich are difficult of interpretation unless their meningo-radicular origin be remembered. These meningeal episodesare seemingly due to congestive meningitis or to sero-

fibrinous meningitis with limited effusion. Traces of themare found in children who have died later from meningitisor tuberculosis, under the form of sclerous thickenings atthe base of the brain, which may have given rise to affectionsof the intellect, or headaches commonly attributed to" I growing " or to migraine. The knowledge of these factsis of importance from a practical point of view, for thesepatients must be subjected to a general and cerebral hygienein accordance with the suspected nature of the lesions.Seaside resorts and certain mineral waters are particularlyunsuited to such subjects. In regard to this latter warningof M. Barbier, Mme. Girard-Mangin, directress of the Anti-tuberculous Dispensary of the Hopital Beaujon, referred tothree deaths from tuberculous meningitis during a course ofstimulating treatment.

The Acade7ny of Medicine.At an election for two foreign corresponding members of

the Academy of Medicine, held on July 16th, Sir WilliamRamsay, of London, and Dr. J. Reverdin, of Geneva, wereelected.

Death of Professor Joannes Chatin.The scientific world of France has sustained a severe loss